We’re changing our 2019 Small Group ACA portfolio
Please be aware of these changes to our 2019 Small Group ACA portfolio
We want to let you know about changes to our 2019 Small Group ACA products. To keep up to date with the latest government standards and healthcare utilization trends, we’ve made updates to our ACA plan designs. These updates can include deductibles, in-network out-of-pocket maximums, out-of-network maximums, ER benefits, and pharmacy benefits in specific states.
As always, please visit Aetna’s Producer World for more information on specific Aetna products applicable to your state. In addition to annual product updates, there are changes to our ACA Small Group Network and underwriting guidelines that you should be aware of. Those changes are detailed below.
Network changes First, we’re changing some of our networks. This could impact some member’s access to out-of-state providers. Starting 1/1/19, certain states will have limited access to in-network benefits with specific bordering states. However, this does not always mean access to the full state – access could be restricted to certain counties or zips within the state. Additionally, in some states, certain plans will be limited to no out-of-state in-network benefit coverage. These changes do not apply for all states. Small Group plans in certain states will continue to maintain the same out-of-state network access they have today. All members will still have emergency benefits coverage when applicable, regardless of plan state or location. Please see the attached grid that outlines which states and plans are impacted. We will also proactively reach out to current members to explain potential impacts to their plan. Our digital provider search tool is the best way for all of our members to search for in-network providers. Members can access the tool by logging into their account at aetna.com,and navigating to the Find Care tab to search for in-network providers. Additionally, members can call the Member Services number located on the back of their ID card for additional support. Underwriting guidelines changes We have changed our underwriting guidelines for certain states. We now require that 51% of the employees must live within the same state as the plan sponsor’s headquarters. For some states, this was already in place. Lastly, for 2019, specific states will not be able to quote employees living outside of a predetermined radius of their plan sponsor’s headquartered state. Again, certain states already had this limitation in place (TX). Please see our underwriting guidelines for specific details on where and when these new underwriting rules apply. These guidelines will be updated on 11/1/18. To access the guidelines, visit Aetna’s Producer World. On Producer World, navigate to the Broker toolkits tab, and select your applicable state. You can then view the underwriting Guidelines.
Please contact your Aetna representative for more information.
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