7/11/2020
California
Aetna has provided the following summary of rate changes for the fourth quarter. They show an annual trend of less than 8%. In addition, please see the rate reductions in Rating Area 15 (Los Angeles).
Rate changes may vary by plan and rating area.
Underwriting reminders
Participation
It’s simple. Just sell Aetna new business plans to groups in California with 1-100 eligible employees. The bonus payout is the same if you sell direct with Aetna or through a General Agent. Bonus is based on the total number of enrolled employees for all the groups you sell with Aetna.
Other information
| HMO | Quarterly | Annual |
| Bronze | 3.2% | 1% |
| Silver | 3.2% | -0.4% |
| Gold | 3.2% | 7.9% |
| Platinum | 3.2% | 3% |
| PPO | Quarterly | Annual |
| Bronze | 2.2% | -2.6% |
| Silver | 2.5% | 1.2% |
| Gold | -0.8% | 5.9% |
| Platinum | 0.6% | -2.9% |
| PPO RA 15 only | Q4 |
| Bronze | -14.5% |
| Silver | -10.1% |
| Gold | -12.7% |
| Platinum | -11.5% |
Rate changes may vary by plan and rating area.
Underwriting reminders
Participation
- Relaxed participation promotion through 12/31/20 effective dates:
- 25% participation for groups of five or more enrolled subscribers
- 65% participation required for four or less subscribers enrolled
- Aetna will allow one other carrier HMO and/or PPO alongside (excludes EPO plans)
- Participation with another carrier is not considered a valid waiver
It’s simple. Just sell Aetna new business plans to groups in California with 1-100 eligible employees. The bonus payout is the same if you sell direct with Aetna or through a General Agent. Bonus is based on the total number of enrolled employees for all the groups you sell with Aetna.
- 1 - 74 subscribers - $50 per enrolled employee
- 75+ subscribers - $100 per enrolled employee
Other information
- Aetna HealthSM App for IOS and Android users — download from app store
- Find doctors, get a copy of ID card, pay claims, etc.
- Teladoc — included with all small group plans
- Pharmacy formulary — 2020 SG CA ACA formulary (www.aetna.com/individuals-families/find-a-medication.html)
- Chiropractic coverage is included on all HMO, EPO and OAMC plans, except for state-mandated plans
- Confirmation of renewal
- Confirmation by the employer via letter, fax or email to the client management team and receive prior to their renewal date
- Premium payment in advance of the renewal date will also act as confirmation
- Confirmation by the employer via letter, fax or email to the client management team and receive prior to their renewal date
- Groups submitting renewal plan changes must be received 10 days prior to their renewal (five days prior if submitting changes on the eList tool)
Source: Aetna