Small Business Benefit Solutions Blog

Archive for the ‘Aetna’ Category

UPDATE:

Continuum Hospitals have reached agreement with Aetna on a new 3 year agreement that will be backdated to April 1, 2010. This means that all services that Aetna members received at the Continuum Hospitals after the termination date, will be reprocessed by Aetna and paid as “in network”.

All Continuum physicians that currently participate with Aetna will continue to remain in network.

Aetna apologized for the stress and anxiety this may have caused it’s employees/clients.

ORIGINAL ARTICLE:

Aetna and Continuum Hospitals are drifting towards a June 5th contract termination if the 2 sides can’t agree on reimbursements for medical services provided to Aetna members by these Manhattan and Brooklyn/Kings County based hospitals .

Aetna claims the hospitals request for a 40% increase over a 3 year period far outweighs the consumer price index, but Continuum claims that the CPI cannot adequately reflect medical cost trends.

Aetna members stand to lose key network participating hospitals including:

• Beth Israel Medical Center, Petrie Division
• Beth Israel Medical Center-Kings Highway Division
• Long Island College Hospital
• NY Eye & Ear Infirmary
• St. Luke’s Roosevelt Hospital Center – Roosevelt Division and St. Luke’s Division

Right now, Continuum Hospitals will at least remain participating until the end of the contract cooling off period which is June 5, 2010.

Small Business Benefit Solutions, LLC  will stay on top of this matter and post updates as they become available.

Some of the largest health insurance companies offering medical plans covering students at school – including Aetna and United Healthcare – were recently subpoenaed, along with several insurance brokers, agencies and consultants, in an ongoing investigation into what the New York Attorney General’s Office says is inferior health coverage at colleges in and around the state.   

 NY Attorney General Andrew Cuomo said that an investigation by his office has revealed “troubling practices” of school-sponsored student health insurance including extremely low coverage limits, excessive costs for coverage provided and inconsistencies with federal protections recently made law, “which leave students at risk”.

Cuomo has written directly to more than 300 colleges, universities and professional and trade schools both in New York and out-of-state suggesting they review plans offered to their students through the major insurance companies.  

Parents often find that their college bound son or daughter is forced to buy a school-endorsed policy from their college or university unless they can prove their child has comparable coverage elsewhere.  

But according to a statement released by Cuomo’s office, many of these school-sponsored plans “leave students at risk while providing massive profits for insurance companies”, because, as his office’s investigation found, the amount of claims paid out by the insurer, in many cases, is only a fraction of the unusually high premiums charged to students and their families.

For example, the investigation found some plans have maximum benefit caps lower than $25,000, while others place a cap on individual illnesses as low as $700. Additionally, many plans either don’t offer prescription-drug coverage or severely limit such coverage, Cuomo said.

“It is important for students to have adequate health care coverage to protect themselves during times of illness or injury, but a bad health insurance plan can have catastrophic and long-lasting effects on a young person’s life,” the attorney general said. “By being informed of the problematic practices that currently exist in the industry, schools can negotiate for better health plans, and students and their families can be better equipped to select the coverage that is best for them.”   

Details of the investigation also suggest that “troubling, conflicted relationships” exist between agents and health insurance companies that involve undisclosed incentives for agents to  persuade schools to take and maintain overly costly plans.  

This kind of practice flies in the face of the ethical and moral obligations agents agree to maintain through the licensing process.  The Independent Agents and Brokers of America, a trade organization for the insurance brokerage industry also encourages members to take that obligation one step further by taking the “Pledge of Performance” oath.  Every member of the Small Business Benefit Solutions, LLC team has taken this pledge* and, as a “Trusted Choice Agency” strives to exceed these requirements* within the context of being solely a health insurance brokerage agency.  

While SBBS doesn’t market student policies, we would be happy to discuss your particular situation.  With many legal changes, your student may already have the coverage he or she needs without having to buy an extra policy from their school.

*Unlike property and casualty policies, where claims require immediate attention in the case of a fire, storm, natural disaster or accident, health coverage is provided in a medical setting around the clock on an as needed basis.  Claims are then filed after the services have been rendered, in some cases many days weeks or even months later.  Health insurance carriers also only operate on a limited schedule with no service available on evenings and weekends.  Our agency is exempt from the 24/7 service clause.

We want to notify you of upcoming changes to AETNA’S NJ Small Group new business and renewing plans.

New NJ Small Group 2010 portfolio

The new plan designs will offer more competitive products to:

• Promote wellness.
• Provide cost-effective solutions business owners

Brief overview of upcoming changes

Aetna will only offer these new NJ Small Group 2010 medical benefit plans to small group employers for new business beginning with May 1, 2010 effective dates.  We are waiting for these plans and coverage summaries to be released to us by Aetna.

Existing clients with anniversary dates of May 1, 2010 to July 31, 2010 may select from the new NJ Small Group 2010 portfolio of medical benefits plans and/or any other plans in the existing New Jersey Small Group portfolio of medical benefits plans.

Existing clients with anniversary dates beginning with August 1, 2010 may only select from the new NJ Small Group 2010 portfolio of medical benefits plans.

For full details, view the 2010 Portfolio Highlights