Aetna Small Group & AFA Updates - November 2022

Aetna provide update on the Attain by Aetna program and new portfolio enhancements for Small Group Aetna Funding Advantage members.

Attain program sunset

Aetna has made the decision to end the Attain by Aetna program to make way for future wellness programs that could have a greater impact for members. Aetna's priority is health and wellness, and they will learn from the Attain program to bring better member wellness programs in the future.

Discontinuation schedule:

• Effective 2/1/2023, Attain by Aetna will no longer be offered to new or renewing clients.
• For clients who currently have Attain by Aetna*, the Earn Your Watch (EYW) benefit will accept new enrollments through 8/31/2023. In the meantime, users can continue to earn and redeem points on the platform. Active users of Attain will be informed of the sunset via in-app notifications.

Here are three examples of how this will work for your clients:

• New or renewing accounts as of 10/1/2022.
  • The Bring Your Own Device version of Attain will remain active until their plan year ends on 9/30/2023.
  • The Earn Your Watch version of Attain will stop accepting enrollments 8/31/2023.
• New or renewing accounts with a 1/1/2023 effective date
  • The Bring Your Own Device version of Attain will remain active until 12/31/2023.
  • The Earn Your Watch version of Attain will stop accepting enrollments 8/31/2023.
• New or renewing accounts after 1/1/2023 will no longer be offered Attain by Aetna.

Aetna will soon send an email to your clients to let them know of the changes.

Aetna has been busy over the last few months enhancing and streamlining their product and processes. They know you’re in your busy season, so they're here to help make things easier.

You can use this email as your cheat sheet to selling Small Group** Aetna Funding Advantage through January 2023.

New portfolio enhancement – CVS Health Virtual CareTM and CVS Health Virtual Primary Care

Starting on January 1, 2023, all Small Group Aetna Funding Advantage members on broad network plans with effective dates on or after October 1, 2022, will have access to two new telehealth solutions at $0 cost-sharing.***

1. CVS Health Virtual Care - Provides 24/7 on-demand care. Plus mental health services such as talk therapy and medication management.
2. CVS Health Virtual Primary Care - Creates the opportunity to build a primary care relationship, virtually. Eligible members choose a physician to help them with a wide range of medical needs and ongoing care. This includes preventive care, sick and wellness visits and chronic disease management. A dedicated Care Team, available 24/7 via secure messaging, supports the physician.

Click here to see the plan sponsor flyer.

Changes roundup

Product portfolio

• Added new plan design options
  • Include leaner IntRX Deductible and Coinsurance (DC) plans. These plans apply the deductible and coinsurance to in-network emergency room, inpatient hospital and outpatient surgery care.
  • Offer more plan options for certain plans to have $0 in-network cost sharing on lab/X-ray services ($0 LXR plans).
  • Offer plan options your clients have been requesting: $0 deductible with $500/day inpatient hospital, $2,000 80/50 and $2,250 80/50 HSA plans.
• Expanded suite of $0 cost share** options to include CVS Health Virtual Care and CVS Health Virtual Primary Care.

Simplified admin fee credit program

• Now every Small Group AFA case can get a general new business credit of $300. Groups can also get either a $200 new business credit for groups with 51-100 employees or a new business credit for groups coming from a different level-funded plan with a surplus. Use this page on Producer World to get details.

Ancillary cross sell credits/discount

• For groups with 2 to 50 eligible employees, cross-sell savings for dental and vision is now an admin fee credit that can stack with the credits above. For groups with 51-100 eligible employees, the cross-sell discount is staying in-place as you know it. Read this flyer to learn more about cross sell savings.

Underwriting improvements

• Consolidated quote cover and census template - Now you just need one document instead of separate cover sheets and census templates. It applies to all Aetna® cases with 2 to 100 employees. You can help avoid delays and shorten overall turnaround time by filling out this document right the first time.
• PEO guidelines - Aetna is now treating small businesses who use the services of a PEO the same as any other group. This excludes any group headquartered in California or New York, or any group currently on an Aetna PEO master health plan.
• Non-ERISA - Aetna now offers Aetna Funding Advantage plans to Non-ERISA groups and they’ll follow their standard underwriting guidelines for them. At this time, Aetna can’t offer Aetna Funding Advantage to Non-ERISA groups in FL, ME, CA, IL and MO.
• Common ownership - Groups who are commonly owned can now write with Aetna Funding Advantage as one group or as any preferred combination of their groups. The group still has to meet eligibility and participation guidelines for its headquarter state.

See the underwriting guidelines for more information.

New business submission deadlines through January 1, 2023 effective dates

You can help your case submissions go smoothly the rest of the year. Just keep these deadlines in mind. 

1095-B tax forms reminder

Aetna recently reached out to you and your clients about the perk they offer of preparing, filing and delivering 1095-B tax forms to members of Aetna Funding Advantage groups with 2 to 50 employees. Aetna doesn't do this for groups with more than 50 eligible employees.

It is you and your clients’ responsibility to make sure that Aetna has accurate information. If it’s not accurate, and the IRS rejects the forms, the plan sponsor will need to refile on their own.

If your clients want to opt out, they will need to submit this form by November 30. 

If one of your clients has had a change in key info, like group name or tax ID, contact your Aetna representative to update the group's information.

For questions, please contact a member of your B&P Sales Team - 888.722.3373.