Tom Bernatavitz
Aetna Vice President of Federal Plans
Wednesday, November 14, 2007
12:00 PM
Are you trying to sort through the changes for the 2008 Federal Employees Health Benefits Program? To figure out the difference between health savings accounts and health reimbursement arrangements? Do you want more information about online personal health records?
Tom Bernatavitz, Aetna vice president for federal plans, joined Stephen Barr, who writes The Post's
The transcript follows.
Archive:
Aetna is one of the largest consumer-driven health plans in FEHBP, with 26,000 members in its two Aetna HealthFund plans -- the Aetna HealthFund Consumer Drive Health Plan (with a health reimbursement arrangement) and the Aetna HealthFund High-Deductible Health Plan (with a health savings account). Both plans give federal employees and retirees access to Aetna's PPO networks in 38 states plus the District of Columbia. The company also offers Aetna Open Access HMO plans, available in the District, Maryland, Virginia and other states. This year, Aetna began offering standalone dental PPO coverage across the country through the Federal Employee Dental and Vision Insurance Program.
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Stephen Barr: Thanks to all joining this discussion today, especially our guest, Tom Bernatavitz of Aetna. Tom, to start this discussion off, please tell us what's new in Aetna for the 2008 FEHBP season, and any tips for federal employees and retirees as they review your health insurance plans. Again, thanks for joining us today!
Tom Bernatavitz: Thanks for the opportunity to be here today, Steve. This is our 47th year of serving federal employees and we have a number of new things to highlight for 2008.
First, as of January 2008, every federal enrollee that selects one of Aetna's medical plans will gain access to a password-protected, online Personal Health Record (PHR) that provides a centralized resource for health information and delivers personalized alerts to improve health care. Right now, all our members in our Aetna HealthFund Consumer-Driven Health Plan and High Deductible Health Plan have access to an Aetna PHR.
We decreased the premiums on our Aetna HealthFund HDHP over 17 percent. We lowered the deductibles on our Aetna HealthFund CDHP and HDHP. Plus, we cover in-network preventive care for medical, dental and vision at 100 percent without anything coming out of the member's funds or health savings account. We're also offering these plans in more markets next year (124 FEHB rating markets, up from 115 in 2007).
We expanded our Aetna Open Access HMO to Delaware, Corpus Christi and El Paso, Texas.
We continue to offer a no-deductible standalone dental PPO plan nationwide that enables members to see any dentist, anywhere.
All our plans offer members a variety of special discounts, including discounts on eye exams, glasses, contact lenses, LASIK surgery, gym memberships and exercise equipment, chiropractic, acupuncture, and massage therapy visits, vitamins and supplements and weight loss programs like Jenny Craig.
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Bethesda, Md.: Why did the HSA deposit decrease under your HDHP plan?
Tom Bernatavitz: OPM issued a policy change on all FEHBP HDHP/HSA plans limiting the premium "pass through" to the HSA to no more than 25 percent of the plan premium and no more than 50 percent of the plan deductible.
Aetna recognizes the value these plans offer federal members and the importance our members place on both quality health care coverage and affordability. So we offset the changes prompted by OPM by enhancing the benefits to both our HDHP/HSA and CDHP/HRA plans, and by reducing the premiums on our HDHP/HSA plan by over 17 percent.
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Washington, D.C.: Re the Health Savings Account for the High Deductible Plan: I appreciate that the deductible is lower, but I anticipate increased out-of-pocket costs if I stay with this plan next year. Am I missing some great advantage of this new set-up?
Tom Bernatavitz: With our lower in network deductible, your out of pocket costs should actually go down next year. Our in network deductibles are $1,500 single. One advantage you'll lose if you leave the plan is your ability to offset out of pocket costs through voluntary, tax-free HSA deposits that you can make at any time through April 2009.
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Norfolk, Va.: I looked into the Aetna Consumer Driven Health Plan last year but I didn't completely understand how it worked. I see that you made some changes this year. Can you explain how it works and what the advantages might be?
Tom Bernatavitz: One thing to look at with our Aetna HealthFund CDHP is not just the amount you pay in premium, but what you get in a fund that's available immediately with your effective date.
For example, singles pay $985 in premium annually, but we give them a $1,250 medical fund and $300 dental fund annually. Families pay $1,761 in premium annually, but we provide them a $2,500 medical fund and $600 dental fund annually. You pay nothing out of pocket until these funds are exhausted. If you don't use these funds, they roll over year to year as long as you stay in the plan.
The plan covers network preventive care for medical, dental and vision at 100 percent and this does not reduce your fund balance. This is a benefit we offer to ensure our members get vital preventive care and checkups.
Other things to look at are that we are paying a higher coinsurance percentage in 2008 (90 percent in network), you have nationwide coverage, and you can choose your providers without any referrals.
Final point is that we have low catastrophic maximums -- the maximum amount a single would pay out of their pocket in a year for network care is $1,750 and families would be $3,500.
So in summary, this plan gives you 100 percent network preventive care, increased fund amounts, low coinsurance (you pay 10 percent in network) and low member responsibility.
For complete information about our plans, visit AetnaFeds.com.
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Washington, D.C.: What is Aetna's coverage when you are treated by out-of-network surgeons in an emergency?
Tom Bernatavitz: In an emergency, all our plans cover you at in-network rates. For specifics on coverage, see each plan's details at AetnaFeds.com.
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Alexandria, Va.: Can you explain how your Open Access HMO plan works? Do I need a referral to see a specialist?
Tom Bernatavitz: No, our Open Access HMO lets you see any network provider without a referral anywhere in the country. You can visit any of our more than 470,000 providers nationwide without a referral.
To give you the highlights, this plan provides medical, dental and vision benefits with no referrals as long as you stay in network. It includes preventive dental and vision coverage at no extra charge. Plus, we give you a $100 eyewear allowance for glasses, contact lenses, etc., every 24 months.
Plus for 2008, there's no copay for any child's preventive care up to age 17. Also, we reduced the urgent care copay to $50 from $100.
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Washington, D.C.: I was in an accident and treated at an in-network hospital by a team of mostly out-of-network doctors. I discovered that my federal health insurance plan did not provide adequate insurance for emergency medical treatment. I was charged more than $30,000 for the emergency medical treatment I sought at a preferred provider hospital. My insurance company asserted that I was responsible for the vast majority of these charges because they exceeded the "non-participating plan allowance" for the treatment I received. I was surprised to learn that my out-of-network coverage (which understood to be 75 percent) applied only to the non-participating plan allowance. Thus, I was contractually responsible for 25 percent of the plan allowance plus any amount the providers charged me above the plan allowance. I learned that in some cases, the plan allowance is a small fraction of what the insurer pays its in network doctors. While federal employees believe they have out-of-network coverage for 75 percent of what would be paid to a participating provider, this is not necessarily the case. I was further shocked to learn that the catastrophic out-of-pocket limits of my plan did not to the gap between the non-participating plan allowance and the charges non-participating providers charge. What is Aetna coverage in these circumstances?
Tom Bernatavitz: In an emergency situation, Aetna would provide plan provisions under all our coverage options as if you were in network. Our catastrophic max (the max amount you'd pay) for all our Washington-based plans are as follows:
Open Access High plan -- $3,000 per individual; $6,000 per family
Open Access Basic plan -- $4,000per individual; $8,000 per family
Aetna HealthFund CDHP -- in-network $1,750per individual; $3,500 per family
Aetna HealthFund HDHP -- in-network $4,000per individual; $8,000 per family
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Annapolis, Md.: My coworker told me that her Aetna medical plan covers visits to the dentist for her family without having a FEDVIP dental plan. Can you tell me more about this?
Tom Bernatavitz: All Aetna medical plans cover preventive dental care. Some of our plans even provide limited dental treatment for fillings and other services.
One plan to consider is our Aetna HealthFund CDHP (plan code 22) which gives you a dental fund up to $600 (family) plus all preventive care covered at 100% in network. This is at no additional premium above what you pay for the medical plan.
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Washington: Which of your plans in the Washington area cover in vitro fertilization?
Tom Bernatavitz: Our Aetna Open Access HMO plans cover infertility services. In vitro fertilization is covered with this plan at 50% up to a max lifetime benefit of $100,000. Please refer to pages 24-25 of our Aetna Open Access plan brochure for all the details.
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Peterborough, N.H.: Will Aetna be participating in paperless reimbursement with FSA Feds in 2008?
Tom Bernatavitz: Yes, we plan to introduce paperless reimbursement during the second quarter of 2008.
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Washington: What are the options for dental coverage?
Tom Bernatavitz: All our medical plans provide preventive dental care at no extra premium.
However, if you're looking for supplemental dental coverage under the Federal Employees Dental and Vision Insurance Program (FEDVIP), Aetna offers a no-deductible, comprehensive dental PPO plan that covers in- and out-of-network treatment at any licensed dentist anywhere. Our plan premiums, which can be payroll-deducted on a pre-tax basis, are very reasonable.
For example, in the District, where we're rating area 2, our bi-weekly rates for single are $13.37. If you want to check rates for another area or family, see the back page of our brochure or go to www.aetnafeds.com and type in your zip code on our rate calculator page.
Here's a snapshot of what our plan covers:
Preventive care (i.e., oral exams, cleanings, x-rays) -- plan pays 100 percent
Basic restorative care (i.e., fillings, simple extractions) -- plan pays 60 percent
Major restorative care (i.e., crowns) -- plan pays 40 percent
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.)
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Accokeek, Md.: Can you characterize the distinctions between your CDHP and HDHP plans as it applies to a particular consumer household? I'm trying to determine which plan is best suited to my needs. ... Thanks!
Tom Bernatavitz: Both feature some of the lowest premiums available in FEHB and work like a PPO network plan. They have an account or fund attached that can be used to pay for medical expenses. Both offer preventive medical, dental and vision coverage at 100 percent in-network. You can see any provider nationwide without a referral.
Here a few distinctions:
The CDHP provides medical and dental fund dollars up front. The full amount of your fund dollars are available on your first day of coverage. Your fund dollars roll over into next year if you don't use them and remain with you as long as you remain in the plan.
The HDHP includes a health savings account (HSA). Our plan includes deposits into that account on a monthly basis. You can also deposit money into this account on a voluntary basis and these are tax-deductible. This money earns interest, continues to grow tax-free and is yours to keep even if you change jobs or health plans.
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Alexandria, Va.: Should FEHBP enrollees sign up for Part D of Medicare, for prescription drug coverage? Thanks.
Tom Bernatavitz: In most cases, the answer is no since the prescription drug coverage in most FEHB plans is considered equal to or greater than that available through Part D.
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Richardson, Texas: Are the drugs covered under FEHB plans' pharmacy going to change in any way? Are plans allowed to cover only the drugs they want, i.e. "their formularies"? Thanks.
Tom Bernatavitz: Most plans in FEHB including Aetna negotiate manufacturer discounts with major drugmakers. Drugs that are put on the plans' preferred lists are called "formulary" and most plans provide incentives to use drugs on their formulary list. These vary plan to plan. All of Aetna's plans offer three tiers of drug coverage with copayments of either $5 or $10 for generics, $25 for formulary, and a maximum of $40 or $50 for non-formulary.
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Washington Newlyweds : My husband and I got married a few weeks ago and both work the federal government. We want to know if there is any advantage for keeping separate health plans or should we just be on one?.
We are young and this may be a wishful thinking, but we want a GOOD health plan that doesn't require us to fight for healthcare or for referrals. It would be great to have dental and vision, too.
Tom Bernatavitz: You should compare the single versus the family premiums on the plans you're considering. Under our Aetna HealthFund CDHP, our fastest growing plan, the non-postal biweekly premium is $37.87 per individual and $87.11 perfamily. If you were to both take single coverage, your "combined" premium would be $75.74. You would not lose any benefits in terms of the fund provided, member responsibility, etc.
Unlike other health plans where if you pay your premiums and don't use much care, we allow you to roll over your unused fund dollars into subsequent years as long as you stay in the plan.
This plan covers network preventive care for medical, dental and vision at 100%. Each of you would also have $300 dental fund to use for additional services.
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Oxon Hill, Md: I just turned 65 and have signed up for Medicare Part B. I am in excellent health, on no medication. For my FEHBP supplemental insurance, should I look at HMOs, fee-for-service, or the HDHP?
Tom Bernatavitz: First of all, you're not eligible for an HDHP with a Health Savings Account if you have Medicare coverage. As far as which FEHB supplemental insurance to take, I suggest looking at the low copays available under HMO plans as well as those fee for service plans which waive deductible and coinsurance amounts for individuals who have Part B coverage.
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Maryland: I joined Aetna's Open Access last year's Federal Open Season. I am very pleased with the versatility of this health plan. Especially not having to get referrals. My 11-year-old daughter is going to be getting fitted for her 2nd go round on braces. Will Aetna cover any costs for the new fitting of braces she will have in the next coming months?
Tom Bernatavitz: Unfortunately, no FEHB medical plans, including Aetna, cover the cost of braces. In fact, all new FEDVIP dental plans require you be in the plan for 24 months before covering orthodontia for children.
One advantage to being an Aetna Open Access HMO member is that we offer you discounts up to a third off when you visit participating orthodontists. So, I suggest you go to AetnaFeds.com and find a participating orthodontist for your daughter.
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Washington: Any changes to prescription drugs next year? Thanks.
Tom Bernatavitz: Our third-tier copay (non formulary drugs) increased from $40 to $50 on some of our plans; however, we also decreased our generic copays from $10 to $5 on others. You can check out specific drug coverage information on our Web site: AetnaFeds.com.
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Kansas City, Mo.: In your Consumer Driven Health Plan, is it necessary to get a written plan before you can see an outpatient mental health provider?
Tom Bernatavitz: No, no referrals are required.
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Washington: What types of discounts are offered on LASIK and gym equipment? I have AETNA Open Access. I have generally been happy with AETNA (other than great difficulty in getting MRIs approved) and I wasn't aware of these benefits.
Tom Bernatavitz: LASIK discounts are offered to all Aetna plan members. On average, the LASIK discounts are around 30 percent off. For a referral to a LASIK provider, call 800-422-6600.
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Sacramento, Calif.: Thanks so much for answering questions today.
Would you please explain how the catastrophic benefits work in your CDHP plan? It appears that expenses covered by the HRA do count towards qualifying for these benefits (say $2,500 out of the $6,000 needed for family benefits). Is this correct?
How does it work if you start the year with carryover funds? Say you have a total of $6,000 in your HRA. Would you have to expend the entire HRA plus your personal responsibility before the catastrophic benefits kick in?
Thanks again for your help.
Tom Bernatavitz: This is a great question.
In a family situation, the medical fund dollars of $2,500, which we provide, and are used to pay for your first-dollar expenses, count towards your annual out of pocket maximum of $6,000. Even though these are not your out of pocket expenses, they count toward that maximum.
If you had rollover dollars from a prior year in the plan, they would also count toward your annual out of pocket maximum. In my opinion, this is one of the greatest deals of FEHB.
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Washington: How much does AETNA's decision to cover optional services like infertility treatments that most insurance companies don't cover factor into the AETNA's yearly cost increases? Has AETNA thought about dropping these coverages or increasing the co-pays for these services since they are optional?
Tom Bernatavitz: Most FEHB plans don't cover infertility treatments, however, OPM requires the local "HMO" plans in the D.C. area to cover this type of treatment. This evolved out a Maryland state mandate. Offering this coverage has a minor impact overall on the premium.
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Pawleys Island, S.C.: Which of your plans works best for a retiree who also has Medicare?
Tom Bernatavitz: I suggest looking at the Aetna HealthFund CDHP because of the low premiums, 100 percent preventive care, dental and vision perks, and the fund dollars that can be used to offset your Medicare deductibles or even used to pay Part B premiums.
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Washington: Just curious -- what justification did OPM give you in setting these pass-through rates for the HDHP? Does that not reduce your competitive edge?
Tom Bernatavitz: As I said to an earlier reader, we offset the changes by enhancing the benefits and reducing the premiums on our HDHP/HSA plan by over 17 percent. I still think we have the most competitively priced HDHP plan and it offers many upsides.
For example, it pays interest on the money in the HSA, no banking fees are passed to you, you can use a no-fee debit card to access your HSA funds, you get preventive care at 100 percent in-network, plus a $100 eyewear reimbursement benefit every 24 months.
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Washington: I'm interested in switching health plans this open season. However, how complicated would it be if I recently found out I was pregnant and had my first visit to the OB under my current plan. Both my doctor and the hospital participate in both plans. Under my current plan and the one I'm interested in it looks like, barring any complications, there is only one fee that I would pay -- such as my co-pay at my original visit to my OB. I'd love to switch plans, but I would rather avoid a headache. Should I wait to switch plans until next year?
Tom Bernatavitz: Given your individual circumstance, my best advice would be for you to call us toll-free at 1-877-459-6604 and talk with one of our reps so we can gather more information.
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Washington: Given the ever higher costs for Medicare Part B, why not drop it and rely on Aetna? What does Part B cover that you do not? Thanks.
Tom Bernatavitz: The decision to pay for Part B is an individual one. I do know that if you don't take this coverage when first eligible, the costs will increase if you choose to enroll later.
Steve tells me that's all the time we have today. Thank you all for the opportunity to talk about Aetna's plans. For more information about our plans for federal employees, please visit us at AetnaFeds.com or call us toll-free at 1-877-459-6604. Take care.
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Stephen Barr: Tom, thanks for fielding questions today -- a great service to Post readers. We'll be back here at noon next Wednesday, so please join our discussion then!
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