Aetna discusses open season options

November 22, 2010 — Tom Bernatavitz, head of Federal Plans for Aetna, joined hosts Tammy Flanagan and Bob Leins to discuss Aetna’s federal employee health benefits plans, changes in 2011 and online resources.

Premium increases but no cuts to benefits
The HMO plans went up 14 percent, with regional variations, Bernatavitz said.

The increased rate represents rising health care costs and the “claim experience” from individuals in the plan. A lot of participants are older individuals or retirees so their health care costs are higher.

“Our philosophy is you can either cut benefits or charge what you need to charge to cover the claims costs,” Bernatavitz said.


Types of plans
Aetna offers four plans — two HMOs, a consumer-driven plan and a high-deductible plan.

The consumer-driven plans offer more freedom and flexibility, including out-of-network benefits, Bernatavitz said. However, “your deductible and co-insurance rates are higher than on the (HMO) plan,” he said.

Consumer-driven plans come with a health reimbursement account (HRA)benefit with $1,000 for single and $2,000 for family. The HRA funds roll over from year to year, but if you leave the plan the benefit goes away.

Participants in the high-deductible plans have a health savings account (HSA) with annual amounts of $750 for single and $1,500 for family.

The enrollees in the consumer-driven are three times higher than in the high-deductible.

Healthy individuals who only utilize preventative care and dental and eye exams, essentially would not pay any premiums for the year.

A new advantage is Aetna will deposit an additional $50 for single and $100 for family if you complete an online health risk assessment questionnaire.

“It helps you monitor your health needs and gives you a heads up on what to look for,” Bernatavitz said.

Bernatavitz said the more significant perks are included in all medical plans, including eye and dental exams, discounts on prescription eyeware, contact lenses and Lasiks eye surgery.

Other perks include discounts for vitamins and supplements, weight-loss programs and gym memberships

Online resources
Aetna’s Express Lane is an interactive tool that helps you pick the right plan.

Aetna also has an iPhone app that allows you to view your personal health record.

Behind the scenes, Aetna looks at an individual’s records “holistically” to identify areas of “omission or commision,” Bernatavitz said.

Omission means someone is not treating a problem. Comission means a person is taking two drugs that are conflicting with each other.

Aetna has nurses who look at these indicators and, if there is a problem, call the person’s primary physician.