EXHIBIT 13b: NARRATIVE SUMMARY ... May 15, 2020 ¢  EXHIBIT 13b: NARRATIVE SUMMARY Company Name: Aetna

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  • Exhibit 13b – Narrative Summary Last Updated: 5/15/2020

    Proprietary

    EXHIBIT 13b: NARRATIVE SUMMARY

    Company Name: Aetna Life NAIC Code: 60054 SERFF Tracking #: AETN-132363851 Market Segment: Small Group

    Aetna is filing revisions to premium rates for Small Group policies that will be sold in New York during

    2021. The rates in this filing will apply to small group policies that are renewed or sold at policy

    anniversary beginning on January 1, 2021. These rate changes will impact approximately 9,500

    policyholders and 16,500 members.

    The requested rate changes for Aetna's Small Group plans are directly related to two main drivers: the

    overall rising cost of health care services in New York, and an adjustment to reflect changes in the type

    and quantity of medical services used by our members which results in increased claim expenses.

    Trends were based on a review of small group data over the period January 2019 – December 2019. The table below reflects our cost trends:

    Utilization Trend

    5.1%

    Unit Cost Trend

    5.5%

    Other Trend

    0.9%

    Total Trend

    11.9%

    Utilization represents the number of services per member per year across all medical expense

    categories. Unit Cost represents the dollar amount per service. Increases in Unit Cost reflect changes in

    our contracted rates and prescription drug costs as well as the price escalation due to usage of more

    intensive services or expensive technologies. Hospital unit cost is projected to increase at 6.6%,

    physician unit cost is projected to increase at 2.0%, and pharmacy unit cost is projected to increase at

    9.9%.

    Other Trend represents deductible leveraging. Deductible leveraging occurs when the rate of change in

    deductibles is less than the rate of change in total medical costs. This results in the rate of change in

    insurer plan cost exceeding the rate of change in total medical costs. The deductible leveraging adds

    0.9% to our total trend.

    New York state law requires that at least 82% of premium must be used to pay medical member costs.

    The remaining 18% is used for administrative expenses, profit, and taxes. Administrative costs include

    (but are not limited to) customer service, processing and paying claims, medical management programs,

    maintaining our provider networks, and complying with State and Federal regulations.

  • Exhibit 13b – Narrative Summary Last Updated: 5/15/2020

    Proprietary

    Aetna takes our commitment to our customers seriously. We have taken a number of steps to try to

    keep our products as affordable as possible, such as:

    • Developing innovative new relationships withhealth care providers that compensate them for the quality of care they provide, and not the quantity.

    • Creatingmedicalmanagement programswhichaddress potential health issues for members earlier, improving health outcomes and reducing the need for high-cost health care services.

    We are also dedicated to increasing transparency within the health care system, as well as helping our

    members best utilize the plans that they have. Members can access Aetna Navigator, our secure

    member website, which allows members to research their specific plan benefits, health care providers in

    a given area, and in some locations, the cost of certainhealth care services. !dditionally, !etna’s Plan for Your Health website aims to educate all consumers—not just Aetna members—on how to take

    advantage of their health care benefits.

    This narrative (exhibit 13) will be posted on Aetna.com, which is open to the public.

    http://www.aetna.com/individuals-families-health-insurance/member-guidelines/stateprocess.html

    http://www.aetna.com/individuals-families-health-insurance/member-guidelines/stateprocess.html http://Aetna.com

  • Aetna complies with applicabl e Federa l civi l right s law s and doe s not unlawfully discrimina te, exclude or treat people differently based on the ir rac e, color , nationa l origi n, s ex, a ge, or disabil ity. We provide free aids/services to peopl e with disabiliti es and to peopl e who need langua ge assistance.

    If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card.

    If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by conta cting: Civil Rights Coor dinator, P.O. Box 14462, Lexingt on, KY 40512 (CA HMO customers: PO Box 24030 Fresno, CA 93779), 1-800 -648-7817, TTY: 711, Fax: 859-425-3379 (CA HMO customers: 860-262-7705), CRCoordinator@aetna.com.

    You ca n a lso fi le a civi l rights com plaint with the U .S. Department of Health and Human Servi ces , Of fice f or Civil Right s Complaint Portal, available at https://ocrporta l.hhs.gov/ ocr/ portal/ lobby. jsf, or at: U. S. Departm ent of Heal th a nd Hum an S ervices, 200 Inde pendence Avenue SW ., Room 509F, HHH Building, Washington, DC 20201, or at 1-800-368-1019, 800-537-7697 (TDD).

    Exhibit 13b – Narrative Summary Last Updated: 3/20/2020

    Proprietary

    mailto:CRCoordinator@aetna.com https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

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