Enrollments and renewals

What documentation is necessary for enrolling a group? 
Documentation requirements for enrolling groups of 2-50 lives (1 life, where required by state law) are regulated by state specific Small Group Reform regulations. Information regarding enrollment activities can be obtained by contacting a local Aetna sales office.

To enable a smooth transition into our Middle Market and National Account plans the following implementation activities are recommended: 

• Both parties have a mutual understanding of the plan design and effective date requested. 
• Both parties meet to agree upon implementation responsibilities and schedules. 
• Develop contact list for both parties.
• Discuss services in progress and the transition of claim history, if applicable. 
• Determine dates, times and locations of any employee enrollment meetings.
• Copies of current plan booklet certificates provided to us.
• Determine how eligibility will be provided. If provided electronically, meet to establish layout of tape and possible programming issues.
• Determine appropriate enrollment materials to be provided to the employees. Develop special employee letters as needed. 
• Test eligibility tape submitted by client if applicable.
• Client schedules enrollment meetings and communicates the transition to all personnel.
• Enrollment materials delivered to all client locations. Enrollment meetings are conducted by our enrollment team.
• Eligibility is provided to us at least two to three weeks before the effective date. 
• Eligibility is fed into eligibility system and member ID cards are produced. ID cards are mailed to the plan members' homes within 10 to 12 business days.
• Client contracts and employee booklet-certificates of coverage are mailed to the client for distribution to employees. 
• Our customer service personnel meet with client to discuss billing and ongoing maintenance of the dental plan.

The process described above should take place at least two months prior to the effective date. If the client provides eligibility information electronically, three months' advance preparation is preferable.

Does the renewal paperwork require signatures from the broker and/or the group, if there are no changes other than the renewal rates? 
A signature may be required upon renewal even if there are no changes other than the renewal rates. This provides confirmation from the employer that they are in agreement with the plan designs and corresponding rates, which become effective on their plan anniversary.

Premium rates and quotes

What are the enrollment deadlines for a new group? 
The enrollment deadline for a new small group (2-50 lives (1 life, where required by state law)) varies by state. Deadlines for your state can be obtained by contacting the local Aetna sales office for your state.

The time it takes to install a plan varies depending on the number of employees, plan design, customer's system capabilities, and development. Because each customer has individual needs, we are unable to exactly estimate the amount of full-time equivalent hours and lead time for the tasks.

Ideally, we need 60 to 90 days to complete installation. This gives us time to process enrollment, generate and mail ID cards, set up plans in our systems, test systems, etc.

Can a group upgrade medical and/or dental at a time other than renewal if the group has grown?

The standard time for plan revisions is the renewal date or within 31 days after the renewal date. Midyear plan revisions may be considered, but require Financial Underwriting approval for the exception.

Can a group downgrade to a less expensive product at a time other than its normal renewal date?
The standard time for plan revisions is the renewal date or within 31 days after the renewal date. Midyear plan revisions may be considered, but require Financial Underwriting approval for the exception.

How do I submit enrollment files to the plan? 
Enrollment applications are utilized in the Small Group Segment (2-50 lives (1 life, where required by state law)) They can be submitted via paper or fax to the appropriate Plan Sponsor Services unit responsible for underwriting. A hard copy of the enrollment material must follow any faxed documents.

Enrollment files for plans over 50 lives can be submitted via paper, tape or electronic media using one of our secure electronic file transfer processes. Submission of eligibility information by more than one location or via multiple methods will result in additional charges. Costs associated with any custom programming necessary to accept eligibility information are excluded from the initial rates and are billed separately.

The customer's file must be IBM-compatible and must contain certain data in a specified format, including employee name, date of birth, Social Security number and covered dependent information.

Middle Market and National Account customers can access EZLink™--our Internet-based benefits and human resources (HR) administration solution. Customers can perform online eligibility, enrollment and account maintenance, as well as online billing and electronic funds transfer (EFT) for payment. EZLink also provides standard HR reports and other HR administration capabilities.

Is payment required at the time of application? 
Binder checks are requested at our discretion as a condition of sale for specific groups with more than 50 eligible employees. Groups with 50 employees, or less, require a binder check.

Can a small group get lower rates if they do not use a broker? 
Rating considerations for broker commissions vary by product and by site.

What percentage of premium does the employer have to contribute? 
We require the employer to contribute at least 50 percent of the total cost of the plan, or 75 percent of the cost of employee-only coverage. State and federal legislation/regulations, including Small Group Reform and HIPAA, take precedence over any and all underwriting rules. These guidelines may vary by state and group size.