Aetna – CA Small Group New Rates & Plan Changes effective April 1, 2012

Aetna will introduce six new plans for Small Group clients in California. The new portfolio includes two HMOs and four Managed Choice® (MC) plans. All are effective April 1, 2012.

All of these new plans build on rates and benefits that brokers and plan sponsors have requested. 

More on the new plans: 

  • The new plans were designed to help employers and employees save on health care costs while getting a plan that meets their needs.
  • All of the HMO and MC/PPO plans alongside each other.
  • Plan sponsors can set their contribution rates on the lowest priced plan, and their employees can “buy up” to different plans if they wish to do so.

Just look at some of the key benefits these plans offer your employees:

IMPORTANT PLAN CHANGES: In addition to introducing new plans, some changes were made to existing plans. Look at the Renewal guide for details about the changes to specific plans. Please note: There are changes to every plan — so it is important for you to review the changes. You can also view the new Plan Guide here

Other plan highlights include:

  • Vision benefit now included with all plans — One exam every 24 months. Includes refractive testing. 
  • Wellness/health incentive benefit — Employees and their spouses/domestic partners can earn up to $100 for completing a wellness program through simple steps.
  • Brokers and employees can complete adds and terms online.
  • As of March 2012, an employer can obtain a new employee’s member ID right in the on-line enrollment tool as soon as the enrollment has been processed.

TIPS ON THE INDIVIDUAL APPLICATION PROCESS

When the Obama Administration’s health reform laws take full effect in 2014, insurance carriers will no longer be able to deny coverage to adult individuals with preexisting medical conditions. Until then, there are federally funded high-risk pools. To qualify for these, you have to be without insurance for six months and you must show you have applied for and been denied insurance in the private market.

If you have a preexisting condition and can’t qualify for the high-risk pools, it’s a smart idea to at least check out the plans available within the private insurance market. “Don’t assume if one insurer rejects you that they all will,” says Anthony Wright, executive director of Health Access California, a statewide advocacy group.   By being a smart consumer you can improve your changes of obtaining coverage. Below are suggestions that we hope will help you in finding individual coverage:

Eligibility Laws
If you’ve exhausted your  COBRA and or CAL COBRA benefits available after leaving a job, federal law guarantees you a HIPAA policy from private insurers if you apply for one within 63 days from loss of other coverage.  Please make sure to retain a copy of the prior carrier’s “Certificate of Creditable Coverage” as proof that you did have coverage and that the loss of coverage occurred within 63 days of the application date.

Underwriting

In California carriers can review your health history, age and gender in order to determine the premium to be charged if you have a history of certain medical conditions.    The carriers are looking for those applicants that may potentially charge a large amount in claims costs.   The carriers also subscribe to a service that tracks your prescription drug records, the MIB Group.  You can request a copy of your 5 year usage history at http://www.mib.com/html/request_your_record.html.

Carefully answer the application

In order to determine the premium to be charged, the carrier’s application will ask many questions about your health.  Please remember to fully answer only the question asked.  Underwriters are looking to see if a medical situation has been resolved, or there are upcoming charges or procedures that may indicate a large expense.  Remember that omitting information may actually cause the coverage to be rescinded.  Sometimes the carriers will schedule a telephone interview in order to gain a better understanding of your medical history, so it is best if you have a copy of your medical records with you during the call, so you don’t have to try to remember all the details, which may be a costly mistake.

Manage your health

Of course it is always best for you to try to maintain optimum health, not only for obtaining health insurance, but to maintain your quality of life.  If a medication is working don’t change it unless there is a generic available.  Lose weight, exercise. Commit to a healthy lifestyle.  

Ask your medical provider to review your records and correct any inaccuracies and update your health history.  Not only will this effect a health insurance application, it is important to have all records be accurate for medical and legal reasons.

Work with a knowledgeable agent

The current insurance atmosphere is in a state of flux, with many changes to happen over the next few years.  Talk to someone in the field for help.  You can contact the National Assn. of Health Underwriters’ website, http://www.nahu.org or you can contact our office at (888) 474-6627   for assistance with the application process.