Federal Diary Live

How do you find an insurance plan that fits your needs in the Federal Employees Health Benefits Program? Trying to figure out the difference between health savings account and health reimbursement arrangements?

Tom Bernatavitz, vice president of federal plans for Aetna, joined The Post's Stephen Barr, who writes the Federal Diary column, to take questions and comments about the 2007 federal employee health insurance program Wednesday, Nov. 29, at noon ET on Federal Diary Live.

Aetna is one of the larger insurance companies in the FEHBP. It offers a traditional health maintenance organization, or HMO, and is expanding the availability of its Aetna HealthFund high-deductible plan with a health savings account and its HealthFund consumer-driven option. For 2007, these plans will be available to 75 percent of all eligible federal enrollees. Premiums also have been reduced for these two plans in 2007.

The transcript follows.

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Stephen Barr: Thanks to all joining in this discussion today, and especially our guest, Tom Bernatavitz of Aetna. Tom, appreciate your willingness to discuss the 2007 federal employee health insurance program. Let's start off with a summary of what options Aetna will be offering next year and what's different from this year. Again, thank you for taking time to share information with Federal Diary readers.

Tom Bernatavitz: We're offering a no-deductible Dental PPO plan nationwide as part of the new FEDVIP. Our plan allows members to see any dentist, anywhere. An important feature is that our coverage level remains the same regardless of whether members see an in- or out-of-network dental provider.

We've lowered the premiums on the Aetna HealthFund Consumer Driven Health Plan (CDHP) and the Aetna HealthFund High Deductible Health Plan with Health Savings Account (HSA). We're also offering these plans in more markets (115 markets, up from 91 in 2006).

Members in these plans get preventive care for medical, dental and vision covered at 100% when they stay in our network.

Members in our CDHP get a medical fund of $1,000 singles and $2,000 for families. New this year: Any dollars you have remaining in the fund at the end of the year can roll over and reduce your member responsibility next year.

We introduced a new lower priced Aetna Open Access HMO Basic Option in seven states. We already offer this plan in the Maryland, D.C., and northern Virginia markets. This plan still allows members to visit any physician in our network without a referral.

Another important new feature is that Aetna is the first and only carrier, at this time, to show federal workers doctor-specific price information, and, in some markets, clinical quality and efficiency data to help evaluate a physician's overall value before a service is performed. This information is available to federal members in 11 markets and we plan to expand it.

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Bowie, Md.: What is the difference between Aetna High and Basic Open Access? Thank you.

Tom Bernatavitz: There actually are many similarities.

In both plans, there are no referrals required to see a network specialist. You have access to the same broad network of health care providers. And both offer out-of-area coverage for your dependents.

There is a slight difference in co-payments ($5 higher in the Basic plan in your area). Hospital co-payments in your area are the same, but in the High option, you stop paying co-pays after three days of hospitalization. Under the Basic option, you stop paying co-pays after five days.

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Chicago, Ill.: I have been in Aetna's CDHP plan for three years now and have hardly used my Medical Fund and have about $2,800 in it. If I switch plans will I lose this Fund?

Tom Bernatavitz: All unused fund dollars will roll over into 2007, and you will receive an additional $1,000 fund for single coverage, or $2,000 if family.

An important point for 2007: Unused fund dollars can now be used to reduce your annual member responsibility (e.g., deductible/coinsurance)

If you decide to leave Aetna's CDHP plan, you will lose the fund dollars you've accumulated.

In 2007, for the first time, Aetna will allow you to roll over unused Dental fund dollars.

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Burtonsville, Md.: I'm currently enrolled in a fee-for-service plan for both medical and dental, and would like to switch to an alternate carrier for my dental needs. First, is it possible to maintain separate coverage for medical and dental; and second, how does Aetna rate in comparison to other plans for major dental procedures, i.e., crowns, periodontal scalings, and root canals?

Tom Bernatavitz: Yes, you can choose separate medical and dental carriers.

While we cannot compare our plan to those of other carriers, here are some basic provisions of our Dental plan:

A no-deductible, comprehensive dental PPO plan that covers in- and out-of-network treatment

Nationwide access to any licensed dentist any where, or members can access our nationwide network of more than 86,000 available dental practice locations

Reasonable plan premiums that can be deducted on a pre-tax basis through payroll deductions (active employees only)

Dental treatment and services, including: Preventive care (i.e., oral exams, cleanings, x-rays) - plan pays 100%;

Basic restorative care (i.e., fillings, simple extractions) - plan pays 60%; Major restorative care (i.e., crowns) - plan pays 40%; Annual plan maximum of $1,200 per member; Orthodontia coverage for children up to age 19 - no deductible; lifetime max of $1,500 (note: There is a 24-month waiting period for orthodontia benefits.)

Premiums for Aetna's plan in your area are in Rating Area No. 2 and will be deducted on a pre-tax basis if you are an active employee.

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Annandale, Va.: Where can I find out about dental plans? Nothing was mailed to me. I am covered as an ex-spouse of a government employee, and I pay the full premium.

Tom Bernatavitz: You can go to www.aetnafeds.com and click on the "Dental" box for information specific to the Aetna dental plan offered under FEDVIP.

To enroll, go to www.benefeds.com.

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Bethesda, Md.: My family and myself are currently enrolled in Aetna's CDHP (which we like very much, although we pay a lot for prescriptions). What would be the additional benefits of enrolling in Aetna's supplementary dental plan, and how much would this cost?

Tom Bernatavitz: I'm happy that the plan is working out well for you and your family.

If you combine your Aetna CDHP medical plan with our new dental plan, you can:

Stretch your dental benefit dollars with the dental benefits included in our medical plans;

Use the same network of dentists;

Access claim information through Aetna Navigator;

Have your medical and dental benefits seamlessly coordinated by Aetna.

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Vienna, Va.: What are the advantages to taking an HDHP plan over a standard PPO plan?

Tom Bernatavitz: A high-deductible plan, when combined with an HSA, provides insurance coverage and a tax-advantaged way to help save for future medical expenses.

The Aetna HealthFund HDHP, with an HSA, gives you greater flexibility and discretion over how you use your health care dollars.

You receive automatic monthly deposits to spend on qualified medical, dental and pharmacy expenses. Annual deposits are $1,500 single, $3,000 for a family.

You can watch your HSA grow with eight different interest-bearing options.

You'll get 100% coverage for in-network preventive medical, dental and vision care.

When you need medical care, you're responsible for a deductible before plan coverage begins. You can use your HSA funds to pay the deductible.

The ultimate advantage of this plan, versus a traditional PPO, is that your HSA dollars are yours forever, whether you switch health plans or employers.

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San Antonio, Tex: Do I need be be enrolled in an Aetna Medical plan to enroll in Aetna's new dental plan?

Tom Bernatavitz: No. You can take the plan separately if you choose.

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Philadelphia, Pa.: I want a plan for family that has dental and vision included, do you have that? And also, I am in Philadelphia, but my son is at college in San Diego, so can I cover him too?

Tom Bernatavitz: All of Aetna's medical plans have dental and vision benefits included, at no extra cost.

And all of our plans cover out-of-area dependents. Selecting our Open Access Plan in Philadelphia, for example, would give your son access to network providers in the San Diego area.

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Confused Fed: With so many benefits offered to Federal employees, what am I to do in making the decision on: FEHB, Flexible Spending Accounts, Dental, Vision. All at the same time, one open season and a bunch of information to go through. Is there an easy way to figure it all out?

Tom Bernatavitz: Often, people are overwhelmed by the sheer volume of choices.

Ask yourself these questions to find a health benefits package to fit your medical and financial needs:

Are there restrictions on which health care providers I can see? Is my health care provider in the network? Do I have to stay in network, or can I see a doctor outside the network? If so, does it cost more to do that?

How many health care providers are in the health plan's network?

Are the prescription medicines I use covered? You may also want to see if the plan offers a mail-order prescription drug program, which often can save you time and money.

Does the plan offer or include alternative medical therapies? Acupuncture, chiropractic treatments and other nontraditional medical services may be included.

What additional health programs are offered? Some offer wellness incentives, discounts on gym memberships, discounts on vitamins, preventive dental coverage, and weight management and disease management programs.

Finally, if you are looking for lower premiums or a way to hold on to health care dollars you don't spend this year, take a look at some of the high-deductible health plans. Premiums for these plans are often lower than other health plans, and you can fund a Health Savings Account (HSA) for out-of-pocket expenses. Plus, your unused HSA funds roll over at the end of the year. Also, if you leave your federal government job, any money remaining in your HSA is yours to take with you. Before selecting one of these plans, however, you should check the total benefits and costs against your own experience and anticipated health needs.

For more assistance, go to http://custom.aetna.com/fehbp/index.shtml and we can answer your question individually.

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Dental What?: I've read thru the so-called dental benefit, and don't see much of anything there. Am I reading correctly that it will cover only $1,200 annually?? What are the premiums for then?

Tom Bernatavitz: Federal workers need to review the options carefully to determine what will work best for them. Important features to note are that many medical plans, including Aetna's, cover preventive dental care. So, you can stretch your dental benefit dollars with our Dental PPO plan to cover other treatments. Another important note is that while federal workers pay the full premiums for the new dental plans under FEDVIP, those premiums are deducted before your income taxes.

The plan covers $1,200 PER PERSON annually.

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Washington, D.C.: Thanks for taking questions today. Will Aetna be participating in the FSA Feds automatic claim submission process in 2007? That would certainly make it less of a hassle if all the co-pays were automatically submitted to the FSA program.

Tom Bernatavitz: We are working on automatic claim submission to FSA Feds, and expect to have it available for Feds in 2008.

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Bethesda, Md.: Thanks for your response regarding CDHP and the Aetna dental plan.

As someone who's been a CDHP subscriber for a few years, would I be "grandfathered"-in for orthodontic coverage if I join the dental plan? What would be the waiting period for orthodontia, what percentage is the coverage, and is there a benefit to going "in-network" for orthodontia?

Tom Bernatavitz: Unfortunately, you cannot be grandfathered for orthodontia coverage under our new FEDVIP dental plan.

You will, however, have access to Aetna's discounted rates with participating orthodontists while you remain in the CDHP without buying additional dental coverage.

You can use your dental fund dollars to help offset your costs.

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Silver Spring, Md.: I'm a federal employee with a family of four, with two kids under 4 years. We live in Maryland. Our health care needs are pretty normal, a couple of regular checkups for each family member, shots for the kids, and some prescription drugs each month. I don't anticipate any major expenses this coming year. Which of Aetna's plans would you recommend for me?

Tom Bernatavitz: You might want to look at the Aetna HealthFund CDHP or the Aetna HealthFund HSA.

Both are offered at some of the most affordable premiums in the federal program and provide 100% coverage for in-network preventive care.

Both have funds that can be rolled over into subsequent years, giving you something back for the premiums you've spent.

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Greenbelt, Md.: I'm confused. I thought that for feds, the money in your HSA expired at the end of the year? Or is that an FSA?

Tom Bernatavitz: HSA funds are yours forever, and are held in a trust account.

Funds in an FSA expire at the end of a plan year, commonly known as a "use it or lose it" provision.

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Washington, D.C.: In theory, would it possible to bank enough money in a HSA that an enrollee at some point could escape premiums or out-of-pocket payments? Thanks for your informative answers today, by the way.

Tom Bernatavitz: That is one of the theories behind HSAs. You can build a nest egg to cover future health care expenses.

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Silver Spring, Md.: I've been having trouble understanding how the new dental plans will work with the dental benefits the HMO FEHB plans are currently offering. My question is...if I currently have an HMO that offers a fee schedule for the dental plan, how will the Aetna dental plan coordinate the benefits with that? For example, let's say my health plan dental benefits has a fee schedule that says I pay $52 for a filling and I have the Aetna FEDVIP dental plan and that shows they will pay 60%. What are they paying 60% of, the fee schedule amount or the usual and customary amount? And how does that work if I only pay a set $52, not a percentage of the UC fees? I'm so confused and it's really causing me to not want to choose any of the plans until after they've been in existence for a while, I'm also finding that a lot of my employees feel the same way and are leery about joining a FEDVIP plan.

Tom Bernatavitz: Here's an example you might find helpful.

If your current health plan dental benefits plan has a fee schedule that says you pay $52 for a filling, and the cost of the filling was $100, under Aetna's dental plan, we would pay the $52 that you are responsible for, since our benefit pays $60 ($100 x 60 percent).

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Arlington, Va.: Tom, you seem to be promoting the Aetna HDHP. I'd like to hear more about why this is superior coverage, compared to your traditional HMO. What pitfalls should feds worry about in HDHPs? Thanks.

Tom Bernatavitz: I'm not trying to promote one plan over another. I recognize that health insurance isn't a "one-size-fits-all" solution. Federal workers need to review all their options carefully to determine what will work best for them.

For example, our HMO plans have fixed copayments and out-of-pocket expenses are more predictable while our Aetna HealthFund options provide consumers more control and flexibility over how their health care dollars are spent.

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Silver Spring, Md.: I am will be moving around the country on different assignments for the next few years. I have been looking at the national plans and Aetna is not among them. Can I choose an Aetna? I thought you were a national company?

Tom Bernatavitz: All of our plans provide coverage throughout the country.

Our national network provides access to 4,248 hospitals, 424,563 doctors and 86,000 dental locations.

The Aetna HealthFund consumer-directed plans provide coverage everywhere, regardless of whether you obtain care in or out of network.

If you select an Aetna HMO or Open Access plan, and we have a network available in the area to which you're traveling, you can go directly to participating providers.

If we do not have an Aetna HMO or Open Access network in the area, you'll be covered for emergencies and urgent care.

You can use Aetna's DocFind on-line directory to search for participating providers anywhere in the country. Access DocFind through www.aetnafeds.com or call 1-800-537-9384.

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Waldorf, Md.: I currently have Aetna Open Access as my health plan. According to your last example, it is sounding as if I may be better of selecting the Aetna dental plan because it will work in tandem with the medical plan. Is this correct? Aetna may then absorb what I may normally be required to pay? Also, are there any time limitations on how many crowns or partial crowns that an individual can get in a year? Or just the dollar limitation?

Tom Bernatavitz: If you combine your Aetna medical plan with our new dental plan, you can stretch your dental benefit dollars with the dental benefits included in your medical plan.

It should be easier for you to deal with only one insurance company.

There are no waiting periods or time limitations on needed treatment, other than orthodontia.

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Washington, D.C.: I am two years from reaching Medicare age and do not plan to retire....ever!!! Should I plan to take Medicare as primary and my Fed health insurance as secondary? Is Aetna a good fit for Medicare?

Tom Bernatavitz: If you remain an active Fed employee, your FEHBP remains your primary payer.

The decision whether to enroll in Medicare is yours.

We encourage you to apply for Medicare benefits three months before you reach age 65.

Just call the Social Security Administration toll-free number at 1-800-772-1213 to apply.

All Aetna medical plans coordinate benefits with Medicare.

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Stephen Barr: Tom, thanks for fielding questions and comments today. Alas, we've run out of time. For the record, please tell Diary readers how they can contact Aetna? Again, thank you.

Tom Bernatavitz: It was my pleasure. Thanks to everyone for your great questions.

If I didn't get to your question, please feel free to submit it on-line at www.aetnafeds.com.

For more information, go to www.aetnafeds.com or call us toll-free at 1-800-537-9384.

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