Sep 28, 2021
Rate Update
For the existing portfolio, rates are decreasing slightly for Q1 2022. Quoting is expected to release this week.
- HMO -0.8%
- PPO -0.2%
Network Updates
Terminated Networks
The HMO Deductible and Elect Choice EPO networks will no longer be available for new and renewing groups as of January 1, 2022. Groups currently enrolled in one of these networks will be moved at their renewal:
- HMO Deductible members will be mapped to HMO AVN.
- OA Elect Choice (EPO) members will be mapped to OA Managed Choice.
While members will be automatically mapped the appropriate network, they will have the option at renewal to move to any plan/network offered by their employer.
New Network – Sutter Health
Sutter Health OAMC is a new offering in Northern California. Available in regions 1-8 and 10, this network offers coverage in 15 counties at a price point of 6-12% less than the full network OAMC. All Sutter OAMC plans will be available in Pick 10.
Providers include Sutter Health, Stanford Health Care, and Brown & Toland Physicians. Members will have access to all Sutter Walk-In Care, MinuteClinic and CVS HealthHUB locations.
View the Sutter Network Flyer and Network Map.
Network Expansions
- Aetna Whole Health HMO network is expanding to include Ventura and Kern counties (regions 12 and 14).
- Aetna Value Network HMO is expanding to include Ventura County (region 12, excluding Santa Barbara, SLO)
- Savings Plus is expanding to include Fresno and Ventura counties (regions 11 and 12, excluding Santa Barbara and SLO)
Portfolio Updates
Aetna has refreshed their portfolio for 2022.
New Plans
- Gold HMO $30/70 1250
- Silver HMO $50/70 0
- Platinum MC 80/50 250
- Gold MC 90/50 2800 HSA
- Silver MC 60/50 1700
- Bronze MC 55/50 4600
Terminated Plans
- Gold MC 80/50 350 Ded
- Bronze MC 60/50 6300 Ded
- Silver EPO 60 2000 Ded
Pharmacy Updates
Maintenance Choice is a new program taking effect January 2022. Members can fill a 90-day supply of their maintenance medication at either CVS Mail Service Pharmacy or at a CVS Pharmacy retail location for a 2x copay.
Members who do not use CVS for maintenance medicine must opt out of Maintenance Choice. Important: members who do not opt out will be required to pay 100% of the maintenance medication cost after the 2nd refill.
In addition, Aetna will now apply True Accumulation to Rx benefits. Only funds paid out-of-pocket will apply to the plan deductible and out-of-pocket maximum accumulators.
Infertility
For 2022 the portfolio offers 2 version of every plan design to account for infertility options:
- Standard plans = cover state mandated infertility only. Benefits mirror the “noINF” plans from 2021
- wINF plans = expanded infertility coverage. Benefits mirror the standard plans from 2021
Due to this change, renewing groups that want to keep their expanded infertility benefits should look at the wINF plan designs. There is approx. a 2% price difference between standard and wINF plan designs.
“M” Mandated Plans
“M” is a new designation to identify mandated plan designs. These plans standardly cover state-mandated fertility preservation services and include acupuncture benefits.
Materials
New Employer and Employee forms are coming for 2022. These MUST be used for 2022 enrollment; 2021 applications will not be accepted. These are expected to be available first week of October.
SOBs are available and will be on our site shortly. SBCs are pending release by Aetna.
