Many retirees and active government employees enrolled with Aetna International sought clarification yesterday on the changes in their new insurance policy, which includes an “applicable deductible” item that was never offered before.
Aetna International account manager Scott M. Muschel, in a special meeting with plan members yesterday, disclosed that prior to receiving the promised 80 percent coverage under the new plan, a member has to first meet the required threshold set by the carrier, also known as the applicable deductible.
For a single member of the policy, the applicable deductible is $300 for the whole year. Every two weeks, a single employee and his/her employer remit equal shares of $82.45 each for the new policy.
A $600 threshold is required for couples, the premium rate of which is set at $169.02 each biweekly from employee and employer. For couples with domestic partners, the threshold is $600 for the year and premium is $255.58 biweekly for both.
For members categorized as family, the premium rate is $263.83 each for employee and employer and assigned a deductible of $900 for the year. For members classified as family including domestic partner, premium rate biweekly is $346.28 for a similar $900 annual threshold.
Muschel explained to members yesterday that a single member with required deductible of $300 for the year has to first pay their full medical billing out of their own pockets until they meet the threshold (deductible) amount. The official said that all transactions with providers will be reported to Aetna, which will monitor all medical recordings of members. Once the $300 threshold is reached by a member, that's the only time he/she can receive 80 percent of the policy coverage. Deductible will apply to all covered expenses except prevention care and prescription drugs.
“You have to pay the deductible [threshold] before you can avail of the 80-20 percent plan coverage.and deductible starts over a year,” Muschel said during the hourlong meeting at the Multi-Purpose Center.
According to Muschel, the “new price structure” was set in an aim to attract more membership to the plan. He said the new insurance policy for 2013 has a full comprehensive medical plan for members and they can avail of services here and off-island. However, he warned that experimental procedures and cosmetic surgeries, among others, excluded in the policy.
Aetna has been the insurance carrier for NMI retirees and many active government employees since 2006. Muschel said their membership on the islands has been slightly decreasing since 2008, mostly due to members who opted to discontinue coverage due to concerns over the premiums.
When asked what convinced the company to offer a lower premium rate this year for the CNMI, he cited the financial challenges of the CNMI pension program and offering a lower rate could help the government extend the life of the program.
Despite the new policy, he projects a flat membership trend.
Muschel said that Aetna serves about 5,000 members, both retirees and active government employees.
He believes that the new premium rate is much more aligned with local carriers but with much more coverage.
Aetna's new policy for NMI members took effect Jan. 1 and open enrollment begun on Jan. 14 through Feb. 15. The new policy is 18 percent lower than the fiscal year 2012 plan.