The New Jersey Small Employer Health (SEH) Benefits Board's recent interpretation of the participation rule will allow carriers to require 75% of eligible employees be insured with one carrier. Subsequent to the SEH's recent interpretation, Aetna will change their underwriting guidelines effective September 1, 2010. We believe other carriers will most likely adopt similar guidelines. (Click here for the SEH Advisory Bulletin)

For new policies issued beginning September 1, 2010, Aetna will require 75 percent participation. Under this revised requirement, 75 percent of the group must enroll with Aetna. Valid waivers will no longer include employees who are enrolled with other carrier group health coverage sponsored by the same employer. Other group coverage sponsored by the same employer will not count towards satisfying the 75 percent participation requirement.

Example:
A group that has 30 employees renewing on or after September 1, 2010 with 15 employees insured with Aetna and 15 insured with Horizon. In this example only 50% of the employees are participating in the Aetna plan. Under Aetna’s new guidelines, 23 employees (75% participation) would be required to enroll in the Aetna plan. If a group does not meet the participation requirement, Aetna will not issue a Small Group policy. Other carriers will most likely adopt similar guidelines.

In addition to the new underwriting guidelines, a large number of existing Aetna plan designs are being non-renewed, beginning with August 1, 2010 anniversary dates. Employers who wish to retain coverage with Aetna will be required to select a plan from their new 2010 portfolio.

The participation requirement applies only to New Jersey small employers with employees who live or work in Connecticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, Virginia and the District of Columbia. Employees outside of these eight states are not included in the calculation.

Dual and triple option changes
Beginning September 1, 2010, Aetna will:

Allow dual option offerings to groups of 2-50 eligible employees.

Allow triple option offerings to groups for 3-50 eligible employees, as long as at least one plan is a HIGH DEDUCTIBLE HEALTH PLAN.

Only set up multiple plans if at least one employee enrolls in each plan.

Not allow the same medical plan to be offered with different Pharmacy options. To offer dual or triple option, the medical plans must be different.

Not allow calendar year and plan year deductible plans to be offered at the same time to the same group. If multiple HIGH DEDUCTIBLE HEALTH PLANS are offered within a group, they must all be calendar year or plan year plans.

For more information about these changes from Aetna, you may contact your Stratford Representative at 866-217-9053.