Due to mounting financial losses and an uncertain marketplace outlook, Aetna has made the decision to leave the Individual market in New Jersey.
Regrettably, this decision also impacts our New Jersey small employer ACA insured medical products. New Jersey law requires a carrier to withdraw from the insured small employer market if it is withdrawing from the individual market. As such, Aetna will withdraw all of its commercial (fully insured) medical plans offered in the small employer health insurance market.
What this means
Health insurance coverage for each of your New Jersey small employer clients will end at midnight on the day before its renewal date, beginning with January 1, 2018 renewals.
- Notices will be sent to you as well as to your impacted clients and their members 180 days prior to their non-renewal.
- We are required to cease selling new business with effective dates after 6/30/17.
- Renewals will continue to be produced and serviced as usual through 12/15/17 renewal dates.
- Your clients’ current coverage will continue until their policy ends on or after January 1, 2018. This decision does not impact our other small group products such as stand-alone dental, stand-alone vision, and group life products, as well as commercial large group (51+) medical plans and Medicare Advantage Plans.
- Offer our Aetna Funding Advantage (AFA) self-insured medical product to small employers (5-50 eligible employees)
- Offer stand-alone ancillary lines of coverage including dental, life insurance, disability, and vision products
On February 22, 2017, New York State published parts of the new Paid Family Leave (PFL) regulations in draft form. They now enter a 45-day public commenting period, and changes could still be made before final versions are released. While we do know that Paid Family Leave will be community rated, the exact rating mechanism along with the actual rates themselves are yet to be determined. Stay Tuned!!
CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline. We will keep you posted on the progress.