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Aetna Medicare Plans

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Do you want more choices to meet your health care needs?

We can help with plans that give you more options than what Original Medicare offers. Some plans
include wellness programs and savings on a wide range of products and services.

Medicare Advantage plans (Part C)

Medicare Supplement Insurance plans (Medigap)

Medicare prescription drug plans (Part D)

Aetna Medicare Advantage Plans (Part C)

Our Medicare Advantage plans offer you the same type of services as Original Medicare (Parts A
and B). And some plans offer coverage for additional benefits, such as dental, vision, hearing and
wellness. You get all your benefits in one plan, with or without prescription drug coverage (Part D).
You choose whats right for you.

Aetna Medicare Supplement Plans (Medigap)

These plans will help cover some of the health care costs that Original Medicare doesnt cover. Get
the freedom to visit any doctor or hospital that accepts Medicare by choosing Medicare Supplement
insurance. Prescription drug coverage (Part D) isnt included, but stand-alone Part D plans are
available.
See if we offer Medigap plans in your state.

Aetna Medicare Rx Plans (Part D)

You can choose from a variety of plans that offer preferred pharmacy benefits for additional savings.
Or plans that offer greater flexibility with standard savings, including $0 deductible and gap coverage
plans. You can add these pharmacy benefits to your Original Medicare (Parts A and/or B), and
Medicare Supplement plans (Medigap).
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Private Fee-for-Service plans (PFFS)

Medicare Medical Savings Account plans (MSA)

Some Medicare cost plans

Postisioning strategy

https://books.google.co.in/books?
id=_QwAAAAAMBAJ&pg=PA42&lpg=PA42&dq=positioning+strategy+of+Aetna&sou
rce=bl&ots=mOQYfr2ypO&sig=M66oTG6ydPd_6AeQDq4AB_GOOY&hl=en&sa=X&ei=c80oVZDhOoKtuQTMl4DoCg&ved=0C
D4Q6AEwBQ#v=onepage&q=positioning%20strategy%20of%20Aetna&f=false
Proactive strategies

PHOENIX, August 26, 2014 Aetna (NYSE: AET) and Banner Health Network
(BHN) today announced that their accountable care collaboration resulted in a
shared savings of approximately $5 million on Aetna Whole Health fully-insured
commercial membership in 2013 and a five percent decline in average medical
coston the members. At the same time, Aetna and BHN improved cancer
screening rates, blood sugar management in diabetic members and reduced
avoidable hospital admissions. The results demonstrate that patients benefit
when physicians and health plans share resources and work together in
accountable care models. Further, Aetna and BHN saw savings and improved
medical cost trend on additional membership outside the Aetna Whole Health
product.
An accountable care collaboration is a group of health care providers who
assume responsibility for the quality and cost of care for a group of patients. The
collaboration between BHN and Aetna gives consumers and employers better
health care options. Consumers who receive care in this new model save money
by using providers in BHN. They also benefit from a more coordinated,
personalized experience that is designed to produce better overall health
outcomes.
Through care coordination by a clinical team and proactive management of
patients needs, rather than episode-based treatment of illness, providers in
accountable care models can provide more efficient and cost-effective care.
Health plans support the practice with relevant patient care data, analysis and
quality measurement along with financial rewards for improved care quality.
Aetna and BHN have a collaborative relationship that is to the benefit of our
members and employers, said Chuck Lehn, BHNs Chief Executive Officer.
These results are rewarding because they validate our model -- it is possible to
deliver quality care at more affordable prices.

Aetna and BHN began their accountable care collaboration in 2011 and the tools
and learning from this relationship supported BHNs Medicare Pioneer
Accountable Care Organization (ACO) model in 2012. Aetna and BHN offer the
Aetna Whole Health plans ACO-centered health plan products to employers
and individuals in the Phoenix area. The products are also available to
individuals on the public exchange. In addition, Aetna care management and
technologies support BHN in delivering patient-centered, accountable care to its
Pioneer Medicare beneficiaries as well as Banner Health employees in seven
states.
The success of this collaboration demonstrates that insurance carriers and
providers can work together in a unified approach to provide quality, coordinated
care while reducing health care costs, said Tom Dameron, Aetnas local market
president for Arizona. We look forward to continuing our relationship with Banner
to help our members live healthier, more productive lives.
Significant results seen during the second full year of the accountable care
collaboration between Aetna and BHN include:
Improvements in cancer screening rates, including cervical and colorectal
cancer screening;
Reductions in the percent of diabetic members with poorly controlled blood
sugar levels;
Reductions in radiology services of approximately 9 percent;
Increases in generic prescribing rate by almost 4 percent; and
Reductions in avoidable admissions by approximately 9 percent.
Aetna is working with health care organizations across the country to develop
products and services that support value-driven, patient-centered care for all
health care consumers. Nationally, more than 2.3 million members are served by
value-based health care models.
About Banner Health Network

Banner Health Network was designed to provide a highly coordinated patient

care experience for beneficiaries of government and private sector insurance
plans. BHN is comprised of 3,000 Banner Health-affiliated providers, caring for
300,000 covered lives. With a population health management focus, and a
sophisticated health information technology as support, Banner Health Network
seeks to provide high quality care at an affordable price. Parent company,
Banner Health, is one of the largest nonprofit health systems in the country, with
operations in seven states. For more information go to www.BannerHealth.com
About Aetna
Aetna is one of the nations leading diversified health care benefits companies,
serving an estimated 45 million people with information and resources to help
them make better informed decisions about their health care. Aetna offers a
broad range of traditional, voluntary and consumer-directed health insurance
products and related services, including medical, pharmacy, dental, behavioral
health, group life and disability plans, and medical management capabilities,
Medicaid health care management services, workers compensation
administrative services and health information technology products and services.
Aetnas customers include employer groups, individuals, college students, parttime and hourly workers, health plans, health care providers, governmental units,
government-sponsored plans, labor groups and expatriates. Learn more about
Aetnas journey to make quality health care more affordable and accessible for
all.www.aetna.com @aetna

Challenging situations

Fines, lawsuits and settlements[edit]

1999[edit]

A jury in California awarded $116 million in punitive damages for

"malice, oppression and fraud" to a patient's widow who contended he died after a subsidiary of
Aetna delayed approving treatment for stomach cancer that its own doctors had recommended.

Lawyers on both sides called it the largest such verdict against a health maintenance
organization. In 2001 a settlement was reached.[56][57][58]

2000[edit]

The U.S. Court of Appeals affirmed a $1,855,000 federal jury award for Brokerage Concepts
Inc. (BCI) against Aetna U. S. Healthcare (formerly U. S. Healthcare), its
Pennsylvania subsidiary, and one of its former senior executives, Richard Wolfson. In its suit,
BCI accused Aetna U. S. Healthcare of tortious interference with contractual relations. BCI
alleged the managed-care company used its economic power in the business of prescription
drug sales to coerce one BCI's clients, the "I Got It at Gary's"pharmacy chain, into using another
Aetna U. S. Healthcare subsidiary, Corporate Health Administrators, as its health benefits
management firm. According to the suit, Aetna U. S. Healthcare threatened to drop "I Got it at
Gary's" from its pharmacy network if the company didn't switch to Corporate Health
Administrators.[59]

2001[edit]

The Maryland Insurance Commissioner ordered five Maryland health plans to pay a total of
$1.4 million in penalties for failing to comply with the state's claims payment practices; Aetna
was cited twice and ordered to pay the largest fine of $850,000. [60]

The State of Texas fined Aetna $1.15 million for failing to promptly pay doctors and hospitals
for services. Texas Insurance Commissioner Jose Montemayor also ordered Aetna to
pay restitution to physicians and health care providers who did not receive timely payment for
claims.[61]

2002[edit]

The New York Department of Insurance fined Aetna US Healthcare and UnitedHealthcare a
total of $2.5 million, citing a litany of bungled claims, improper treatment denials, unlicensed
health insurance agents, and poorly performing claims processors using out-of-date software.[62]

Aetna agreed to streamline communications, reduce administrative complexity, and improve

the quality of the health care system, ending litigation between Aetna and
700,000 physicians and medical societies. The physicians' lawsuit, settled for $470 million,
charged Aetna with systematically reducing payments to physicians and overriding their
treatment decisions.[63]

2003[edit]

Aetna and the American Dental Association (ADA) announced a class-action settlement by
dentists who accused Aetna of interfering with dental procedures to cut costs and forcing
dentists to comply with excessive paperwork. The settlement called for Aetna to pay $4 million to
40,000 to 50,000 dentists and $1 million to the ADA Foundation, acharitable group.[64]

Georgia Insurance Commissioner John W. Oxendine fined Aetna's Prudential Health Plan
$100,000 for violating Georgia's prompt pay law by delaying claims payments. Aetna companies
had been fined four previous times by Oxendine's office, in 2000 and again in 2002, for a total of
$411,200.[65]

2007[edit]

The New Jersey Department of Banking and Insurance filed an administrative order levying
a $9.5 million fine against Aetna for refusing to appropriately cover certain services provided by
out-of-network providersincluding emergency treatmentin violation of New Jersey rules and
regulations.[66]

2009[edit]

Former Aetna employee Cornelius Allison of Darby, Pa., filed suit against Aetna in U. S.
District Court in Pennsylvania after hackers gained access to a company Web siteholding
personal data for 450,000 current and former employees as well as job applicants. The suit
charged Aetna with negligence, breach of contract, negligent misrepresentation and invasion of
privacy.[67]

The Arizona Department of Insurance fined Aetna Life Insurance Company and Aetna
Health, Inc. after examination of their practices exposed multiple violations of Arizona insurance
laws. The department found that Aetna violated significant state laws governing important areas
of health insurance operations, including Aetna's: failure to provide policyholders with
information about their rights on appeals of medical claims or services denials; failure to
acknowledge receipt of policyholder appeals; failure to notify policyholders about appeal
decisions/outcomes; and, in some appeals involving the denial of services for potentially lifethreatening conditions, failure to inform policyholders of their decision within the required,
expedited time frames.[68]

2010[edit]

Aetna paid a $750,000 fine as part of a settlement with the New York Insurance
Department related to the company administering an affordable healthcare plan for the state.

Aetna's violations included failing to provide a required 30-day notice of rate increases to about
946 members in 2007, failing to provide notice to 1,406 terminated workers of their rights to
convert to another policy, failing to report enrollment data from May 2007 through August 2008,
and failing to respond to Insurance Department requests for data in March 2008. [69]

Life insurance policies on slaves[edit]

In 2000 Deadria Farmer-Paellmann, head of the nonprofit Restitution Study Group of Hoboken, New
Jersey, disclosed that from approximately 1853 to approximately 1860 Aetna had issued life
insurance policies to slaveowners covering the lives of their slaves. [70]
Aetna acknowledged that concrete evidence exists for Aetna issuing coverage for the lives of slaves
and released a public apology.[71]
In 2002, Farmer-Paellmann brought suit against Aetna and two other companies in federal court
asking for reparations for the descendants of slaves. The lawsuit said Aetna,CSX and Fleet were
"unjustly enriched" by "a system that enslaved, tortured, starved and exploited human beings. " It
argued that African-Americans are still suffering the effects of 2 centuries of enslavement followed
by more than a century of institutionalized racism. The complaint blamed slavery for present-day
disparities between blacks and whites in income, education, literacy, health, life expectancy and
crime.[16]
This suit was denied, and the denial largely upheld on appeal.[72][73]
In 2006, Farmer-Paellmann announced a nationwide boycott of Aetna over the issue
of reparations for its policies covering slaves. Aetna stated that its commitment to diversity in the
workplace and its investment of over 36 million dollars in such areas as education, health, economic
development, community partnerships, and minority-owned businessinitiatives in the AfricanAmerican community is more effective at aiding descendants of slaves and African-Americans in
general than making restitutions for Aetna's life insurance policies on slaves. [74][75][76][77][78][79]

Marketing Research Process ( change according to your Company)

Marketing Research process By Express Scripts
Problem Definition: When specialty drugs started coming in the market , Express
scripts had to change the way they were dealing in providing drugs.

Research Design: In depth interviews were done for the various segments such as
for children being treated for ADHD the parents were interviewed for adherence
levels in children for therapy.
Data Collection: Data collection is done on a regular basis.
Data Analysis: graphs are used for analyzing the trends and decision models are
used for formulating new techniques. They hire different organizations for market
research.
Report: Express Scripts adjusts again to offer payers and patients solutions to effectively
manage the distribution and utilization of these medications while also providing patients with
clinical support and expertise to help them take their medications safely
Follow Up: follow up is done via feedback and frequently asked questions over a
period of time to know more about the products and services being offered.
LAunch
https://news.aetna.com/news-releases/?s=launch
Brand development
http://www.siegelgale.com/services_detail/brand-development/

After Sales Services

http://www.aetnagroup.com/bom/downloadfree.asp?lib=Files&ID=5074&UT_ID=

http://www.aetna.com/investors-aetna/assets/documents/2013%20Investor
%20Conference/2013-Investor-Conference-Presentation.pdf
Distribution channel
About Swiss Life Network
Swiss Life Network is a global association of 60 leading local life insurance
companies and business partners. Through this network, Swiss Life offers
comprehensive employee benefit solutions, including life insurance, pension and
health solutions for over 400 multinational corporations in 70 countries and
territoriesworldwide. The Swiss Life Network, founded 1962, is the leading global
employee benefits network and a pioneer of the international risk pooling concept.
Swiss Life Network has the objective to provide top-quality employee benefit
solutions to multinational corporations around the globe for their international and
local employee benefit needs. For more information, see www.swisslifenetwork.com.

The health insurance industry operates through two types of organizations: independent
insurance companies and managed care organizations. Independent insurance
companies offer traditional plans where a certain amount or percentage of medical
costs are reimbursed in exchange for regular monthly payments to the company, which
is called a premium.
Unlike traditional insurance providers, managed care organizations (XLV) enter into a
contract with a set of health care providers, called the plans network, to provide care
for members at reduced costs.

Physicians
Aetna reimburses the PCPs participating in its network on both a fee-for-service basis
and capitation basis. In a fee-for-service payment method, physicians are paid for
services provided to members at a fixed rate for the services provided.
Capitation is a form of risk sharing arrangement where the physician receives a monthly
fixed fee for each member. This method closely aligns the financial incentives of the
physician and the managed care organization, as lower medical costs help physicians
earn higher profits. Aetna, however, uses capitation only in certain geographic areas
and in case of HMO offerings.
Managed care organizations such as Aetna (AET), Humana (HUM), Cigna (CI), and
Anthem (ANTM) use capitation payment methodology to pay PCPs because they act as
gatekeepers in an HMO network. Individuals enrolled in an HMO can seek specialty
care only if their PCPs refer them, thus making the PCPs directly responsible for the
HMOs medical service utilization. Aetna reimburses its specialist physicians at
contracted rates per visit or per procedure.

Hospitals
Aetna typically pays the hospitals in its network on a per-day or per-case basis and
generally has fixed rates for ambulatory, surgery, and emergency services. The
company also monitors the length of stay of the patients to control wasteful usage of
services. Aetna uses the fee-for-service model to pay laboratory, imaging, urgent care,
and other freestanding health facility providers.

Private label?
The term private-label health plan derives from the common retailing practice in which
a well-known manufacturerperhaps a clothing manufacturerallows a retailer to sell
its product under a label selected by the retailer.

What it is

In its basic form, Aetnas private-label health plan is a limited or tiered network benefit
plan where Aetna holds the insurance license and performs its traditional insurer
functions while the health system acts as the leading in-network provider.
Private-label plans are intended to capitalize on the characteristics of limited network
plans. We use traditional benefit design strategies and steering mechanisms such as
copayment differentials to financially reward the individual for staying within the
network, says Kennedy.
Aetna is looking to form private plans with the dominant health systems or physician
organizations in a market. We attempt to pick a provider that an employer would buy,
says Kennedy.

USP
http://www.summit-re.com/files/published/Administrative_Services_Only.pdf
Ethics
http://www.aetna.com/investors-aetna/assets/documents/code-of-conduct.pdf
CSr
http://www.aetna.com/investors-aetna/assets/documents/code-of-conduct.pdf
Sustainable pg 27
CVP
http://thesavvystrategist.com/2011/03/28/making-a-good-customer-valueproposition-better-3/
Customer satisfaction survey

http://insurancecompanyreviews.about.com/od/Insurance_Company_Reviews/fr/Aetn
a-Health-Insurance-Company-Review.htm
http://articles.latimes.com/2013/mar/11/business/la-fi-mo-health-insurancerankings-20130311