Communicating Benefit Plan Changes

[insurehound]

I had a very interesting meeting today with my Aetna Small Group Rep. He gave me a great "oh, by the way". Apparently he has had some issues and feedback from various brokers that Aetna does not notify their members when there are benefit changes at renewal. The member must go to the website to learn about them.

As a good broker, I always try to communicate any plan changes at renewal but I would think that since Aetna and the member have a contract, Aetna has the obligation to inform them of any changes to that contract.

Have you heard of this?

 

[ABC]

Good topic.
I have this issue bite me a few times. The last batch was on ER Co pays being changed from $150 to $250.

My carriers are all over the board.

UHC does not change the plan designs. That is why they have over 300 strings of coverage.

Anthem informs the group at renewal with only the renewal policy and the certificate of coverage. The COC has more than 100 pages in it.

I think you would have to dissect the master contract to see the legal definition of what the carriers responsibility is. This is why we now have to deal with SBC 90 days in advance to plan changes.

 

[insurehound]

Oh, I'm sure they have found a way to get by any legal issue but it's still wrong. I'm going to have to make sure I spend extra time reviewing the changes to benefits. It's too bad Aetna can't help me out on it. It would better to hear the changes from the company your paying and from the agent. I like how they pushed that onto the agent's image

 

[Bruce]

I don't think there is a specific contractural relationship between the carrier and a group's members. The contract is between the insurer and the group and any rights the members have are via the group. Using another example, say the group stops paying premium and the carrier cancels the group... does the carrier need to notify each group member? No.

That said, almost every carrier, almost every year, makes changes to contract language (even if the schedule of benefits does not change). You'd think they could provide their brokers with a summary of the 'before' and 'after' language. But they don't as a rule.

When I was a group rep/group sales manager, I made sure to do this for brokers and clients. So, now I do it for groups and their members. It's actually a lot of work.

 

[insurehound]

I hear you Bruce and good point on the contractual relationship. But it still (IMO) that it is not right to change the terms and not notify someone. If the relationship is with the Group, then a "before and after" matrix should go out to the Group. I still think they have an obligation to at least send out something to the member.

 

[leevena]

As a rule of thumb, non-hmo contracts are usually between the employer and the carrier. HMO contracts are usually have a relationship between the HMO and the member, and an agreement to collect and remit between the HMO and the employer.

Notification of changes is usually regulated at the state level, including timing, deliver, and sometimes wording.

Insurehound, if you find a situation where changes were made, without notification when there should have been notification, you should bring this to the attention of the appropriate department within the state involved. However, I would caution you to make sure that this is in fact true. California is a very heavily regulated state for carrier to work in.

 

[insurehound]

Thanks leevena...will do. I am confirming this now before I do anything rash.

 

[insurehound]

answer from Aetna on this issue:

The broker or plan sponsor can call and order a set of plan designs to be mailed to them. However, Aetna does not actively send out notifications of changes nor plan designs.

 

[somarco]

http://www.aetna.com/externalweb/documents/sbc_sg_brochure.pdf

http://www.aetna.com/externalweb/documents/SBCBrochure.pdf