Renewal is coming for your Aetna and CoventryOne individual clients in Pennsylvania

Individual Pre-65

Renewal is quickly approaching and we are beginning to reach out to your clients in Pennsylvania regarding their coverage and plan options for 2016.  

Member outreach will take place by November 1

We will send letters to our individual Aetna and CoventryOne subscribers by November 1:

For members in Bucks, Chester, Delaware, Montgomery and Philadelphia counties, the letters will explain: 

  • Their current coverage ends December 31, 2015 and we will not offer their current health coverage for next year; however we will suggest a new, similar plan.
  • Their new monthly premium for 2016
  • Highlights of the new plan
  • If they like the new suggested plan and there are no changes to their Marketplace application, they don't need to do anything except make their premium payment. They will receive their January premium invoice in November. To avoid a gap in coverage, they need to pay it before December 31, 2015.
  • Changes described in the letter will be effective January 1, 2016. Unless members take action by December 15, 2015, they will automatically be enrolled to continue coverage for 2016. If members decide to enroll in a different plan, they should do so by December 15, 2015. If they enroll after that date, their new coverage won’t start until February 1, 2016 or March 1, 2016 depending on the date they enroll.
For members in all other Pennsylvania counties, the letters will explain:

  • We will continue to offer their health coverage for next year; however some plans or plan details may have changed.
  • Their new monthly premium for 2016.
  • If they like their new plan and there are no changes to their Marketplace application, they don't need to do anything except make their premium payment. 
  • Changes described in the letter will be effective January 1, 2016. Unless members take action by December 15, 2015, they will automatically be enrolled to continue coverage for 2016. Members can enroll in a different plan anytime between November 1, 2015 and January 31, 2016. If they want coverage to start January 1, they need to make sure they enroll by December 15, 2015.    

New this year

For on-exchange members, the letters will also share information about the member’s Advanced Premium Tax Credit (APTC) amount, if applicable. The 2016 APTC amount is based on the 2015 amount, per federal guidance. The final billed amount may be different once CMS updates their 2016 subsidy eligibility amount and it may vary from what is included on the member’s letter.

CMS will send a Marketplace Open Enrollment Notice (MOEN) to all on-exchange members. This notice will contain certain basic information, including: a description of the annual redetermination and renewal process; the requirement to report changes affecting eligibility, the channels and timeframe for reporting such changes; and the last day a plan selection may be made for coverage starting January 1.

Also, CMS is re-determining subsidy eligibility for all on-exchange membership. The Marketplace will use the newest income data available to re-determine advanced payments of the premium tax credit (APTC) and cost-sharing reductions (CSR) for enrollees. Members are encouraged to go to HealthCare.gov and update their income information on their 2016 Marketplace application by December 15, 2015 to make sure they get the correct subsidy amount and to avoid a potential gap in their health coverage. In mid-October 2015, CMS will send a Batch Auto-Renewal (BAR) file with members’ 2016 renewal plans and subsidies to carriers. Once we receive the BAR file from CMS, we’ll mail a BAR notification letter to Aetna on-exchange members to communicate their updated 2016 subsidy amount and to encourage active re-enrollment if their subsidy has been zeroed out.  We will send an updated APTC notification letter to Coventry on-exchange members with the same information. 

Remind members to log into their Marketplace account using the same username, password and email address as last year. If they can’t remember their username or password, members can follow the steps on HealthCare.gov. 

Some members whose APTC has been zeroed out may receive a pre-recorded member outreach call in November as a follow-up to encourage them to complete an active enrollment through the Marketplace. Also some members will receive a reminder via postcard and email in late November or early December regarding the December 15, 2015 deadline to make any plan changes or update their application on Healthcare.gov. 

Grandfathered (pre-ACA) plans are being discontinued
Grandfathered members in Pennsylvania will not be able to keep their grandfathered plan and they must transition to a new Affordable Care Act (ACA) plan to be effective January 1, 2016.

If subscribers do not like the plan changes, the letter gives them three options to get coverage:

  1. Visit www.healthcare.gov and look at other plans on the Health Insurance Marketplace.

  2. Visit www.healthcare.gov and see if you or your family qualify for Medicaid or the Children’s Health Insurance Program.

  3. Look at other plans outside the Marketplace.

Our goal is to make this transition as easy as possible. We encourage you to work with members to help them understand their 2016 options both on and outside of the exchange, if they decide to shop for another plan.

Coverage through the Marketplace

Members should keep in mind that if they qualify for financial assistance to lower their monthly premiums or out-of-pocket costs, they can only get these savings if they enroll through the Marketplace.

If they can’t afford a plan from the Marketplace they can contact the Marketplace and apply for a hardship exemption. This exemption will allow them to buy a catastrophic plan that usually has lower monthly premiums and will mainly protect them from very high medical costs. 

If you have any questions, contact your sales representative, the Aetna National Broker Support Unit at 1-888-54-Aetna (1-888-542-3862). Representatives are available Monday - Friday from 7:30 a.m. to 6:00 p.m. Central time.

This information is intended for brokers only.

Aetna individual health insurance plans are underwritten by Aetna Life Insurance Company, Aetna Health Inc., and/or by Aetna Health of Utah Inc. (Aetna).

Coventry health plans are underwritten by Aetna Heath Inc., Aetna Health of Utah Inc. and/or the following affiliates of Aetna Life Insurance Company: Coventry Health and Life Insurance Company, Coventry Health Care of Florida, Inc., Coventry Health Care of Kansas, Inc., Coventry Health Care of Nebraska, Inc., Coventry Health Care of Illinois, Inc., and Coventry Health Care of Virginia, Inc.

Coventry Health Care of Georgia, Inc., Coventry Health Care of the Carolinas, Coventry Health Care of Louisiana, Inc., Coventry Health Core of Iowa, Coventry Health Plan of Florida, Inc., Coventry Health Care of Virginia, Inc., and HealthAmerica Pennsylvania, Inc., plans are underwritten by Aetna Health Inc.

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