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Highlights of Q3 Aetna Changes

Aetna’s July 1, 2019 rates are available for quoting, but we wanted to go over some important changes they made.


Broker Bonus

Aetna is running a Broker Bonus Program for July 1, 2019 through December 1, 2019 effective dates. You can earn up to $100 per enrolled medical employee. See the flyer for complete details.


Q3 Rate Action

Northern CA (Regions 1-14)

  • HMO: 1% decrease quarterly, 1% decrease annually
  • OAMC/EPO: 6.6% increase quarterly, 1.9% increase annually

Southern CA (Regions 15-19)

  • HMO: 3% decrease quarterly, 1.8% decrease annually
  • OAMC/EPO: 3% increase quarterly, 1.2% increase annually


Product Updates

Aetna has added two new plans effective July 1st:

  • OA Managed Choice POS Bronze 50/50 6800 Ded
  • OA Savings Plus Managed Choice POS Bronze 50/50 6800 Ded


These plans are non-HSA plans with first dollar outpatient benefits for:

  • Primary care visit
  • Lab services
  • Walk in clinics
  • Urgent care
  • Generic drugs


Underwriting Updates

Aetna does not require a DE-9C for groups with 6 or more enrolling with prior employer group coverage. A DE-9C must be provided for groups with:

  • 1-5 enrolled employees
  • 6-100 employees with:
    • No current health coverage
    • More than 10% of the employees are located outside California
    • More than 20% are COBRA/CalCOBRA enrollees
    • Associated, affiliated, multiple companies


Participation Updates

Aetna has relaxed their participation requirements to:

  • Sole carrier: 60%
  • Offered alongside another carrier's HMO: 25% participation and a minimum of 5 employees enrolling in an Aetna plan


Individual coverage on and off exchange is now a valid waiver.


More Time to Submit New Business

Aetna’s new submission deadline is the 1st of the month for 1st of the month effective dates. For a July 1, 2019 group, please submit all paperwork to B&P by June 30th so we can get the complete submission to Aetna by July 1st.


Re-applying for Aetna within 12 Months

A small employer can re-apply for coverage without waiting the 12-month period if:

  • Group is replacing other group coverage
  • Group is in good standing and pays any premium balance due


Reminder on Renewing Business

With the requirement to notify employees of plan changes well in advance of the renewal date - and to ensure timely enrollment of employees on their new plans and their ability to access updated benefits - Aetna is requiring employer plan change requests for renewals to be submitted 10 days prior to the renewal date. Employee plan changes can be submitted through the month of the renewal.


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