State Health Aetna Members Must Switch but CWA Negotiated Strong Options – What You Need to Know

State Health Aetna Members Must Switch but CWA Negotiated Strong Options 

Starting in January 2020, Aetna will NO longer provide plans through the NJ State Health Benefit Plan (SHBP) medical plan for active employees and early retirees.   SHBP recently rebid the medical contract for active members and early retirees; Horizon’s price and presentation were deemed superior — they will be the sole carrier for SHBP active employees and early retirees. Aetna will continue to provide the Medicare Advantage and Dental Expense plans.

This means that anyone in an Aetna PPO (Freedom), HMO, tiered network (Liberty), or high deductible plan will need to switch to a Horizon plan during the October open enrollment.

The plan design (coverage, copays, deductibles) for the Aetna options is identical to the plan design for the Horizon equivalent.  However, there can be significant differences in networks particularly in certain geographic areas and for Tier One of the Tiered network plans (Aetna Liberty; Horizon Omnia.)

Current  Aetna members living out-of-state should understand that while Horizon directly contracts with a limited number of out-of-state providers they will have access to the robust networks of local Blue Cross affiliates like Independence Blue Cross in Southeastern Pennsylvania and Empire Blue Cross in New York through the Blue Card program.

 

Aetna Members in PPO (Freedom) Plans

Since the Horizon and Aetna PPO (Freedom, Freedom 10, 15, 15/25, etc) plans have a huge overlap of providers, most Aetna PPO members will see little change in switching to the Horizon equivalent plan.  For instance, all acute care hospitals in New Jersey, NYC, and Philly are in-network with Horizon.  However, there are some medical practices and specialty providers (mental health, physical therapy, chiropractic, etc) that are not in the Horizon network.

To find out whether your regular provider is in the Horizon network check the Horizon website and contact your provider to confirm as insurance company lists of participating providers are often out of date.

Aetna HMO Members

Members in the Aetna HMO should seriously consider switching to the CWA Unity PPO plan for the following reasons:

  • It is likely that your Aetna Primary Care Provider (PCP) will not be a Horizon PCP,
  • The Horizon HMO is geographically limited to New Jersey and surrounding Pennsylvania and New York counties,
  • You will have an out-of-network option you do not have now,
  • You will now be able to join a Direct Primary Care practice (R-Health and Paladina) and never pay anything for primary care,
  • It will cost less.  The CWA Unity PPO/NJ Direct plan for CWA, AFSCME, and IFPTE members includes significant savings in payroll health contribution deductions ranging from $330 to over $1500 a year depending on income and coverage type.

 

Aetna Tiered Network (Liberty) Members

Aetna Liberty members should carefully review the Horizon Omnia (tiered network plan) tier one providers as going to tier two providers, even though they are considered in-network, is expensive.

There are some areas like Middlesex where Horizon has a strong tier one provider network but others such as Mercer and Burlington where there are gaps.  Check the Horizon list of tier one providers and confirm this with your regular professional providers.

 

Union Action

Without our union, Steve Sweeney would have forced a high deductible plan on us all.  The Direct Primary Care initiative (no copays), lower healthcare contributions (payroll deductions,)  the $1000 bonus for joining the Omnia tiered network for a year, and the new zero copay for mail order generic drugs for active members (effective November 1) are the result when we join together in union.

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