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Aetna’s National Advantage™ Program

With our National Advantage Program, customers and their employees can save on medical claims through access to contracted rates for out-of-network benefits (NAP), application of reasonable charge criteria on out-of-network facility claims (FCR), and high-dollar in-network facility claims reviews (IBR).  The National Advantage Program contributes to the stabilizing of overall medical cost trend.

Last year we announced changes to some of our ID cards and claims processes for members whose plans include Rental Networks and the National Advantage™ Program (NAP).

Effective January 1, 2009, we began adding logos of NAP vendors to member ID cards for plans using NAP in all states. This helps us to accommodate state legislation requiring network logos, and to more easily price claims based upon real-time provider data. 

Here is some additional information:

Update

  • ID cards with a Rental Network logo, Alternate Network logo or Rural PPO Network logo will not display an NAP Vendor Logo.
  • ID cards for members in insured plans in Illinois will not display an NAP Vendor Logo or the "NAP" program name due to state regulations.
  • Montana will not display an NAP Vendor Logo because the rental network vendor covers the majority of the state.

ID card reissues

  • New cards issued for January 1, 2009 renewals and new business with NAP are first to have NAP vendor logos. Plan sponsors will bear the cost of these new cards, as usual.
  • Following the January 1, 2009 card issues, we are reissuing cards to remaining members of plans that renew January 1, 2009 who did not receive a new card for another reason. Aetna is bearing the cost of ID cards reissued only to add the NAP vendor logos. The reissues will continue over the course of 2009, with reissues coinciding with plan renewal date.

Please note: if a member is in a plan with a network, they may pay more to see an out-of-network doctor or facility (even with an NAP discount) than they would to seek care in-network. Coinsurance and deductible amounts are often higher for out-of-network services.

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Small Group
February 2009
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Aetna This information is provided for brokers only.

This material is for informational purposes only. It contains only a partial, general description of plan or program benefits. Plans and programs may not be available in all service areas.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Those companies include: Aetna Health Inc., Aetna Health of California Inc., Aetna Dental of California, Inc, Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In MD, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156.

Material in Aetna Broker and Consultant e.Briefing does not constitute a contract or legal advice and is subject to change.

©2009 Aetna Inc.

 

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