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Aetna in MI ...


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Aetna recently re-entered MI individual market and like to hear some thoughts on thier plans, dealing with the company...etc.

The Good?
The Bad?

Thanks for the input.
They have greatly improved. Commissions have been worked out - and trust me when I say it was a rough start. Now it's like clockwork. They, in Maryland, have extremely generous underwriting and it's nice to have a company that doesn't rider. Watch the weight - they use BMI instead of a height/weight chart.

Be sure to read their pre-ex clause. In MD the verbage is if they don't have credible coverage and a condition has been treated in the past 6 months it's an automatic 12 month exclusion.

I wouldn't even dream of washing an app with them. Their claims review machine goes into override if the client seeks treatment for anything that wasn't disclosed on the app. Saying that they have always paid claims - better be sure to milk all the pre-ex conditions out of your client.

Zero flexability in their plans. Families of three are punished by imposing one family rate while familes of 5 or more make out. They're great for immediate maternity coverage.

All in all I am liking them more and more. They get about 20% of my business and if they continue to shape up they'll see about 40% of my business. They mail policies directly to clients however if they request medical records the client's on the hook.
First, thanks for prompt reply.

"They're great for immediate maternity coverage."

The litature I recieved today states maternity isn't covered at all. Did I miss something?
They are not offering maternity in GA either and probably wont for a long time . . . if ever.

The following apply to GA. May be different in your state.

$5k cap on Rx on all but one plan. This is a deal killer for my clients unless they opt for the PPO Value with no cap.

Pre-ex waived if they have creditable coverage within 63 days of applying for coverage with Aetna.

Limited geographic availability. Right now only in major metro areas covering maybe 40% of the state. I find this odd, but they are going county by county negotiating with providers before opening up that county for coverage. They have been here about a year & a half and rep tells me it will be another year, maybe longer before they have state wide cover.

6 month rate guarantee (changing to 12 month with November effective dates).

General stuff.

No riders as John said, but they do rate up for conditions either 25% (B rating) or 50% (C rating).

Combination BMI and a ratable condition will get your client denied more often than not.

I talk to quite a few people that dont like the hassle on claims. Several have jettisoned Aetna in favor of someone else just because of the claim review.

Finally got an online app.
I put my sister's kids on Aetna because their pediatrician didn't take any Assurant network and Assurant was price prohibitive. Even at that I still recommended Assurant. She overruled me and wanted Aetna. It's my sister's kids so obviously I disclosed every single thing on the app.

Her daughter got the flu about 2 months later. She got a "claim under review" notice in the mail and it was just a doctor visit with NO meds prescribed. About 2 months later and 3 or 4 calls from my sister screaming at them they paid the claim.

They are now on Assurant.

I use Aetna for maternity and for times with GR or Assurant riders a major condition. Aside from that I have absolutely no use for them. Unfortunately a lot of people need maternity and I do NOT like my clients signing riders.

If you're one of those agents (and you know who you are) who doesn't really dig hard into people's health history I wouldn't even bother filling out a single Aetna app. Claims review will destroy them.

I think of Aetna as "damned if I do damned if I don't."
Thanks again all.

Just a note-
The RX here in MI is unlimited except on the PPO High deduct 5000, that has a 5k limit.
One more if you folks would-

American Community?

Wife and I are ramping up to sell individual here in MI and looking to start with 5-6 companies.