What Aetna Means for RI Businesses

Monday, August 10, 2020

Sam Slade, Contributor

 

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There’s a new entrant in the Rhode Island group health insurance marketplace: Aetna. A subsidiary of CVS Health since 2018, the company is now a local opportunity not just for CVS employees in the state but other companies as well. Since choice and competition in the healthcare market can help address affordability, another player may be a welcome relief for some companies in the state.

On a recent webinar explaining Aetna’s new offerings in Rhode Island, the company explained its options for small groups with 10 to 100 employees as well as large employers, meaning those with 100 workers up to 5,000. Common among the plan offerings is Aetna’s commitment to deliver a new healthcare experience for companies and their members with solutions designed to control the cost of care, engage members, and make healthcare easier – all to build a better health outcome.

Here are a couple of highlights of the new offerings:

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Small Groups: For the small group, Aetna’s offering something called Funding Advantage, which is a little different than traditional self-funding. With this level-funded product, a combination of stop loss and a claims fund priced out evenly similar to a fully insured, companies have the opportunity to win. That’s because employers pay a couple portions of premium that will fund a claims fund, and will be able to get money back if the total claims funding is greater than the annual claims paid, with 50% retained by Aetna and 50% returned to the group directly. The program also allows employers to track the surplus throughout the year. If, instead, a company’s running negative, it can know how to intervene to educate members. With Aetna Funding Advantage, there are two network options for greater cost control.

Large Groups: In the large group space, Aetna’s value proposition is that it will bring down the total cost of care for companies and members. It’s offering flexibility with a large product portfolio with deductibles that range from $0 to $7,350, giving employers plan options similar to what they have but with the ability to underwrite and revaluate costs. It also has industry-specific solutions for verticals like technology and hospitality. Like the small group market, Aetna can also offer the Funding Advantage for companies with 101 to 300 employees, giving them the best of a fully-insured product with the flexibility of self-funding. It’s also driving member engagement and changing the way healthcare is delivered through options like HealthHUB locations and MinuteClinic retail sites to further increase value.

For change to happen, companies and members need choices. With Aetna now firmly in Rhode Island, it will be interesting to see how local companies respond.  

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Sam Slade is Managing Director, Employee Benefits, at The Hilb Group of New England, where he delivers consulting and brokerage services to local employers. He has extensive experience in all aspects of employee benefits, including underwriting, plan design, communications, compliance, and analytics, with a particular focus on alternative funding and self-insurance. Sam lives in South Kingstown with his wife and three sons.  

 

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