Aetna has recently clarified their underwriting requirements when a doctor’s visit is needed in order to underwrite a new application. The doctor’s visit must be performed by a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner/Certified Registered Nurse Practitioner (NP/CRNP) or Physician Assistant (PA).

Aetna Online Application

Age/Timeline Requirements:

Newborn through age 17: The application must include a doctor’s visit within the past 3 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. The only exception to this policy would be a newborn, under 31 days old, or a newly adopted child who is being added to a policy without underwriting.

Age 18 through age 30: The application must include a doctor’s visit within the past 5 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. A physical must include height, weight, and a blood pressure reading.

Age 31 through age 49: The application must include a doctor’s visit within the past 5 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. A physical must include height, weight, a blood pressure reading and lab results for blood sugar and cholesterol.

Age 50 and older: The application must include a doctor’s visit within the past 2 years. If there is no doctor’s visit, a current medical exam (within the last 6 months) and physical is required. A physical must include height, weight, a blood pressure reading, and lab results for blood sugar and cholesterol.

If the Underwriter determines (either through outreach to an applicant in a phone interview or by review of medical records) that the applicant has not had a doctor’s visit within the required time frames, the underwriter will close the application.

The underwriter will document what information is required to be considered for enrollment and a written letter will be sent to the applicant to advise that their application has been closed.

Example: A 50 year old applicant applies for coverage with no medical history. A telephone interview is conducted and at that time, the applicant confirms that he/she has not seen a physician in over 5 years.

At that time, the clinician performing the telephone interview will advise the applicant during the conversation that “To proceed with underwriting your application, the results of a current physical exam is required. This includes but is not limited to: height; weight; blood pressure; lab results for cholesterol and fasting blood sugar; and past medical history. Your application can be continued if you submit this documentation to the underwriting department within the next 30 days. You may fax this information to (866) 223-2041.” The applicant should identify on the fax that this is a “Request to reopen their application” and they should include their closed letter.

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Tags: Aetna Doctor Visit Requirement, Aetna Individual and Family Underwritiing Guidelines, Aetna Individual Underwriting, Aetna Underwritng Requirements

Effective November 16, 2009, Aetna implemented a new policy for dependent verification related to newborn/adopted child(children) for all Aetna Advantage Plans for Individuals, Families and Self-Employed nationwide. The new policy requires an attestation form verifying eligibility for the newborn/adopted child(children) to be submitted in order for the newborn/adopted child(children) to be added to the member’s policy after the first 31 days of life/adoption.

A verification form is required if:

• The mother is not on the plan
• The mother is on the plan, but has no record of maternity claims
• Adoption

To add a newborn/adopted child to the member’s policy, Aetna requires a completed attestation form from the subscriber/member within 31 days of the date-of-birth/adoption. In order for the child to remain on the plan, the policyholder must provide a birth certificate, Adoption Decree or proof of legal responsibility within 60 days of DOB/Adoption unless otherwise required by the state. If documentation is not received within the allotted time frame, the request for coverage may be declined.

Note: The newborn/adopted child will be covered under the policyholder’s plan during the first 31 days (whether or not we receive a form as is required by the state).

No additional verification is required if the mother is covered under an Aetna Advantage Plan, either as a subscriber or dependent, and has maternity-related claims in the system or an admission for delivery is indicated. Newborn child(children) will be enrolled when Aetna receives a written request within state guidelines.

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Tags: Aetna Adoption Policy, Aetna Adoption Verification, Aetna Newborn Identification, Aetna Newborn Policy, Aetna Newborn Verification

Effective October 1st, Bank of America will administer Health Savings Accounts (HSA) for HSA-compatible Aetna Advantage Plans for Individuals, Families and the Self-Employed. There is no change to Aetna’s HSA-compatible AARP® Essential Premier Health Insurance Plans at this time.

HSAs are currently administered by JPMorgan Chase Bank. Existing members who currently have an HSA with JPMorgan will not be impacted by this change.

What’s New?

Through Bank of America, HSAs will automatically be set up for new members who enroll in an HSA-compatible plan effective on or after October 1st. If no action is taken on the HSA, it will automatically close after 90 days.

The new HSA website will be co-branded with Aetna and Bank of America logos and will provide more tools to help members manage and modify their account online. For example, members can issue payments to providers using an online bill-pay option. They can also set up automatic money transfers to their HSA from their checking or savings account. As another perk, members can view their cash and investment accounts on a single integrated statement.

How are Members Impacted?

• There is no impact to existing members who currently have an HSA with JPMorgan.
• For new members who enroll in an HSA-compatible plan effective on or after October 1st, an HSA will automatically be set up for them. Members will receive a debit card and a welcome package with information to get them started.
• New members can opt out of the HSA by calling Bank of America– or if they take no action, the account will automatically close after 90 days.
• New members will not be able to link to their Bank of America HSA from Aetna Navigator; however, there will still be a link to the JPMorgan website for existing members. Members must save the website link www.benefitsolutions.bankofamerica.com that’s provided in their welcome packet.
• Member customer service is provided by Bank of America from 8:00-11:00 PM EST. The dedicated phone number for Aetna HSA members is 1-866-791-0250; TTY is 1-866-867-0701.

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Tags: Aetna Bank of America HSAs, Aetna Health Savings Account Administrator, Aetna Health Savings Accounts, Aetna HSAs

Mercy Harvard Hospital will be joining the Aetna Chicago network effective October 1, 2009. Mercy Harvard Hospital is a 77 bed facility, that is located in Harvard Illinois. This addition will provide members additional choice and improve hospital access.

The Mercy Harvard Hospital will be available to members enrolled in the following Aetna Advantage products:

• HMO
• Aetna Open Access® (an HMO plan)
• Quality Point-of-Service® (QPOS®)
• Aetna Choice® POS
• Aetna Golden Choice®
• Aetna Golden Medicare®
• Managed Choice® POS
• Aetna Open Access® Managed Choice POS
• Aetna Choice® POS II
• Elect Choice® EPO
• Aetna Open Access Elect Choice EPO
• Aetna Select
• Open Access Aetna Select
• Open Choice® PPO
• Aetna HealthFund®
• National Advantage™ Program
• Aetna Workers’ Comp Access

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Tags: Aetna Illinois Hospital Networks, Aetna Illinois PPO Network, Aetna Network Illinois, Mercy Hospital Joins Aetna Network

Aetna has announced that the Order of Saint Francis (OSF) Healthcare System will be joining the Aetna Northern IL network effective September 1, 2009.

The OSF Healthcare System will be available to members enrolled in the following Aetna Advantage products:

• Aetna Choice® POS II
• Open Access Aetna Select
• Open Choice PPO
• Aetna HealthFund
• National Advantage Program

OSF Healthcare System is located across Northern Illinois. This addition will provide members an additional 225 physicians (including 144 primary care physicians and 81 specialists) and improve hospital access. With this addition, Aetna will now have 23 participating hospitals in the Northern Illinois network.

Facilities in the OSF Healthcare System include:

• OSF Saint Anthony Medical Center – Rockford, IL
• OSF St. Mary Medical Center – Galesburg, IL
• OSF Holy Family Medical Center – Monmouth, IL
• OSF Saint Francis Medical Center (Flagship hospital) – Peoria, IL
• OSF St. Joseph Medical Center – Bloomington, IL
• OSF Saint James Hospital – Pontiac, IL

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Tags: Aetna Illinois Network, Aetna OSF Healthcare System, Aetna PPO Network Illinois, Order of Saint Francis Hospitals, Order of St Francis Healthcare System, Order of St Francis Hospital Aetna networks

CHICAGO–(BUSINESS WIRE)–Aetna (NYSE: AET) is introducing a health insurance plan with the goal of helping small businesses in under-served communities offer health insurance to their employees for the first time ever.

Called the Aetna Illinois Community Plan, it is designed for Chicago-area small businesses with 2 to 50 eligible employees and is approximately 25 percent less expensive than other Aetna small group insurance plans with similar benefits.

Aetna’s Illinois Community Plan is available through insurance brokers to members and member affiliates of the Illinois Hispanic Chamber of Commerce, which is open to anyone.

“We’re very excited about this affiliation,” said Omar Duque, President and CEO of the Illinois Hispanic Chamber of Commerce. “We’re hopeful this plan will allow businesses to offer their employees and their families health insurance who have never been able to afford it before.”

“This plan was designed in direct response to the needs raised by the local business community. They told us they needed a health plan that was affordable for the business and their employees, close to home, easy to understand and with robust benefits,” said Marty Castro, vice president of external affairs for diverse market strategies at Aetna’s Chicago office. “So, we designed this plan to make sure it includes hospitals and health care providers in the neighborhoods where people live. There are more than 40 hospitals, 2,400 primary care physicians, 740 Ob/Gyns, 5,600 specialists and 2,000 behavioral health providers participating in this plan. Hospitals and physicians are located in Cook, DuPage, Lake, Kane, Kankakee and Will counties.”

Aetna’s Illinois Community Plan is a tiered plan, meaning there are three tiers of health care providers. If people use the health care providers in the first tier, known as the “Tier 1 community network,” generally they have the least out-of-pocket expense.

The plan focuses on prevention. When using the “community network,” co-pays and deductibles are waived for well-baby exams, child exams, immunizations, adult physical exams, routine mammograms, eye exams and routine gynecological exams. In addition, the plan covers use of “walk-in” clinics that belong to the network.

“There are insurance plans in the marketplace that advertise they’re ‘low-cost,’ but once you check into it, you find they have substantial out-of-pocket costs and don’t cover many things. Aetna’s Illinois Community Plan is one with limited out-of-pocket expense that covers a full spectrum of health care services – doctor’s visits; hospitalizations; lab and x-ray services; outpatient physical, occupational and speech therapy; chiropractic services; outpatient surgery; emergency room and urgent care; and generic prescription drugs,” said Aetna’s Castro. In addition, those with Aetna insurance have access to a wide array of health information and wellness resources on the Aetna web site.

The plan includes hospitals and physicians located in Chicagoland’s Hispanic communities, where many speak Spanish. The Spanish-language website for the new plan (www.aetnaILCommunityPlan.com) will go live in late January and includes a DocFind link to search the physician database. In addition, Aetna offers a Spanish version of its website (www.aetna.com/espanol/) and partners with the Financial Planning Association on a Spanish language informational website about health insurance (www.planifiqueparasusalud.com) A DocFind® site for the Illinois Community Plan is currently available in English: http://www.aetna.com/docfind/custom/ilcommunitynetwork/

“While direct medical costs account for 24 percent of employers’ health care expenses, the cost of on-the-job productivity loss due to illness accounts for 63 percent,” said Castro. “Employers need to look not just at the cost of health benefits when considering whether to offer health insurance, but at the bigger picture of how employee health conditions are affecting benefit results and productivity. These days, having health insurance is critical to a family’s and a community’s financial well-being and security.”

Aetna is well-known for its involvement in Chicago’s Hispanic community. Over the last 3-1/2 years, Aetna and the Aetna Foundation have awarded more than $2 million to organizations in Chicago, most of which are providing health and wellness services in Chicago’s under-served communities, including the Hispanic community. In addition, Aetna’s Chicago employees volunteer thousands of hours in Chicago’s communities and are committed to serving the health needs of our neighbors.

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Medicare beneficiaries in Cook County now have access to almost twice as many hospitals and physicians compared with last year through two types of Aetna Medicare Advantage plan options – the Aetna Golden Medicare Plan® (HMO) and the Aetna Golden ChoiceSM Plan (PPO). “Aetna is extremely pleased to have added 18 hospitals and more than 1,200 physicians to the Aetna network, and more specifically, our HMO and PPO offerings for Medicare,” said Nitin Bhargava, North Central Region head of sales for Aetna’s Consumer Segment. “Some notable additions to our network include the University of Illinois at Chicago Health System, Resurrection Health System, Little Company of Mary Hospital and Healthcare Centers, and St. James Hospital and Health Center, among others.”

In addition, Aetna is offering two HMO plans with a zero-premium option in 2009 that are available to all Medicare beneficiaries in Cook County.

Plan Features

Aetna’s Individual Medicare Advantage plan options in Cook County that also include Part D prescription drug coverage feature a wide range of benefits, including:

• Coverage for doctors visits, hospitalization and prescription medications through one plan with the convenience of a single ID card.
• Coverage for all Medicare Part D prescription drugs, including those for common conditions such as high blood pressure, diabetes, allergies, high cholesterol and arthritis.
• Discounts on vision and hearing aid products and services, and special rates on alternative health care services.

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Tags: Aetna Medicare, Aetna Medicare Advantage Plans, Medicare Cook County

Effective January 1, 2009, the following changes occurred with regard to domestic partner coverage with Aetna:

Aetna small group health insurance plans will allow domestic partner coverage in Illinois, although it is not state mandated. Coverage is available to eligible dependents who are same sex or opposite sex partners to groups with 5 or more eligible employees, and is available with the 2007 and future portfolios of plans. Existing Aetna groups who want to provide domestic partner coverage will need to convert to a 2007 or later plan design (2009 plans effective 4/1/09) and it can only be added at renewal.

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Tags: Aetna, domestic parter coverage, domestic partner insurance law, Illinois domestic partner

HARTFORD, Conn. – September 20, 2008. – Aetna announced that it has contracted with Maxim Health Systems for the fifth year in a row to administer influenza vaccinations (flu shots) to all members enrolled in its health benefit plans. In addition to receiving the vaccination from their physicians, Aetna members will have the option to get their flu shot at one of Maxim’s more than 25,000 sites in retail facilities and corporations, as well as other clinics across the country. The flu shot clinics will begin on October 1 and continue through mid-November 2008.

“We want to make it as easy as possible for our members, especially those in the high risk groups for influenza, to take this important preventive step,” said Troyen Brennan, M.D., Aetna’s chief medical officer. “These flu shot clinics allow our members and their families to find times and locations that are convenient for them.”

To find a Maxim flu clinic, members can go to a website Maxim has set up (www.findaflushot.com) and enter their zip code and the distance they want to travel. They can also call a toll-free phone number (1-866-466-2976) to help locate a clinic or obtain information about the flu shots in either English or Spanish.

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Tags: Aetna, flu shots

HARTFORD, Conn. – September 3, 2008. – Aetna announced today that it has made its CareEngine-powered Personal Health Record (PHR) available to current Aetna Medicare members who purchased their Medicare plans individually. This unique, interactive tool is designed to better engage Medicare members in managing their own health, as well as make it easier for members to share health information with their physicians.

Aetna’s PHR combines a wide variety of health information gathered from across the health care spectrum — such as physician offices, labs, diagnostic treatment and pharmacies — with user-entered information such as family history or allergies, and houses it in a secure, online location. This type of tool is especially important to Medicare members as more and more of them use the Internet. A May 2008 study from the Pew Internet & American Life Society estimates that 35 percent of individuals age 65 and over use the Internet, and the percentage increase for this age group has been greater than any other since 2000.

“This is a great example of the value that we provide to our Medicare members,” said Frank McCauley, head of Aetna’s Consumer Business Segment. “Instead of storing medical records in a file cabinet or a shoe box, Aetna’s PHR allows members to access their medical information any place an Internet connection is available.”

With permission from the member, the Personal Health Record can be shared online with physicians and other health care professionals. In addition, members can easily print copies to bring to office visits to help fill out forms. They also have the ability to create and print a wallet-sized Emergency Information Card that contains important information such as name, date of birth, blood type, emergency contacts, allergies, medications, and physician and insurance information.

Aetna’s PHR also uses patented CareEngine technology that continuously scans an individual’s health data and claims information and compares it to current, established medical best practices. It can then alert members and doctors about possible urgent situations and opportunities to improve care.

Recent Enhancements

Through a recent pilot program that made the PHR available to more than 750,000 members, Aetna discovered that members with an ongoing health condition were twice as likely to use their PHR as those without one. In part because of this finding, Aetna added Health Trackers to the PHR to help members better follow their health data. With this new feature, members can more effectively monitor their blood glucose levels, blood pressure, cholesterol, BMI and more.

Aetna has also made the PHR available online to treating physicians’ offices (if given access by the member) through Aetna’s secure provider website via NaviNet®.

“With age usually comes an increased need for health care services, and our Medicare members are more likely to have chronic conditions they need to monitor on an ongoing basis,” McCauley said. “These new features will give them the ability to better track their own health information and share it with their physicians. Improvements in both of these areas can help our members make better decisions concerning their health care.”

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Tags: Aetna, Aetna Medicare, Medicare, monitor health, Organize medical information, Personal Health Record