Aetna (NYSE: AET) has listened to market feedback on the year-old NYC Community Plan. In addition to making the plan more affordable for more people, it has enhanced the offering with two new plan designs that include: lower hospital copays; generic-only pharmacy benefits with unlimited calendar year maximums; and discounted rates for brand drugs.
Insurance brokers in New York welcome the enhanced product for their small business clients.
"The recent NYC Community Plan enhancements, combined with significant rate reductions, make an excellent product even better. Aetna clearly listened to market feedback, and has responded with benefit and rate improvements, making this product very attractive to the NYC small business owner," said William Medina, chief executive officer, United Association Of Entrepreneurs in Bethpage, NY. "While other companies are announcing significant premium increases for struggling small businesses, Aetna is lowing premiums, which is timely, especially in this challenging economic climate."
Aetna's ability to lower the rates on this plan -- while the premiums on competing offerings are rising -- is a reflection of the strong relationship between Aetna and the committed group of doctors, hospitals and other providers who are participating in the NYC Community Plan network.
"The care providers who have contracted with Aetna to participate in the NYC Community Plan network agree that it is important to increase the number of people with insurance in New York, particularly within traditionally underserved communities," said Miguel Centeno, Aetna vice president, strategic market development. "By working together, we have developed reimbursement arrangements that help keep health care costs in check so that premiums can be affordable."
As always, members in all six NYC Community Plan design options receive preventive care -- such as routine physicals, screenings and immunizations, well child and well woman visits -- covered at 100 percent, with no co-pays, and no claim forms to fill out, if they receive care within the NYC Community Plan Referred Network.
"By covering preventive care at 100 percent, Aetna is removing a financial barrier for many employees, helping to increase health care access and encourage people to take advantage of wellness programs and preventive screenings," Centeno said. "In addition, these plans offer a wealth of programs and features that complement the standard medical coverage, such as savings on products and educational materials geared toward employees' special health needs."
The NYC Community Plan also helps address cultural disparities in health care by utilizing local physicians and diverse Aetna sales and service teams who live and work in the community and are more familiar with the health care needs, preferences and the overall environment in New York communities. Aetna provides cultural competency training for its own workers as well as physicians working in the community. In addition, many Aetna employees speak multiple languages, which will make it easier to interact with customers from diverse ethnic backgrounds.
The plan, is exclusively offered in Manhattan, Staten Island, Queens, Brooklyn and the Bronx, and features two in-network benefit levels, referred and self-referred.
Members are eligible for referred benefits when they receive covered medical services from or through a primary care physician (PCP) who participates in the new NYC Community Plan Referred Network. The PCP coordinates care, and members pay no co-pays for routine and preventive services. Out-of-pocket expenses are limited to any applicable co-pays, and there are no claim forms. Referrals will be required for services not provided by the PCP.
Members may also directly access providers in the NYC Community Plan Self-Referred Network without receiving referrals from their PCP. They will be responsible for an annual deductible and coinsurance, and subject to a lifetime benefits maximum. Out-of-pocket costs will be significantly more affordable when members use referred, participating providers.
For further information about the plan, employers and brokers should call
Miguel Centeno at 212-457-0440 or visit us on the web at www.aetnaNYCplan.com.
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.2 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. www.aetna.com.