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Take note of important New York Small Group health benefits updates

Story Content Provided by Aetna on 10/28/14

Changes to 2015 plan offerings

Aetna is committed to helping employers build healthy businesses. In this changing economy, we know there is a need for affordable, simple health plan choices. We're constantly reviewing our portfolio to ensure that we're offering competitive products and affordable solutions to your clients.

With this in mind, we have made some changes to our medical plan offering in New York for 2015. We will be streamlining our plan offering to bring our out-of-network reimbursements into alignment across our portfolio. These changes are as follows:

2-50 plan changes

We are eliminating the Open Access Managed Choice (OAMC) plan. All 2015 plans will have in-network benefits only. The OAMC plan is the only 2-50 plan we are eliminating.

51-100 plan changes

We are withdrawing five plans that have a 300% out-of-network Medicare reimbursement. Customers in one of these plans will have the option of requesting an alternate plan, or will be automatically enrolled in the closest available plan. The closest available plan will have the same benefits as a customer's current plan, but will utilize our standard reimbursement for out of network services.

What you and your clients can expect

Our new plans will be available at your clients' next renewal on or after January 1, 2015. At renewal, affected groups will switch to a plan beginning with the January 1, 2015 renewing cases. At that time, any of your clients with a plan that is not being offered in 2015:

  • May choose to renew into any plan in the 2015 product portfolio
  • Will automatically be enrolled into a new Aetna policy that is similar to their current policy, if they do not select a plan from the portfolio

We will be sending affected clients a letter to inform them that they will need to pick a new plan when their current plan ends in 2015. Affected Plan Sponsors will also be mailed their renewal packet with the plan mapping and alternate options 60 days in advance of their renewal date. Any groups affected by this change will receive a letter 90 days before their renewal date, as required by law. You can view samples below.

2-50 90-day plan sponsor notice

51-100 90-day plan sponsor notice

We're also sending a similar letter to your clients' employees:

2-50 90-day employee notice

51-100 90-day employee notice

Plan Sponsors with a plan that is not being eliminated will receive a summary of changes to their existing plan with their renewal packet 60 days in advance of their renewal date. The renewal packet will be accompanied by a cover letter highlighting changes:

2-50 60-day plan sponsor renewal notice

Contact us with questions

If you have questions or concerns, please contact your FNA Sales Executive.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance and its affiliates (Aetna).

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