Aetna announces leadership change in line with growth strategy

We are facing a period of unprecedented change and opportunity in the health care system. Today we are announcing a new operating model and the associated leadership changes that are designed to position us well to capitalize on the opportunities ahead.

Our new operating model aligns us more closely to our customers, will make us more effective at capitalizing on emerging opportunities related to health reform, and will help us transform to a more consumer-oriented company. We want to share this new organizational model and leaders with you

National Businesses is a new organization that will be led by Joe Zubretsky, now our senior executive vice president and chief financial officer. National Businesses combines some of Aetna’s most prominent businesses. This change reinforces our commitment to transform the network model by aligning provider and payer incentives to improve the quality and affordability of health care.

The organization will include: National Accounts, Care Management, Medical Cost Analytics, National Networks, Pharmacy, Behavioral Health, Vision, Prodigy and Payflex. Joe will continue to lead Emerging Businesses (including Accountable Care Solutions, ActiveHealth Solutions, Medicity and iTriage), Workers Compensation, Cofinity, Enterprise Strategy and Business Development.

This appointment reflects the significant contributions Joe has made to both Aetna’s financial strength and strategic direction since he joined Aetna in 2007.

Local and Regional Businesses is a new organization that will be led by executive vice president Karen Rohan. This change underscores that health care is local and will help us more fully prepare for our proposed acquisition of Coventry. This organization will include the individual, small group and middle market businesses, the regions, strategic development and product, and health care exchanges. It also will include Life Insurance, Disability, Dental, Voluntary, Student Health and the Consumer Platform/CarePass. Karen also will continue her role as the head of our Coventry integration team. Since joining Aetna in 2012, Karen has become an increasingly valuable member of the leadership team and made significant contributions to our growth strategy.

Today we also are announcing the retirement of executive vice president Frank McCauley, who will continue to work with Chairman and CEO Mark Bertolini on a number of important initiatives, including preparing the company for health reform, until he retires later this year.

We also have named Shawn Guertin to succeed Joe Zubretsky as Aetna’s chief financial officer, with responsibility for Finance and Investments.

There are no changes to our Government Businesses or International Businesses.

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The Affordable Care Act (ACA) brings significant and sweeping changes to how Americans access and pay for health care. And while change is good, it can be challenging. We are navigating these changes together. Our goal at UnitedHealthcare is simple: To help you understand what health reform means to you and your clients.

As regulations, mandates and laws become effective over the next months and years, it’s important to know where to begin and what to focus on as you prepare your clients. To help you get started, please see the attached.

Please refer to the United for Reform Resource Center for updates and more detailed information at www.uhc.com/reform.

Also see:
UnitedReformBrochure (Size: 288 Kb )

Preparing for health care reform’s Comparative Effectiveness Research Fee

The health care reform law includes a new Comparative Effectiveness Research Fee (CERF) for insurers and self-insured plans to fund research that determines the effectiveness of various forms of medical treatment. The Internal Revenue Service (IRS) issued its final rule on this provision on December 5, 2012.

The fee applies on the first day of the policy/plan year beginning on or after October 2, 2011 and continues to apply through policy/plan years ending before October 1, 2019. (These dates are based upon the federal government’s fiscal year of October 1 through September 30.)

The fee is classified as a tax, and it will be reported and paid to the IRS via Form 720 Federal Excise Tax Return. Currently, Form 720 is a quarterly reporting form, and is being revised by the government to account for this annual fee. We expect to receive updated forms and filing instructions and will keep you informed.

The fee is based on the average covered lives for the applicable 12-month policy/plan year and is payable on July 31 of the calendar year that follows the year in which the policy/plan year ends.

For more information about this fee and how it may impact employers, please visit Cigna’s dedicated CERF website to find your complimentary CERF Toolkit: www.cigna.com/CERF-Toolkit.

In your toolkit, you will find:

• CERF Fact Sheet (printout!)
• Detailed payment schedule by renewal date (printout!)
• Details about the fee specific to the employer’s situation, including how it will be collected and used
• Sample eligibility reports, log-in information and report-generation instructions for self-service access
• Links to news alerts and government resources about this fee

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Horizon BCBSNJ Brief Notes V. 22, No. 900
Nationwide Dental Network for Blue Cross and Blue Shield Customers.

Applies to: All markets

Nationwide Dental Network for Blue Cross and Blue Shield Customers

Seamless in-network access to dentists means greater convenience, savings in all 50 states

Horizon Blue Cross Blue Shield of New Jersey and a consortium of Blue Cross and Blue Shield plans announced an initiative that creates one of the nation’s largest networks of dentists. The solution, National Dental GRID, links the dental networks of most of the nation’s Blue plans to provide customers with a hassle-free solution for stronger access and in-network discounts across the country.

The National Dental GRID and National Dental GRID + are industry-leading dental network solutions for group customers. Now, our dental customers with employees in multiple states can have the convenience of savings and peace of mind that’s instantly made possible by this impressive, shared national network.

• The National Dental GRID will be offered to 51+ PPO groups.
• The National Dental GRID + network is a broader network that will be offered to small group DOP, and 51+ DOP groups.

The national dental network solutions are free from access fees that add up for customers using leased networks. This means better pricing for the groups that purchase dental benefits for their employees, in addition to the network savings the employees receive. And for dentists, it means more patients because they are in network for participating Blue plans nationwide.

Multi-state employers expect a simple, uniform experience across all locations where employees work  and it’s one of the key advantages of the network. Customers reap the advantages of a national network solution without any changes to the way they currently work with their Home
plan:

• Member benefits Home plan ID cards, Explanation of Benefits (EOBs) and plan benefits continue to be managed by the Home plan.
• Group benefits  All account management services are received from the Home plan.
• Additional benefits  Customer service, web access and claims processing take place through the Home plan.

Attached for your reference are questions and answers to help your clients understand the nationwide dentist networks.

Also see:
2013BNationalDentalGrid (Size: 752 Kb )

New Jersey/New York brokers:

New, lower-priced Aetna Savings Plus plans come to New Jersey February 1, 2013

We’re joining with certain providers in New Jersey to bring you a new, innovative product: Aetna Savings Plus. Effective February 1, 2013, you can offer a variety of competitive plans to New Jersey businesses with 2-50 and 51-100 eligible employees.

The Savings Plus plans help businesses provide health benefits that fit their needs and budgets. The plans give members access to an affordable network of health providers right in their own community.

These quality-based, lower-cost network plans offer your clients anywhere from 10%-22% savings (on average), compared to similar Aetna plans. Members have lower out-of-pocket costs when using the New Jersey Savings Plus network. Review the 2-50 Savings Plus plan guide and the 51-100 Savings Plus plan guide for more benefits details.

Savings Plus service area

The Savings Plus plans are ideal for New Jersey-based employers whose employees use doctors and facilities in New Jersey and in the following New York boroughs and counties for those individuals covered under New Jersey plans who prefer to visit providers in New York:

• Manhattan
• Queens
• Brooklyn
• Staten Island
• The Bronx
• Long Island
• Westchester County
• Rockland County
• Putnam County Orange County
• Dutchess County
• Ulster County
• Sullivan County

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Stay up to date with Health Reform Weekly.

We want you to have access to the latest health care reform news from Washington, D.C., and states across the country. This weekly e-mail links you to updates on health reform legislation that could significantly impact you.

This week’s health care reform news:

43 State Legislatures Convene in January

Forty-three states have convened or are scheduled to convene in January, with many dealing with the launch of health insurance exchanges later this year. Other issues facing many states include Medicaid expansion, benefit mandates and provider contracting.

Other highlights include:

• California’s governor is seeking $350 million in the state budget for Medicaid expansion.
• Delaware is expected to wrestle with specialty pharmacy drug tier and biosimilars legislation in the new session.
• New Mexico will accept federal dollars to expand Medicaid.

To view the full articles, visit Health Reform Weekly.

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Health Care Reform: Impact on Renewals

The Affordable Care Act (ACA) has mandated funding from all health insurers to build a pool of funds for several initiatives. The funds will be used to help stabilize premiums for the newly insured, develop best practices to improve the quality of medical outcomes, and prevent undue profits as more Americans purchase health insurance.

Several taxes and fees to support these programs began appearing on the AmeriHealth New Jersey medical rate paperwork in November 2012. Because we anticipate that groups will be confused by several new lines of charges on the Rate Renewal Worksheets, and will pose a number of questions concerning these fees and taxes, it is important that we can explain them. This piece will help you to understand and explain the fees and taxes to group decision makers who call with questions.

Plese click on the link below for details.

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