Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Aetna Broker Webinar NJ 2-100 Broker Seminar Fall 2013 14.25.050.1-PA (9/13 This material is for illustrative purposes, is intended for brokers only, and may not be distributed to plan sponsors or members. This material is not an offer or invitation to contract. Rates and benefits vary by location. Plan features and availability may vary by location and are subject to change.
Welcome Thank you for your time Today we will discuss: How we can help you to unlock the right combination of products, programs and services to provide solid solutions for your small group clients How Aetna can help you survive and thrive in 2014! This material is for illustrative purposes, is intended for brokers only, and may not be distributed to plan sponsors or members. This material is not an offer or invitation to contract. Rates and benefits vary by location. Plan features and availability may vary by location and are subject to change. 2
And here s how we ll do it We ll partner to help unlock the right combination of cost and coverage We ll provide the tools and technology you ll need We ll share our knowledge and experience We ll listen We ll take time to understand your needs Our values drive who we are & what we do. 3
Reform Update This material is for illustrative purposes, is intended for brokers only, and may not be distributed to plan sponsors or members. This material is not an offer or invitation to contract. Rates and benefits vary by location. Plan features and availability may vary by location and are subject to change.
Actuarial Value vs. Minimum Value 2-50 ~ Actuarial Value 50+ FTEs ~ Minimum Value Metallic designations Based on the percentage of expected health care costs that a health plan covers. Each level includes the same essential health benefits, but the levels differ in how much the health plan pays. Metallic Tiers Platinum 90% (88%-92%) Gold 80% (78%-82%) Silver 70% (68%-72%) Bronze 60% (58%-62%) Employer required to offer affordable, comprehensive coverage for full-time employees and their dependents or face potential penalties from the IRS. Affordable - employee should pay no more than 9.5% of employee s household income for Employee-Only coverage. Comprehensive - at least one plan cover a minimum value of 60% of the expected health care costs. Employers may have plans above and below 60%, as long at least one plan is at least 60% and is affordable to eligible full time employees. 5
Essential Health Benefit requirements Health insurance plans (both inside and outside Health Insurance Exchanges) must cover a list of essential health benefits (EHB) as part of a core package of benefits and services. Ambulatory Services Emergency Services Hospitalization Laboratory Services Preventive / Wellness Services Mental / Behavioral Health Rehabilitative / Habilitative Services Chronic Disease Management Maternity / Newborn Care Pediatric Dental / Vision Prescription Drugs This material is for illustrative purposes, is intended for brokers only, and may not be distributed to plan sponsors or members. This mateial is not an offer or invitation to contract. Rates and benefits vary by location. Plan features and availability may vary by location and are subject to change. 6
Product This material is for illustrative purposes, is intended for brokers only, and may not be distributed to plan sponsors or members. This material is not an offer or invitation to contract. Rates and benefits vary by location. Plan features and availability may vary by location and are subject to change.
HCR Requirements: NJ 2-100 No pre-existing condition provisions All plans Federal MHP compliant Religious Exemption - Available for every plan design and does not cover: contraceptives (oral drugs, injectable drugs and devices) contraceptive counseling voluntary sterilization (male and female) tubal ligation and vasectomy elective abortions DME maximum removed on all plans 8
2-100 Plan Naming Convention 2-50: Must include the following fields with the last being variable to represent additional benefits such as, dental or another business requirement such as coinsurance or CY vs. PY. State + Metallic Level Bronze Silver Gold Product Type HMO PPO OAMC Deductible Level & Other Cost Shares 1,000 500 0 + Additional Benefits or other business requirements: Coinsurance Dental CY/PY 51-100: Follows 2-50 convention, but removes the metallic level requirement. Examples: 2-50: NJ Silver QPOS 2000 70/50 NJ Bronze OAEPO 2500 50% CY HSA NJ Silver HNOnly 2000 10/40/75RX PY HSA NJ Silver Savings Plus HMO 1000 60/50 S1 51-100: NJ MC 500 90/50 15/35/60RX NJ Savings Plus HNOption 100/80/50 S2 9
Medical Details: NJ 2-100 Autism ABA: Age and dollar max will no longer apply Chiro in-network cost-sharing for most plans updated to coinsurance up to 25% Vision hardware reimbursement benefit ($100/24 months) removed HSA plans offered on a calendar year (CY) and plan year (PY) basis RX applied to the Maximum OOP (or referred to as OOP in this presentation) 10
HCR Requirements: NJ 2-50 Actuarial Value / Metallic plans Essential Health Benefits (EHB): State specific standard for coverage including: Pediatric dental / vision Mental health parity applies Annual or lifetime dollar limits are not allowed on EHBs ( i.e., DME) Max deductible = $2,000 / $4,000 (may exceed to reach a metal tier, however, NJ is capped at $2,500 / $5,000 per state legislation) No employer penalties for not offering coverage Out-of-Pocket (OOP): All cost-sharing goes towards OOP for medical and prescription drugs - OOP includes copays, coinsurance and deductible OOP does not include premiums, balance billing amounts of out-of-network providers or spending for non-covered expenses Maximum in-network OOP : $6,350 Individual /$12,700 Family RX safe harbor not utilized for 2014 prescription drugs do go towards medical plan OOP 11
Health Incentive Programs NJ 2-50 Health Assessment and Screening Incentive Applies to all plans Employee and spouse may earn $50 credit each ($100 in total) per year in the form of a gift card when they: 1. Complete or update their Snapshot health assessment on Simple Steps or update their health assessment on Simple Steps To A Healthier Life, and 2. Complete a biometric screening 12
Pediatric Vision Details NJ 2-50 Applies to members under 19. Medical deductible and OOP apply. Out-of-network benefits do not apply for HMO, HNOnly, OA EPO or Indemnity plans. Vision exam (1 per 12 months) Benefit Preferred eyeglass frames, prescription lenses, or prescription contact lenses* Non-preferred eyeglass frames, prescription lenses, or prescription contact lenses* NJ In-Network: 0%, deductible waived Out-of-Network: 50% after deductible In-Network (non-hsa): 0%, deductible waived In-Network (HSA): 0% after deductible Out-of-Network: 50% after deductible In-Network: 50%. If plan has an in-network deductible, deductible applies. If no in-network deductible applies, no deductible applies. Out-of-Network: 50% after deductible * The following limitations apply: One set of eyeglass frames per 12 months. One pair of prescription lenses per 12 months. Prescription contact lenses maximum per 12 months: daily disposables (up to 3 month supply), extended wear disposable (up to 6 month supply) and non-disposable lenses (one set). Important Notes: This plan will cover either one pair of prescription lenses for eyeglass frames or prescription contact lenses, but not both, per 12 months. 13
Pediatric Dental NJ 2-50 Applies to members under the age of 19. States have flexibility to change age limit in future. Integrated with medical and pharmacy benefits dental benefits apply toward medical deductible and OOP max Plan limits and exclusions may vary by state based on dental benchmark plan selected Include coverage for these dental services: Preventive, Basic, Major and Medically Necessary Orthodontia During open enrollment, a member will have the opportunity to purchase the pediatric dental benefits embedded within their medical plan and decide to either enroll or terminate their existing standalone dental plans based on their needs. Current Standalone Comprehensive Dental plans Full orthodontia benefits (not limited to medically necessary) Wide range of plan design options New Embedded Pediatric Dental plans Medically necessary orthodontia only Plan design options limited to medical plan variations Coverage of all dental benefits up to age 26 Coverage of dental benefits to age 19 Annual dental only deductible and plan maximums National DPPO with DPPOII vendor networks Deductible and Out-of-Pocket Maximums shared with Medical National DPPO network (excludes vendor networks) 14
Pediatric Dental NJ 2-50, cont. In-Network Benefit NJ Out-of-Network is not covered for any plan. Preventive Diagnostic Non-HSA / HSA: 0%; deductible waived Non-HSA: 0%, deductible waived / HSA: 0% after deductible Basic Non-HSA / HSA: 30%. If plan has an in-network deductible, deductible applies. If no in-network deductible applies, no deductible applies. Major Non-HSA / HSA: 50%. If plan has an in-network deductible, deductible applies. If no in-network deductible applies, no deductible applies. Ortho Non-HSA / HSA: 50%. If plan has an in-network deductible, deductible applies. If no in-network deductible applies, no deductible applies. 15
Medical Details: NJ 2-50 Continue to have separate portfolios 2-50 and 51-100 Reduced number of plans in 2014 portfolio vs. previous portfolios May 2010 portfolio = 224 plans. December 2012 portfolio = 129 plans 69 plan options (not including OOS or RE): Gold 15 / Silver 44 / Bronze 10 No changes to Group Situs / Multi-State 2-50 portfolio will be: Calendar year based for non-hsa and Calendar/plan year based for HSA True aggregate or non-embedded deductibles and OOP apply to all plans HSA plans will not use these provisions OVR50/UND50 EHBs: Skilled nursing: Unlimited days / year Home Health Care (includes private duty nursing): 60 visits/year Hearing Aids: Removed $1,000 max., but age limit still applies Cost-sharing of the actual hearing aid will be subject to DME benefit / costsharing while the other costs related to the hearing aid (such as the audiologist visit) will be continue to be subject to the non-specialist (PCP) cost-sharing Adult vision exam limit changed from 1 per 24 months to 1 per 12 months and vision hardware reimbursement removed 16
Plan Relativities NJ (2-50) - 4% -9% HNOption QPOS (MC = -3%) HNOnly (OA EPO = -7%) -12% HMO 17
RX Details: NJ 2-50 Choose Generic with DAW override: If a physician prescribes a covered brand-name prescription drug where a generic prescription drug equivalent is available and specifies Dispense As Written (DAW), the member will pay the cost sharing for the brand-name prescription drug. If a physician does not specify "DAW" and the member requests a covered brand-name prescription drug where a generic prescription drug equivalent is available, the member will be responsible for the cost difference between the brand-name prescription drug and the generic prescription drug equivalent plus the applicable cost sharing. Transition of Coverage Formulary will remain open, but comply with EHB standards. Please note that not all drugs on the formulary are covered under the plan. Performance drugs or supplies for the treatment of erectile dysfunction, impotence or sexual dysfunction / inadequacy are not covered on any plan. Specialty drugs are included in the RX plan. RX Tiers: Generic / Preferred brand name / Non-Preferred brand name 18
NJ 2-50 Portfolio At A Glance 1/1/14 Plan Name Products Offered INN DED IND/FAM COINS IN/OON INN OOP IND/FAM PCP SPC IP OP ER Rx ONN DED IND/FAM OON OOP IND/FAM NJ Gold 100/60 300D HNOption $0 / $0 100/60 NJ Gold 500D NJ Gold 70% NJ Gold 1500 70% NJ Silver 1500 70/50 HMO, HNOnly, HNOption, OA EPO, OA MC HMO, HNOnly, HNOption HMO, HNOnly, OA EPO HNOption, OA MC $0 / $0 100/50 $0 / $0 70/50 $1,500/ $3,000 $1,500/ $3,000 70/No OON 70/50 $6,000/ $12,000 $20 $40 $6,000/ $12,000 $30 $50 $6,000/ $12,000 $3,500/ $7,000 $6,000/ $12,000 $300/D, 5 Day Max $500/D, 5 Day Max $300 OP Hosp, $150 ASC $500 OP Hosp, $250 ASC $30 $50 30% 30% 30% $20 DW $40 DW $35 DW $50 DW 30% 30% 30% 30% 30% $20/$50/$75 30% $20/$50/$75 30% DW 50% DW $3,000/ $6,000 $10,000 $20/$50/$75 $10,000 $10/$40/$75; $20/$50/$75 N/A (OA EPO = 10/40/75) $20/$50/$75 $10,000 $10,000/ $20,000 $10,000/ $20,000 $10,000/ $20,000 N/A $10,000/ $20,000 NJ Silver 2000 60/50 HNOption $2,000/ $4,000 60/50 $6,000/ $12,000 $30 DW $50 DW 40% 40% 50% DW $20/$50/$75 $10,000 $10,000/ $20,000 NJ Silver 2000 50% HMO, HNOnly $2,000/ $4,000 50/No OON $6,000/ $12,000 $30 DW $50 DW 50% 50% 50% DW $20/$50/$75 N/A N/A NJ Silver 2000 70% (Unridered Plans) NJ Indemnity 500 80% (Unridered Plan) NJ Silver 1200 70% (Unridered Plan) HMO, QPOS, OA EPO, MC $2,000/ $5,000 70/50 Indemnity N/A 80 Indemnity N/A 70 $10,000 30% N/A N/A 30% 30% 30% 30% 30% 30% 30% $100 + 30% $100 + $100 + 30% $20/$50/$75 $10,000 30% $500/ $1,000 $1,200/ $2,400 $10,000/ $20,000 $6,000/ $12,000 $6,350 $12,700 19
NJ 2-50 Portfolio At A Glance, cont. 1/1/14 Plan Name Products Offered INN DED IND/FAM COINS IN/OON INN OOP IND/FAM PCP SPC IP OP ER Rx ONN DED IND/FAM OON OOP IND/FAM NJ Silver 2000 CY/PY HSA HNOnly, HNOption $2,000 / $4,000 100/50 $4,000/ $8,000 $30 $50 $400/D, 5 Day Max, aft ded $200 After ded: 30% $10/$40/$75; $20/$50/$75 $10,000 $10,000/ $20,000 NJ Silver 2000 100% CY/PY HSA HMO $2,000/ $4,000 100/No OON $6,350/ $12,700 0% 0% 0% 0% 0% After ded: $20/$50/$75 N/A N/A NJ Silver 2000 90% CY/PY HSA HNOnly, HNOption $2,000/ $4,000 90/50 $6,350/ $12,700 10% 10% 10% 10% 10% After ded: $20/$50/$75 $10,000 $10,000/ $20,000 NJ Bronze 2500 50% CY/PY HSA HMO, HNOnly, HNOption, OA EPO, OA MC $2,500/ $5,000 50/50 $6,350/ $12,700 50% 50% 50% 50% 50% 50% (No max per RX) $10,000 $10,000/ $20,000 20
NJ 2-50 Portfolio At A Glance, cont. 1/1/14 Plan Name Products Offered INN DED IND/FAM COINS IN/OON INN OOP IND/FAM PCP SPC IP OP ER Rx OON ONN DED OOP IND/FAM IND/FAM NJ Silver Savings Plus 1000 60/50 NJ Silver Savings Plus 1500 70/50 NJ Silver Savings Plus 2000 70/50 NJ Silver Savings Plus 1500 70/50 CY/PY HSA HMO, HNOnly $1,000/ $2,000 HMO, HNOnly $1,500/ $3,000 HMO, HNOnly $2,000/ $4,000 HMO, HNOnly $1,500/ $3,000 60/50 70/50 70/50 70/50 $6,000/ $12,000 $6,000/ $12,000 $6,000/ $12,000 $6,350/ $12,700 $35 DW 50% aft ded $35 DW 50% aft ded $35 DW 50% aft ded $35 50% aft ded 40% aft ded 50% 30% aft ded 50% 30% aft ded 50% 30% aft ded 50% 40% aft ded 50% 30% aft ded 50% 30% aft ded 50% 30% aft ded 50% 40% aft ded 50% 30% aft ded 50% 30% aft ded 50% 30% aft ded 50% 40% 30% 30% 30% $20/ 50% to $125/ 50% to $150 $20/ 50% to $125/ 50% to $150 $20/ 50% to $125/ 50% to $150 $10/ $40/ 50% to $150 N/A N/A N/A N/A N/A N/A N/A N/A 21
Dental
NJ 2-9 Standard Options (Ortho is excluded) Product Options DMO Option 2 DMO 100/80/50 Option 10 DMO plan code 41 Freedom-of-Choice Option 3 FOC DMO 100/90/60 PPO Max 100/70/50, 100/70/40, $1000 Option 8 FOC DMO 100/90/60 PPO $1500, 100/80/50 PPO Max Option 4 PPO Max 100/80/50, $1500 NJ Option 7.1 Prev Care PPO Max 100/0/0 PPO Option 5 Active PPO in 100/80/50, $1500 out 80/60/50, 80/60/40, $1000 Option 6 PPO 100/80/50, $1500 Option 9 PPO 2000, 100/80/50 23
NJ 3-9 Voluntary (Ortho is excluded) Product Options DMO Voluntary Option 2 DMO 100/80/50 Voluntary Option 5 DMO plan code 41 Freedom-of-Choice Voluntary Option 3 FOC DMO 100/90/60 PPO Max 100/70/50, 100/70/40, $1000 PPO Max Voluntary Option 4 PPO Max 100/80/50, $1500 NJ Option V7.1 Prev care PPO Max 100/0/0 24
NJ 10-100 Standard and Voluntary (Options can include or exclude Ortho) Product Options DMO Option 1A DMO Access, plan code 42 New Option 1B DMO plan code 53 Option 2A DMO 100/80/50 Option 3A DMO plan code 64 Option 4A DMO 100/100/60 New Option 4B DMO 100/100/60 B (ortho copay $1750) Option 5A DMO Plan code 56 Freedom-of-Choice Option 6A FOC PPO Max Low DMO 100/90/60 PPO Max 100/70/50, 100/70/40, $1000 Option 7A FOC PPO Max, High DMO 100/100/60 PPO Max 100/80/50, $1000 Option 8A - FOC PPO Low 80 th DMO 100/100/60 PPO 100/80/50, $1000 Option 9A - FOC PPO 1000 80 th DMO Plan code 56 PPO 100/80/50, $1000 Option 10A FOC PPO 2000 80 th DMO 100/100/60 PPO 100/80/50, $2000 25
NJ 10-100 Standard and Voluntary (con t) (Options can include or exclude Ortho) Product PPO Max Options Option 11A PPO Max 1500, 100/80/50 Option 11B PPO Max 1500 Plus, 100/80/50 (prev exc from cym) new Option 11C PPO Max 1000, 100/80/50 PPO Option 12A PPO 1000 80 th, 100/80/50 new Option 12B PPO 1000 90 th, 100/80/50 Option 13A PPO 1500 80 th, 100/80/50 Option 13B PPO 1500 80 th Plus, 100/80/50 (prev exc from cym) New Option 13C PPO 1500 90 th, 100/80/50 Option 14A PPO 2000 90 th, 100/80/50 new Option 15A Active PPO 80 th A in 100/80/50 $1500 out 80/60/50 $1000 (ortho $1000) new Option 15B Active PPO 80 th B in 100/80/50 $1500 out 80/60/50 $1000 (ortho $1500) new Option 16A Active PPO 1500 80 th A in 100/80/50, $1500 out 80/60/50, $1500 (ortho $1000) new Option 16B Active PPO 1500 80 th B in 100/80/50, $1500 out 80/60/50, $1500 (ortho $1500) 26
Rating
What s changing in NJ 2-50 for 2014? Rating Variables Elimination of Rating by Gender NJ-specific Age Curve New benefit mandates EHB s New rating methodology member-specific rates 28
2014 - A New Way to Develop Rates for 2-50 Calculated at the MEMBER level not subscriber level How is the Member level rate calculated? Market Index Rate as of January 1, 2014 x Effective date factor x Benefit plan factor x Member age factor x Rating area adjustment What is a Market Index Rate? A new way of displaying the Community Rate level = Final Member Rate Required under the ACA as the starting point to develop member rates Reflects a per member, per month (PMPM) rate as of January 1, 2014 for an adult with a 1.0 age factor 1 Market Index Rate per state per legal entity 29
2-50 Group Rates in 2013 Historically, Small Group rates in New Jersey have reflected a Composite rate structure, whereby all employees pay the same rate determined by the type of dependents they cover Single EE, Couple, EE with Child(ren), and Family: In 2013 Employee 1 Employee 2 Employee 3 Employee 4 Employee 5 Employee, age 45 Employee, age 45 Employee, age 45 Employee, age 45 Employee, age 45 Spouse, age 43 Spouse, age 43 Spouse, age 43 Spouse, age 43 Spouse, age 43 Child, age 12 Child, age 12 Child, age 12 Child, age 22 Child, age 11 Child, age 11 Child, age 21 Child, age 8 Child, age 8 Child, age 8 Child, age 6 Child, age 6 Child, age 4 Child, age 4 Couple rate Family rate Same rate as Same rate as Same rate as EE #2 EE #2 EE #2 30
2-50 Group Rates in 2014 In 2014 Employee 1 Employee 2 Employee 3 Employee 4 Employee 5 Employee, age 45 Employee, age 45 Employee, age 45 Employee, age 45 Employee, age 45 Spouse, age 43 Spouse, age 43 Spouse, age 43 Spouse, age 43 Spouse, age 43 Child, age 12 Child, age 12 Child, age 12 Child, age 22 Child, age 11 Child, age 11 Child, age 21 Child, age 8 Child, age 8 Child, age 8 Child, age 6 Child, age 6 Child, age 4 Child, age 4 Member, age 45 Member, age 45 Member, age 45 Member, age 45 Member, age 45 + Member, age 43 + Member, age 43 + Member, age 43 + Member, age 43 + Member, age 43 = "Couple" rate + Member, age 12 + Member, age 12 + Member, age 12 + Member, age 22 = "Family" rate + Member, age 11 + Member, age 11 + Member, age 21 + Member, age 8 + Member, age 8 + Member, age 8 = "Family" rate = "Family" rate* + Member, age 6 + Member, age 4 *3-child cap is = "Family" rate* reached; the youngest 2 children aren't *3-child cap does not included apply because the oldest 2 children are age 21+. 31
Sample Rate Output: HealthConnect new 2014 rate report option Aetna - Silver HNOption 2000 60/50 ID: 14019675 Eff Dt = 1/1/2014 Cost Share Information In-Network Out-Network Individual/Family Deductible $2,000/$4,000 TIF $6,000/$12,000 TIF Individual/Family OOP Limit $10,000 (included) $10,000/$20,000 (included) Co-Insurance 40% 50% Inpatient Services Inpatient Hospital 40% after ded. 50% after ded. Inpatient Surgery Refer to Inpatient Hospital Refer to Inpatient Hospital Outpatient Services Outpatient Facility Refer to Outpatient Surgery Refer to Outpatient Surgery Outpatient Surgery 40% after ded. 50% after ded. Employees Age Tobacco Member EE Total 01, Employee 27 Yes $385.31 $385.31 02, Employee 35 No $416.75 $824.56 02, Spouse 32 No $407.81 03, Employee 41 No $434.63 $896.99 03, Dependent 8 No $231.18 03, Dependent 6 No $231.18 04, Employee 52 No $569.33 $1,352.89 04, Spouse 51 No $552.38 04, Dependent1 17 No $231.18 MONTHLY PREMIUM $3,459.75
Additional Rating Details for 2-50 When do member rates change? Although members will have birthdays and change age all during the year - per ACA, rates can only chance once a year on renewal How are mid-year enrollees handled? Their age is calculated as of their enrollment date 33
Underwriting
Underwriting 2-50 Pre-Ex Eliminated Accepting Elists on 10-50 life groups Minimum Participation & Contribution No change to the current, state-specific guidelines ACA established Group Open Enrollment period for groups that do not meet the carrier minimums. 11/15-12/15 submission dates, for a 1/1 effective date Benefits Waiting Period Maximum of 90 Calendar Days written into ACA 1 st of the month following 0, 30 or 60 days (2-100) 15 th of the month effective date/billing cycle also available Employer Acknowledgement NEW!! New Business Attestation Form required if not built into ER application Established Business Included in the Renewal package NJ DEP 30 HINT form still required Overage dep will pay single rate based on their age 35
Underwriting 2-50 Renewal Business For the most part, no changes to 2-50 Renewal Underwriting Guidelines Benefits Waiting Period Established Business New language included in the Renewal package Guaranteed Renewability Although new customers may enroll without meeting participation requirements during the special OE period, we can still NON RENEW these groups for Violation of minimum participation/contribution requirements Underwriting will enforce participation requirements at renewal 36
Renewals 2-50 UBM notification letters will be sent to all plan sponsors and members 90 days in advance notice of renewal All groups will be mapped to closest plan option in 2014 portfolio All HMO based groups will renew into ACAS products Metallic value for renewal option will be listed on renewal 37
Commissions
Traditional Channels Brokers & Insurance Agencies Base commissions Medical & Specialty sales bonus Premier Producer Program rewards $ $ $ 39
Medical & Specialty Sales Bonus You benefit from: Increased revenue with our quarterly bonus program Medical New Business Bonus Apps sold 25 49 $25.00 50 74 $50.00 75 149 $75.00 Bonus per app 150+ $100.00 Sell 100 apps between January 1, 2014 and March 15, 2014: 100 apps x $75 = $7,500 bonus Specialty Bonus Apps sold 25 49 $10.00 50 74 $15.00 75 149 $20.00 150+ $25.00 Bonus per app Sell 100 apps between January 1, 2014 and March 15, 2014: 100 apps x $20 = $2,000 bonus If writing thru a GA, broker bonuses will be subject to 50% credit only 40
Base Commissions 2014 Broker Base Commissions NJ 2-50 4.5% new business 4% renewal Effective for New Business - 1/1/14 Effective for Existing Business - Upon renewal, beginning 1/1/14 Direct or through a contracted Aetna General Agent 41
51-100
Product
Health Incentive Programs NY 51-100 No-Cost-Health Incentive (same as today) Applies to all plans except HSA Employee and spouse may earn $50 credit each ($100 in total) per year toward the plan s deductible and coinsurance when they: 1. Complete or update their Health Assessment on Simple Steps To A Healthier Life, and 2. Complete one online wellness program 44
Medical Details: NJ 51-100 Continue to have separate portfolios 2-50 and 51-100. 52 plan options (not including OOS or RE). All plans pass the minimum value test (> 60%). Group situs does not apply to any plans. Multi-state is still applicable. Products: All products, except Savings Plus, changing from QPOS/HNOption to MC/OAMC. Savings Plus will remain as HNOption. Due to change in product to MC/OAMC, out-of-network RX benefits apply. Plan Administration: RX applied to OOP on all plans. Non-HSA: Embedded administration for deductibles and OOP. Calendar year based plans HSA: Non-embedded (true aggregate) administration for deductibles and OOP. Calendar year (CY) and plan year (PY) based plans available. Chiro OON limit updated from $1,000 max/year to 20 visits/year. Vision exam limit (adult/pediatric) remains at 1 per 24 months. Vision hardware reimbursement benefit ($100/24 months) removed. Dental is not offered under the 51-100 plans. 45
NJ 51-100 Portfolio At A Glance 1/1/14 Plan Name Products Offered INN DED IND/FAM COINS IN/OON INN OOP IND/FAM PCP SPC IP OP ER Rx ONN DED IND/FAM OON OOP IND/FAM 'NJ 100/70 0A (Note: 300% OON reimb. option available with $15/$35/$60 RX) MC, OAMC $0 / $0 100/70 NJ 100/50 0A OAMC $0 / $0 100/50 NJ 100/70 500A (Note: 300% OON reimb. option available with $15/$35/$60 RX) NJ 100/50 150D NJ 100/70 250D NJ 100/50 400D OAMC MC, OAMC $0 / $0 $0 / $0 100/70 100/50 $2,500/ $5,000 $2,500/ $5,000 $3,000/ $6,000 $25 $25 $2,500/ $5,000 OAMC $0 / $0 100/70 $4,000/ $8,000 OAMC $0 / $0 100/50 $4,000/ $8,000 NJ 100/50 500D MC, OAMC $0 / $0 100/50 $10,000 NJ 1000 80% Indemnity N/A N/A N/A $20 $20 $0/Adm $0 $100 $20 $20 $0/Adm $0 $100 $20 $40 $20 $40 $20 $40 $30 $50 $500/ Adm $150/D, 5 Day Max $250/D, 5 Day Max $400/D, 5 Day Max $500/D, 5 Day Max $250 $100 $150 $100 $250 $100 $400 $100 $500 $100 $5/$20/$40; $15/$35/$60 $5/$20/$40; $15/$35/$60 $5/$20/$40; $15/$35/$60 $5/$20/$40; $15/$35/$60 $5/$20/$40; $15/$35/$60 $5/$20/$40; $15/$35/$60 $5/$20/$40; $15/$35/$60 MC: $2,000/6,000 OAMC: $1,000/$3,000 $15,000 $2,000/ $6,000 $15,000 $4,000/ $12,000 $15,000 $15,000 $15/$35/$60 $1,000/ $2,000 $15,000 $30,000/ $90,000 $15,000 $30,000/ $90,000 $10,000/ $30,000 $30,000/ $90,000 $30,000/ $90,000 $6,000/ $12,000 46
NJ 51-100 Portfolio At A Glance, cont. 1/1/14 Plan Name Products Offered INN DED IND/FAM COINS IN/OON INN OOP IND/FAM PCP SPC IP OP ER Rx ONN DED IND/FAM OON OOP IND/FAM NJ 500 90/70 OAMC $500/ $1,000 90/70 $2,500/ $5,000 $20 DW $40 DW 10% 10% DW $5/$20/$40; $15/$35/$60 $2,500/ $7,500 $15,000 NJ 500 90/50 NJ 1000 90/70 NJ 1000 80/60 NJ 1000 80/50 NJ 2000 90/50 NJ 2000 80/50 NJ 1500 100/70 HSA CY or PY NJ 2000 100/50 HSA CY or PY NJ 2000 90/70 HSA CY or PY NJ 2000 90/50 HSA CY or PY NJ 2000 80/50 HSA CY or PY NJ 2500 90/50 HSA CY or PY MC $500/ $1,000 OAMC $1,000/ $2,000 OAMC $1,000/ $2,000 MC, OAMC $1,000/ $2,000 MC, OAMC $2,000/ $4,000 MC OAMC OAMC OAMC OAMC OAMC OAMC $2,000/ $4,000 $1,500/ $3,000 $2,000/ $4,000 $2,000/ $4,000 $2,000/ $4,000 $2,000/ $4,000 $2,500/ $5,000 90/50 90/70 80/60 80/50 90/50 80/50 100/70 100/50 90/70 90/50 80/50 90/50 $2,500/ $5,000 $4,000/ $8,000 $10,000 $4,000/ $8,000 $10,000 $10,000 $3,000/ $6,000 $4,000/ $8,000 $4,000/ $8,000 $4,000/ $8,000 $4,000/ $8,000 $10,000 $20 DW $40 DW $30 DW $30 DW $30 DW $50 DW $30 DW $50 DW $30 DW $50 DW $30 DW $50 DW 0% 0% 10% 10% 10% 0% 0% 10% 10% 10% 10% 10% 10% 0% 0% 10% 10% 10% 10% 10% 10% 0% 0% 10% 10% 10% DW $100 DW DW DW DW DW $5/$20/$40; $15/$35/$60 $15,000 $15/$35/$60 $3,000/ $9,000 $15/$35/$60 $4,000/ $12,000 $15/$35/$60 $15,000 $15/$35/$60 $15,000 $15/$35/$60 After ded: $15/$35/$60 After ded: $15/$35/$60 After ded: $15/$35/$60 After ded: $15/$35/$60 After ded: $15/$35/$60 After ded: $15/$35/$60 $15,000 $3,000/ $9,000 $15,000 $4,000/ $12,000 $15,000 $15,000 $15,000 $30,000/ $90,000 $10,000/ $30,000 $15,000/ $45,000 $30,000/ $90,000 $30,000/ $90,000 $30,000/ $90,000 $6,000/ $18,000 $30,000/ $90,000 $7,500/ $22,500 $30,000/ $90,000 $30,000/ $90,000 $30,000/ $90,000 47
NJ 51-100 Portfolio At A Glance, cont. 1/1/14 Plan Name Products Offered INN DED IND/FAM COINS IN/OON INN OOP IND/FAM PCP SPC IP OP ER Rx ONN DED IND/FAM OON OOP IND/FAM NJ Savings Plus 100/80/50 NJ Savings Plus 100/70/50 HNOption HNOption $0/$0 $1,500/ $3,000 $0/$0 $2,000/ $4,000 100/80/50 100/70/50 $3,000/ $6,000 $6,000/ $12,000 $4,000/ $8,000 $8,000/ $16,000 $20 $20 30% $20 $40 30% $0/Adm $150/D, 5 Day Max 30% $0 $150 30% $100 DW $100 DW $15/$35/$60 $15,000 $15/$35/$60 $15,000 $30,000/ $90,000 $30,000/ $90,000 NJ Savings Plus 1000 80/60/50 HNOption $1,000/ $2,000 $2,500/ $5,000 80/60/50 $10,000 $10,000/ $20,000 $30 DW 40% $50 DW 40% 40% 40% DW $20/$40/$70 $15,000 $30,000/ $90,000 48
Renewals
Underwriting 51+ - Renewal Business For the most part, no changes to 51+ Renewal Underwriting Guidelines Guaranteed Renewability. Participation and Contribution Levels: Participation and contribution levels cannot be used to decline coverage. Underwriting, however, can price for incremental risk by utilizing judgment as allowed within state filings. The work team has developed a sliding scale of incremental factors for low participation groups. The following table will be filed for 1Q14 effective dates and can be used to adjust manual rates or projected claims on experience rated groups Reasons for NON RENEWAL Non payment of premium Fraud Failure to comply with state regulations 50
Renewal Impacts NJ 51-100 All groups will be mapped to the closest plan in the 2014 portfolio Notification of plan mapping and ACA compliance will be included in renewal package Anyone in a NJ QPOS/ HNOption will be converted to the corresponding NJ MC/OAMC plan. Anyone enrolled in an Out-ofarea OAMC plan will convert to the NJ MC/OAMC plan 51-100 / 1-1-2014 renewals to be released week of October 21 st 51
Commissions
Base Commissions 2014 Broker Base Commissions NJ 51-100 flat 4% Effective for New Business - 1/1/14 Effective for Existing Business - Upon renewal, beginning 1/1/14 Direct or through a contracted Aetna General Agent 53
These times demand Aetna. Thank you! New Jersey Brokers demand Aetna. www.aetna.com 2013 14.25.050.1-PA (9/13) This material is for illustrative purposes, is intended for brokers only, and may not be distributed to plan sponsors or members. This material is not an offer or invitation to contract. Rates and benefits Aetna vary Inc. by location. Plan features and availability may vary by location and are subject to change.