Aetna boosts product line with POS/PPO blend
Consumers get more choice
Just when you thought you had a grip on all the different kinds of managed care products, payers have come up with one more. The twist this time is a product that combines the features of all products along the health care continuum, from traditional indemnity to PPO and HMO products and even point-of-service (POS) plans.
In this model, the employer purchases one product that lets the consumer choose at the point of service to access care using benefit coverage and provider networks associated with a traditional insurance, PPO, HMO, or POS product. The copayment or deductible provisions that come into play depend on which choice the consumer makes.
Two payers have introduced products along these lines. Blue Bell, PA-based Aetna US Healthcare has introduced its US Access product in 16 states, and plans to expand the product to other states the plan does business in as well.
Dallas-based Harris Methodist Health Plan introduced a similar product late last year with less success. The health plan pulled the product from the market because it simply was not able to make money with the concept, says public relations manager Lisa Osteen.
Product well-received
However, Aetna US Healthcare says its US Access product has been received extremely well. "We’ve quoted close to 3,000 accounts [for US Access], and that’s with the product only being available in the last couple of months," says David Rocchino, head of core sales and marketing for Aetna US Healthcare. "About 500 of the groups we’ve quoted on are groups with over 100 [lives]."
Aetna US Healthcare currently has 10,000 members enrolled in the product, he says.
US Access has different features from a POS product because it incorporates several levels of choice, Rocchino says. With a POS product, it’s typically an all-or-nothing issue: Either you access the physician network through a primary care physician gatekeeper, or you go directly to a specialist or outside the network with no copay but with typical 70/30 coverage once a deductible is met.
With US Access, however, a consumer is eligible for several different coverage options. The consumer may choose to access the HMO network through his or her primary care physician and incur a $5 copay. However, the member could visit any participating physician in the plan’s PPO network for a $15 copay, or go outside the network with coverage similar to that associated with a standard indemnity plan.
Some of the states US Access is currently offered in include Pennsylvania, Arizona, Colorado, Delaware, Tennessee, and Virginia, Rocchino says. Applications are being filed continuously to expand the product to other markets.
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