We are more than happy to help. So, now that I have that out of the way, I am excited to have Susan Martinez here from Aetna to go over some a FA updates. I hope you find this valuable. FA has been extremely competitive this year, so start quoting.

Thanks for coming I'm gonna hand this over to Susan to introduce herself. Good morning everybody. Thank you Elise. my name is Susan Martinez and I am the new business rep for a FA for groups with two to 100 eligible. So I put together some slides. Some of it is a refresher from when we had, seminars or webinars in the fall, and some of it is new information.

It's always good. To have a refresher on the agenda today, updates on our level funded product, a FA, and also some reminders about a FA, a couple changes to underwriting, all positive.

I'm gonna touch on our member programs that we offer for all of our new a FA groups as well as, what we offer for brokers.

So just a reminder on the network for FA, in Pennsylvania, we. Right now have the choice point of service to network. So it is a national network. It's the largest network that Aetna offers. and that's been true in all the years, I've been here. It's always been the network used for self-funded products.

It's open access. You don't need a referral. You don't need PCP selection. And you know, really when you're looking at a map especially, you know. In our area, Pennsylvania and the surrounding states, you really, will be happy with the network. It's, there's not any or many holes, and there's tons of providers to choose from.

This, portfolio came out in September 2024. if you quoted anything, starting with nine one effective dates last year and, you know, moving through current, these are the plans that you would have seen. we usually do a refresh. about once a year in the fall.

I would anticipate, they'll tweak it a little bit. Probably, nine, one of 2025, as of nine one of last year. there are a lot of different FA plans, if you're looking at. An a FA proposal, you'll see, I think we have like 60, 70 different plan options.

So it, it is a national portfolio, so we try to meet everybody by offering different options. Depending on the area and competitors are offering. So, right now in the portfolio, you're gonna see deductibles ranging anywhere from no deductible all the way up to, 9,100.

All plans include prescription drug coverage, and different value added benefits, which I won't go over on this slide 'cause I'm gonna talk a little bit towards the end of the, the, presentation about all of our, value add that we have for members.

We also have premier plans. So Premier and the regular point of service plans, they're all on the point of service to network. With the Premier plans, the benefits are a little bit richer. So if I'm gonna attach the plan grid in the follow up email,

But when you're looking at the copays, the copays stay the same. So if you're looking at the 500 plan or. You know, a plan that is a couple thousand dollars. The deductibles are 2040 primary care and specialists. it's a richer benefit. and includes all of the same value adds or wellness programs that we offer in the standard plans.

We added three new plans, in September last year. one. It has a $3,000 deductible and you'll see zero LXR in the plan name. That means no copays for lab or x-ray we also added two HSA plans. one is 4,000 with no co-insurance after deductible, and then one is 4,500 with a 20% co-insurance after deductible.

Of the HSAs we added are embedded deductibles, meaning not one person can hit the whole family deductible You would need a combination of a couple people in that family. so again, just a couple new offerings. We offer and anytime, you know, there's a maybe a hole in our proposal that, you know, you don't see a plan option, a group might like share with me, share with the leads.

I always pass everything up to upper management. 'cause when they are coming out with the new plans. They are looking for, feedback groups of five or more can offer any five plans. a combination of the premier plans or general point of service plans.

Any combination you like. Sometimes groups do a base or a buyout. If you have a group that has two to four employees, you can offer. any two plan. So keep that in mind when you're looking at the proposal. You're not limited to just one plan.

A couple of the highlights with the new portfolio, we are expanding some of our coverages and networks, so, With the nine one plans, artificial insemination is now included under basic infertility It doesn't include IVF or other, fertility, procedures

It's just artificial insemination, new as of nine one last year. we are also allowing members to purchase contraceptives up to 12 months at a time. So if they're doing mail order, they're going into a pharmacy, they can fill their whole year of contraceptives. Instead of every month right now, if you're on maintenance medication and a copay plan getting. a three month supply, you're paying two months of a copay and you're doing that either on CVS pharmacy or Caremark. We expanded that network a little bit and you can now do maintenance choice medications at Costco, or Kroger I think Costco, you might see that, I'm not sure where a lot of Krogers are, but we're expanding that network a bit as well. And we have a couple new, Member tool. So we have an Aetna Health Your Way Engage lets members earn up to a hundred dollars per year in gift cards.

They go to the member site and they would complete different wellness activities and they can earn points to earn gift cards. And we also have Smart Compare. allowing members to find a provider, in a certain area or specialty looking at different cost and network.

It helps members choose the right provider we sunset. Sunsetted peer fit. There wasn't a lot of, membership or people using this, so we just kind of thought, you know, we'll put money into something else and we will discontinue peer fit. And again, all these were new with the nine one portfolio.

So new groups that started nine one or later, or if you had existing groups as they come up for renewal, you'll see the new plan designs and the new, member programs.

this I think is important and, and I, I'm gonna attach a copy of the, list of the preventive medications, but we have a list of, drugs that are on, Preventive care list, there's about 200 different, drugs. And this would be for members on an HSA, integrated RX or value plans.

So instead of. Everything going immediately to the deductible like you would see, you know, normally with an HSA plan, the medications on this list are going to be a cost share. So instead of going towards a deductible, they would be a copay, for these members. So it's things for, like diabetes or hypertension.

I think this is nice. for groups enrolling in a high deductible plan where part of their, out of pocket spend would be towards the deductible. This way, if they're choosing a medication from this list, it would just be a copay. I'll attach that. it's really nice for new groups on the high deductible plans.

The maintenance choice, you can go to a retail pharmacy, CVS, Costco, Kroger, or Caremark, and get, A three month supply for two copays. Michael, I see your question in the chat. I'm gonna attach that to the follow up email and I'll send it to Elise she will send out the preventive care formulary after the call,

A couple underwriting updates. the past few years, underwriting has really been able to work with sales and they've made a lot of positive changes. just a reminder, if you are quoting a group currently fully insured, so they're coming off an a CA plan, we would need a medical questionnaire.

If they have two to 14 employees enrolled, if they have 15 to a hundred employees enrolled, we are gonna look at that member level census. if you are quoting a group. currently level funded. on a SO level funded plan with another carrier. We only need medical questionnaires if they have two to four employees enrolling five plus.

We're gonna look at the claims, the renewal, the current rates, and use that member level census and pull prescription information for the group. A reminder on the participation. So groups that have two to 50, employees eligible are going to need 30% participation with a minimum of two enrolled.

We always round up on that. So if they're on the fence, you know, underwriting is gonna round up a little bit on that.

a couple more under any update. So if a group doesn't have current coverage we would require an IMQ regardless of size. Now these groups, maybe it's a startup group, they don't have any kind of coverage, are going to follow the fully insured a CA guidelines. So. In the state of, if you have a group in the state of Pennsylvania, they have no coverage.

We do not need an IMQ if they have 15 plus employees enrolling. We would only need one if they have two to 14 employees enrolling. the other positive change from underwriting is they have lowered the participation on groups that have 51 to 100 eligible down to 20%. So that just happened. It's in effect now. That's really good news. those are the underwriting updates.

I wanna touch on the member programs. this is, a copy of the front of the flyer that I'm going to attach to the email. This flyer has all the member programs that we offer listed inside. It also has a QR code on the front, so if you or the member scan the QR code. It will take them to the member website so they can log in if they're already members or they can register I'll go through everything in the member programs, but this flyer is a really nice, handy dandy resource to hand out. So like if you have a new group and you're doing enrollment meeting or you know you have an existing group and you know, maybe they want. To know or they want a reminder on member programs.

This is a nice, flyer to send out.

Since we're part of cvs, we have, Minute clinic offering. So in all of our plans, if a member is on a copay plan, they can go to a minute clinic and it is at no cost to them. If they are on an HSA plan, it's a lower cost, you know, till they get out of that deductible or co-insurance

But, it's a nice place if there's one near you If a child has a cold, you can't get in with a regular doctor, it's nice to use the Minute Clinic. they save time and costs you can go onto the CVS website, look up clinics and schedule your appointment it'll tell you if there's a wait time, how many providers the Minute Clinic is a benefit with FFA plans. go to the CVS website, put in the zip code, it will let you know where all the minute clinics are.

And we also have health hubs too. in certain areas. It's like a MinuteClinic, but it has expanded services, so you may see. Minute Clinic or health hubs. but same thing, health Hub or MinuteClinic. If the member is on a copay plan, there are no copays for visiting a Health Hub or MinuteClinic. If they are on an HSA plan, they would have to hit that deductible first.

We offer virtual care. So we have, Teladoc that members can use. we, in addition to Teladoc, we have CVS virtual care. So, you know, if they were, not able to get an appointment with Teladoc or their primary care, and they still would like to see somebody virtually, they could go again through CVS and schedule a virtual, That way. We also have virtual primary care, with CVS. And that is not to take the place of a member's primary care doctor, but if you had multiple virtual visits and you wanna see the same provider.

She'll be right back. she had a bit of, technical difficulty, There you are. did you lose me? Yeah. you might wanna go back to the last slide. I think you said something about virtual care. And then you froze. Sorry about that. It's all good.

so for virtual care. We have Teladoc, and CVS virtual care. this is just a little flyer on that. It's also included in the member flyer that I'm going to send out. But, you can, you know, of course your own provider, this isn't taking the place of that. It's just giving you the option to use a CVS Health virtual provider.

if you had multiple appointments, you can schedule it with that same provider. they call it CVS. Virtual primary care, not taking the place of the member's regular care team, but it does allow you to have the same provider, on numerous occasions if you're doing it virtually. So I will make sure this is included in the follow up this is probably our most popular member program It's called Over the Counter Health Solutions, and it allows every member to have, a. $25 to spend at a CVS store every quarter on CVS branded health products.

Think CVS branded Tylenol or Band-Aid, if you are on as a family, each member in your family would be entitled to that $25 per quarter you can. Go to a CVS store. If you go in person, there are little blue tags on the shelves that denote which products would count towards this program.

You could go online and you can also call. This started I think, with Medicare. So there is still an online catalog in a number to call if members like that. One thing I say is keep in mind it is. $25 per member. if you're a family, they are separate transactions. So, if mom gets $25 worth of CVS Health branded items, the next person in the family would go and it's a separate transaction.

if you were to go and your bill is $27, the first 25 would be included. You'd have to pay. The extra $2. and it's, it's separate transactions for everybody in the family, but I think it's a nice benefit. I would say take advantage of it. If you don't use it, you lose it. It does not roll over to the next quarter.

So I would encourage members to go to the store, go online, call and make sure they use this benefit. and if they're going into the store, they just go to the register, they, the cashier, their card, their information, they can look them up and they'll apply it automatically this is a way to engage members in wellness activities. send them the, flyer, they go into the member site with the QR code or through aetna.com. once in, they can complete wellness activities and earn.

Points to purchase gift cards, and it would be maximum a hundred dollars a year for the members. So a couple nice wellness programs that we offer. We, continue to offer the employee assistance program. So this is included in all of the a FA plans. It's eligible to, you know, anyone who is enrolled in the a FFA plan children up to 26, even if they don't live at home.

If you have a college student who's away at school and also, Household members. So even if they're not related to the employee, maybe you have, a grandparent living in the house. They can use the EAP program all information on this, again, will be in the flyer that I'm going to send out.

The credits. we started offering these last year in September. This is going to continue through eight one effective dates. I imagine we will probably offer something, you know, after eight one, so into the fall. I just don't know. Sometimes they like to change the programs up when we. Roll out the new product for portfolio, but basically, the credits are for new two to 100 a FA groups.

non existing groups, new groups you're bringing onto a FA. It's a one-time credit per Enrolling employee automatically applied to the second invoice. So there's nothing that you have to do as the broker or, the GEA. It's $400 per enrolling employee.

If the group is coming from a level funded carrier and in a surplus position, they would get an extra $200. So that would be $600 for those groups. and when underwriting is looking at your group and issuing a quote, they're checking the claims and they're making a note in the system. so again, all automatically applied.

if you offer dental with medical, they get an extra $150 per enrolling employee on their second invoice. I think a lot of times, groups forget that they got this credit and you know, health brokers come back to me and they'll say, you know, what's this admin credit on this group?

So it's good news and, you know, say that's correct and, It's, it's a nice little benefit. Again, you don't have to do anything. It automatically will process through the system and put it right on their second month. These are renewal stats from last year, I only do new business.

on average the renewals for a FA have been pretty steady. and about like 39% of groups are eligible for a surplus. So the renewals, On this slide, it's saying about 80% are renewing with a FA, I think it's actually higher in Pennsylvania, but this slide is done. I think they look at the national stats and put this out.

So again, the renewals have been steady for a FA for a FA, you get a funding advantage report. It's a spreadsheet. It comes once a month. It lists all of, the money that we've taken in, in premium and what we've taken out in claims.

the account managers, can go through these with you if you have a question on a specific group. if you're looking at the report all the way to the right, it'll let you know. that last column, is where they have, like surplus or deficit.

So it just kind of get. Give an idea of how the group is tracking the, Aetna Health Information report is an on-demand report and it's really for groups that are a little bit larger, I think. Five or more employees can get the report, but 20 or more employees can get the full report. those two reports are out there.

One thing I wanted to mention is, and I, I have included in the follow-up email a list of different dates, but I don't have a slide on this. Starting with five, one effective dates. for new business, not renewals, we are moving away. From Springboard and putting groups on e-business.

If you're interested e-business has more capabilities than Springboard. like multiple benefit waiting periods and, you know, if they had to class out the employees. So there's a few additional things that eBusiness can do. So I think, you know, internally.

Management was listening to feedback from brokers, and they were looking for more capabilities than Springboard could offer. So we'll slowly start moving into that for your new business groups. and I'm not sure the timeline on the renewals, but the, your account manager would be able to tell you. I, I know it's not starting May 1st, I imagine it'll follow in the next few months.

These are just some. Services that we offer to you as broker and to your clients. We do the 10 95 B form. So this is for groups with two to 50 employees. So we'll take care of that. We'll do the form filing and the distribution, which is on the member. website we have the HIPAA toolkit.

When you sell a new group the sales implementation manager sends an email with the, member IDs, they will include a couple attachments that you can use. It's a template for different, HIPAA information that they might wanna send out. We also are supporting groups through the RXDC reporting, so emails.

Go out to the groups, to fill out the information the account managers would work with you on that there's a how to guide on pcori. if groups, have questions on PCORI or you're looking to pull, information for them, the account managers would help you with that lastly, The only way to pay for a FA is through a CH withdrawal, It's auto draft from the groups. always pulled on the second business day of the month, we do a snapshot around the 23rd, 25th of the month. Then we would put the invoice out for the group, and then the second business day of the month, we would pull those funds.

Reminder on broker commissions, these are default for a FA You can put, up to $99 when filling out the member level census if you want anything other than the default list it and the underwriter will apply it.

If you don't list anything The group is headquartered in central Northeast or Western Pennsylvania. It's a $30 PEPM in the Southeast Lehigh Valley. The state of Delaware. It's $41 PEPM. Again, that's just the default. You can select any amount that you would like to see in that quote up to 99.

This is the broker service team, so I am your sales executive. the sales implementation manager would take over, so once the group is sold, the underwriter approves it. The sales implementation manager is there to help. If there's any changes, like if you know somebody wanted to enroll, they were missed on the spreadsheet,

They can help with name changes, all those little kind of things that come up in the first. 45 days post-sale they also send out the ID numbers. After that, it would move to your account executive, so your renewal person will take over from there and help you with anything from the 45 days through when the group's renewal is issued.

And then finally there is the Aetna Answer team. So they are really great. they're a one-stop shop. If you had questions on claims billing, enrollment. I would encourage you, pick up the phone, give them a call. They can pull ID numbers, ID cards, all those different great things. they're a really good resource.

So that's it. That was my last slide. We're right up on 30 minutes. I really appreciate everybody's time. I'm gonna be sending out a follow up email to Elise and she'll get it out don't sit on quoting at a FA. the rates are really good. The renewals are really good. I know sometimes, the IQs throw people off, but it really is underwritten fairly They tend to keep them once they're on board.

Give myself or my team a shout and we will help you through that. thank you again, Susan, for doing this. I appreciate your time. I appreciate everybody's time and I hope everybody has a great rest of the day. Thanks everyone.