Oct 22, 2024
Looking ahead to 2025, Aetna is making changes to their New York small employer group product portfolio as ACA plans have continued to face significant headwinds. The following changes will apply, starting with January 1, 2025, effective/renewal dates.
Broker Commissions
Aetna will no longer pay broker commissions for new sales of NY SG ACA medical plans with effective dates on or after January 1, 2025. For existing business, this change will take place on the group’s 2025 renewal date.
ACA Portfolio & Quoting
The Small Group ACA 2025 portfolio has been reduced to 14 plans (7 base and 7 dependent 30 plans). New business quoting will only be available in Small Market Aetna Rating Tool (SMART), a web-based quoting tool, within Producer World. Quoting will no longer be available in external quote platforms.
Renewal Group Notifications
Impacted groups and members of plans being discontinued effective January 1, 2025, have been sent the required discontinuance notices 90 days prior to the non-renewal date. Plans discontinuing after February 1, 2025 will be sent the discontinuance notice on a rolling basis, at least 90-days prior to the non-renewal date.
Groups may purchase a new policy from another insurance company or Small Business Marketplace (SHOP) certified policy in their service area at the NY State of Health Small Business Marketplace, www.nystateofhealth.ny.gov. SHOP is the only place where employers can take advantage of the Small Business Health Care Tax Credit, if eligible.
Renewal Process in 2025
The 2025 renewal process will vary by group, depending on whether the plan(s) are included in the NY SG ACA 2025 portfolio OR are no longer offered (referred to as discontinued plans) effective January 1, 2025. Refer to the NY SG ACA Broker Renewal Resource document (details shown below):
First, check to see if a renewal proposal has been sent. If the renewal proposal has been sent, then check the renewal proposal to see if any employees are showing as waived.
| WAIVED ON RENEWAL? | WHAT DOES THIS MEAN? | WHAT DOES BROKER/THE GROUP NEED TO DO? |
|---|---|---|
| Renewal proposal received - No employees show as waived | All members will be enrolled in 2025 plans being offered | Members are automatically enrolled in 2025 plan(s) unless broker or group notified Aetna otherwise. |
| Renewal proposal received - Some employees show as waived* | If a member does not show waived, then they will be enrolled in 2025 plans being offered If a member shows waived, then they have a plan that has been discontinued for 2025. | The renewal proposal will only show plans for the members that will be enrolled in 2025 plan(s) being offered. For those members that are in discontinued plans, the group and these members will receive a discontinuation notice 90 days prior to the non-renewal date. The client should ensure they comply with Attachments A and B of the plan sponsor discontinuation notice. If the group wants to select Aetna 2025 plans for all members, then the broker or group needs to contact Aetna and provide the plan selection(s) for all members in the group. Important: If the broker or group does not contact Aetna, then only members under the 2025 plans shown in the proposal will be renewed. Any members showing as waived in the proposal will be terminated on the group’s renewal date, since they are on plans that have been discontinued. |
| No renewal proposal received | All members have plans that have been discontinued in 2025. | Impacted groups and members will receive a discontinuation notice 90 days prior to the non-renewal date. The client should ensure they comply with Attachments A and B of the plan sponsor discontinuation notice. The group and its members will be terminated at the end of the policy’s plan year. Important: If the group wants Aetna’s NY SG ACA 2025 plans, run a new business proposal via SMART. The group will need to circle and sign which plans have been selected and return that documentation to Aetna. |
Reach out to your Amwins Connect Sales Representative to ensure your clients have a smooth transition.
* The client should receive their bill for 2025 coverages approximately 15 days prior to the effective / renewal date. If you or your client did not contact Aetna regarding members on discontinued plans, then the bill only reflects those members with 2025 coverages. If the client wants to add terminated members to their existing 2025 plan(s), then contact Aetna to add them. If the client wants to add terminated members to a new 2025 Aetna plan(s), then contact Aetna to go through the new business submission process.
