Aetna CA Small Group Q3 2021 Rate Changes, Individual Market Updates, Industry News & More!

Aetna California Small Group 3rd Quarter 2021 Updates

The journey to a member’s best health is the trip of a lifetime. And we’re here for every step along their journey to their best health. Learn  how CVS® HealthHUBTM helped Luis diagnose and treat his diabetes. Below are important updates and highlights of plan information for 1 – 100 size groups in California. We appreciate your business and look forward to working with you in the 3rd quarter.

Q3 Rate changes

The below is a summary of rate changes for the 3rd quarter of 2021:
Rates changes may vary by plan and rating area.

Quarterly medical increase
            California Statewide
                        OAMC/PPO: -2.1%
                        HMO: -1.7%

Annual medical increase*
            No. Ca
                        OAMC/PPO: -2.2%
                        HMO: 1.5%

            So. Ca
                        OAMC/PPO: -1.1%
                        HMO: -1.1%

*Actual rates may vary by metallic tier and rating areas

Quarterly dental rate reduction for small groups between 1- 9 subscribers
            Approximate rate reduction of 5% to 30% for these dental plans

2021 Aetna California ACA Small Group (1 – 100) – Portfolio Reminder

16 CA HMO plans without infertility were added to our portfolio. These “noINF” plans offer an approximate 2% savings.
You can download the most current SBCs and PDDs from our website.

2021 Broker bonus

Earn up to $150 per enrolled employee
It’s simple. Just sell Aetna Small Group new business plans to groups in California with 1-100 eligible employees. You can even earn an extra incentive when you sell an Aetna Whole HealthSM- Southern California network plan.

The bonus payout is the same if you sell direct with Aetna or through a General Agent.  Bonus is based on the total number of enrolled employees for all the groups you sell with Aetna.
• 1 – 74 subscribers – $50 per enrolled employee plus an additional $25 per enrolled employee in an Aetna Whole Health product.
• 75+ subscribers – $100 per enrolled employee plus an additional $50 per enrolled employee in an Aetna Whole Health product.
Click here to download our 2021 program flyer or contact your Aetna Sales Executive for details.

California Small Group differentiation solutions

Pick 5 is now Pick 10 – effective 5/1/21. Pick any 10 plans! No need to worry about which network can be sold together. Competitive networks include Aetna Whole Health HMO which is priced approximately 20-23% less* than the full HMO network.

* Based on the assumption that Aetna Whole Health HMO plan rates are 20-23 percent less than broad network Aetna HMO plans in Los Angeles County, Orange County, Ventura County, most of Kern, San Diego, Riverside and San Bernardino counties. For illustrative purposes only. Actual results vary by customer and county.

Attain by Aetna®

The Attain app is available to all commercial medical members, their spouses and 18+ dependents. You must have an iPhone to download Attain from the App® store.
The Attain app is a first-of-its-kind health experience designed in collaboration with Apple®. It combines your health history with your Apple Watch® activity to offer personalized goals*, achievable actions and big rewards** — like an Apple Watch or gift cards from popular retailers.
On March 11, Attain users started receiving Healthy Actions cards containing access to important information from Aetna® and CVS Health about vaccine safety, development and distribution. We hope to soon be able to reward members for getting the vaccine.
Take a victory with the Attain by Aetna app to see what we have been up to!
View the self-paced member webinar to learn more about Attain!

* Goals and suggested health actions should not replace your doctor’s advice. If you have a medical condition that prevents you from meeting your goals, or if your doctor advises you not to take part in physical activity, there may be an opportunity for you to earn the same reward by different means.

** Eligibility for particular incentives varies by health plan type and location, including availability of Apple Watch as a reward.  Download the Attain by Aetna app and sign in to see which categories of incentives are available to you.

MinuteClinic® and CVS® HealthHUBTM services at no cost/low cost* to them

MinuteClinic locations make it easy for members to get the care they need, when and where they need it. MinuteClinic locations are open every day, including evenings. We are also expanding our footprint with CVS HealthHUB locations. See how we’re connecting members to more health services, one-on-one guidance, and total health resources here.

Find a MinuteClinic or HealthHUB location near you or download our sell sheet here.
• Aetna HMO members pay PCP copay
• Aetna OAMC member pay $0* copay

*Aetna OAMC members on HSA plans receive $0 copay after deductible is met. Applies only to covered services at MinuteClinic locations. Video visits are not a covered service under this benefit. Members in indemnity plans are not eligible for this benefit. Visit for age and service restrictions.

Aetna Dental Networks

Aetna Dental ranks #2 in customer satisfaction among dental plan insurers based on the J.D. Power 2020 U.S. Dental Plan Satisfaction ReportSM.

Three dental product choices with a large selection of plans:

Aetna Dental DMO – Quality dental coverage that fits everyone’s budget. An in-network primary care dentist (PCD) guides members’ care, with no deductibles, paperwork or hassles. It’s the simple way to care for smiles. DMO is also available out of state.

Aetna Dental PPO & Dental PPO MAX – If your members like freedom, they’ll love Aetna Dental PPO. They can pay a little more to visit any out-of-network dentist. Or, stay in our broad network to budget and save. There are no referrals required either way.

Aetna Freedom-of-Choice DMO PPO – Members can switch between two plans, with two networks, to fit changing needs. For one price, choose Aetna DMO for the simplicity and savings of in-network, PCD-guided care. Or, choose our PPO or indemnity plan for the freedom to visit any provider, anywhere. In fact, members can switch between two plans every month. It’s that easy.

Dental offerings:

• Standard rating for 2-9
• Voluntary and non-voluntary
• 10+ groups rates
• Voluntary and non-voluntary with and without ortho available

Envision more with Aetna Vision Preferred plans

Aetna Vision ranks #1 in customer satisfaction among vision plan insurers based on the J.D. Power 2020 U.S. Vision Plan Satisfaction ReportSM.  We offer big network and savings along with a 4-year rate guarantee.

Click here to download our vision flyer which includes the monthly rates or contact your Aetna Sales Executive for more details.

Aetna HealthSM App and Website – Find doctors, copies of ID cards, pay claims, manage prescriptions, fitness and wellness perks

Teladoc® – included with all Small Group plans

Pharmacy Formulary – Pick up 90-day prescriptions at any CVS Pharmacy®

Acupuncture and Chiropractic coverage is included on all HMO, EPO and OAMC plans, except for State Mandated plans


New Business Submission Deadlines

• 1st of the month effective dates – complete submission due by the 10th of the month of the effective date
• 15th of the month effective dates – complete submission due by the 20th of the month of the effective date


L.A. Care Covered American Rescue Plan Account Statement

Dear Agents,

The American Rescue Plan (2021 Federal Stimulus Package) was signed by President Biden on March 11, 2021 to help rebuild the U.S. economy affected by the COVID-19 pandemic and continuing recession.

If your clients are currently enrolled with Covered California and are receiving federal and/or state subsidies, and if your client’s enrollment is not terminated, cancelled, or on hold, they may be eligible to receive additional premium assistance effective as early as May 1st, 2021.  You will not need to take any action on your clients’ behalf in order for them to receive the new benefits.  Covered California will automatically send L.A. Care the updated premium amounts beginning April 12, 2021.  As such, the total amount due on the May 2021 Account Statement may not reflect what is truly owed once the updated subsidies take effect.  If your clients have set up recurring payments, the amount that will be deducted from their bank account on April 30, 2021, should be based on reduced, updated premium payment amount.

Your clients must have provided “Consent to Verify” income for coverage year 2021 in the enrollment portal.

For questions how this affects their premium amount, please contact the Covered CA Service Center at 1 800-300-1506 after April 12, 2021.

Molina Marketplace Update

We want to make sure past Molina Marketplace members who have fallen off your books are aware of the newly expanded subsidies that are now available to them through the American Rescue Plan. You can assist termed members by identifying their termed policies in your Book of Business (BOB) by status (terminated), status date (2021), and effective date (2021). Below are links to step by step instructions on how to search your BOB and pull a report where you then can filter by termed policies as well as current members in grace period (by paid thru date).

Agent Book of Business Search

Agency Book of Business Search

*Please note, ALL policies from previous years will show as terminated in your BOB, so searching by 2021 effective dates will ensure you’re reaching out to members who are truly inactive*

Oscar Health Launches A Tech Platform 

Tech-enabled insurance provider Oscar Health just launched its tech platform for payers and providers, called +Oscar. Facing steep hurdles, the company is selling +Oscar to everyone from other payers looking to improve their consumer experiences to medical groups looking to jump into value-based care arrangements. Click here to see how it works.


Most Uninsured Americans Are Already Eligible For Coverage

Most uninsured Americans are already eligible for Medicaid or subsidized Affordable Care Act coverage. One path to universal health coverage would involve signing millions of Americans up for insurance that’s already available to them, and some states are pursuing that goal. Click here for the whole story.

Eliminating Audio-Only Telehealth Coverage Could Put Safety Net Clinics at Risk

While the increased use of telehealth during the pandemic allowed many patients to maintain access to care, reimbursement for a large portion of these visits may end with the public health emergency, creating challenges for low-income patients who rely on such services. Read more about these proposed cuts here.

How Agents Influence Medicare Beneficiaries’ Plan Choices

Just 43% of available Medicare Advantage products, and 65% of Part D plans, were showcased on broker plan selection tools, according to a report released by The Commonwealth Fund. Web results primarily showcased information directly from health plans — not from neutral government, or third-party, sources. After looking through multiple large brokerage sites, researchers found one page that included information about Medigap plans, and only 18% of those available benefits were showcased. Click here for the whole story.