News
Aetna decides it wants out
Plan no longeravailable after July 1, 2002

March 22, 2002 - The JHCC recently completed the request for proposal (RFP) process that determines which HMOs will be offered to state employees. The RFP is sent to all health plans across Ohio.

During the HMO bidding process Aetna failed to submit a complete bid. When Aetna was informed it had not submitted a complete bid, it decided to pull out. Aetna cited the fact that it lost $15 million on the state account last year and has never made a profit on the plan. This leaves some 20,000 state of Ohio employees in the position of having to select a new health plan during the upcoming open enrollment period.

It is important that members understand that it was Aetna's decision to not be offered, and not the case that the state or the union excluded them. This is part of a continuing national trend of fewer and fewer HMOs being available, and fewer HMOs being willing to bid on state of Ohio employees.

In fact, a number of HMOs did not submit bids for consideration-Anthem, Cigna and Choice Care are three large plans that did not bid. Aetna had stated publicly that its desired employee group size is now 500 to 10,000 employees, further stating it would be closely scrutinizing whether or not to renew bids with larger groups.

Why are State of Ohio employees considered less desirable by HMOs?
First we are older than most groups and have a higher utilization of health care than most.

Second, we have a very rich benefit package (our drug co-pays are among the lowest in the Midwest).

Third the JHCC has taken a very aggressive stand in rate negotiations with plans. While this has netted us some lower rates, many plans have taken huge losses on the state plan. So all of this makes us less desirable to health plans.

What other HMOs will be available next July?
United Health Care will be available in 64 counties; Kaiser will be available in 5 northeastern counties. Paramount will be available in some 10 northwestern counties and The Health Plan of Upper Ohio Valley will be available in 4 eastern counties.

Also available in the northeastern part of the state are two HMOs new to state of Ohio employees: SummaCare (9 counties) and QualChoice (4 counties).

Only 5 counties will have no HMO option-all of which are in northwestern Ohio.

Of course, the Ohio Med PPO will be available in all counties

When will employees get notice from the state about their choices?
During the week of April 15, all state employees will receive a letter from the state telling them what their current plan is and what their options are for the next benefit year. Also sometime that week employees will get the comparison chart that spells out the rates and other important features about the plans.

Open Enrollment actually begins April 29 and ends May 10. Employees in Aetna must select a plan. If they do not, the state will put them in the Ohio Med PPO.

Related Check out the March 15, 2002, New Directions article for more details.