Profile: Aetna Inc (AET)
14 Mar 2014
Aetna Inc. (Aetna), incorporated on December 20, 1982, is a diversified healthcare benefits company. The Company offers a range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, medical management capabilities, Medicaid healthcare management services and health information exchange technology services. The Company’s operations are conducted in three business segments: Health Care, Group Insurance and Large Case Pensions. Its customers include employer groups, individuals, college students, part-time and hourly workers, health plans, healthcare providers, governmental units, government-sponsored plans, labor groups and expatriates. As of December 31, 2011, the Company served approximately 36.4 million people. In May 2013, the Company announced it has completed its acquisition of Coventry Health Care Inc.
In January 2011, Aetna acquired Medicity Inc. (Medicity), a health information exchange company. In June 2011, it acquired Prodigy Health Group (Prodigy), a third-party administrator of self-funded healthcare plans. In October 2011, the Company acquired Genworth Financial, Inc.'s Medicare Supplement business and related blocks of in-force business. In October 2011, it also acquired PayFlex Holdings, Inc. (PayFlex), an independent account-based health plan administrator.
The Company’s Health Care products consist of medical, pharmacy benefit management services, dental, behavioral health and vision plans offered on both an insured basis and an employer-funded, or administrative, basis. Medical products include point of service (POS), preferred provider organization (PPO), health maintenance organization (HMO) and indemnity benefit (Indemnity) plans. Medical products also include health savings accounts (HSAs) and Aetna HealthFund, consumer-directed health plans that combine traditional POS or PPO and/or dental coverage, subject to a deductible, with an accumulating benefit account. The Company also offers Medicare and Medicaid products and services, as well as specialty products, such as health information exchange technology services, medical management and data analytics services, medical stop loss insurance and products that provide access to its provider networks in select markets. Aetna refers to insurance products (where it assumes all or a majority of the risk for medical and dental care costs) as Insured and administrative services contract products (where the plan sponsor assumes all or a majority of the risk for medical and dental care costs) as ASC.
Aetna’ principal products and services are targeted specifically to large multi-site national, mid-sized and small employers. It also serves individual insureds, expatriates and, in certain markets, Medicare and Medicaid beneficiaries. Medicare and Medicaid products and services are categorized separately from the Health Care products and services it sells to employers, other groups and individuals, which it refers to as Commercial. Commercial products and services offered by the Company include ActiveHealth Management, behavioral health, Personal Health Record , pharmacy, dental, provider network access (Cofinity), stop loss, Aetna Vision Preferred, provider solutions and other commercial products and services.
Through the use of CareEngine system, the Company’s ActiveHealth Management business provides evidence-based medical management and data analytics products and services to a range of customers, including health plans, employers and others. Its behavioral health and employee assistance products provide members who experience stress, depression and other types of mental health related illness with integrated behavioral health benefit administration, access to a network of providers and wellness programs. It provides customized behavioral health solutions to members in all 50 states. Aetna’s Personal Health Record provides members with online access to personal information, including individual personalized messages and alerts, detailed health history based on available claims data and voluntarily submitted information, and integrated information and resources to help members make informed decisions about their healthcare.
The Company offers pharmacy benefit management services and specialty and mail order pharmacy services to its members. Its pharmacy fulfillment services are delivered by Aetna Specialty Pharmacy (ASP) and Aetna Rx Home Delivery. ASP compounds and dispenses specialty medications and offers certain support services associated with specialty medications. Aetna Rx Home Delivery provides mail order prescription drug services. During the year ended December 31, 2011, CVS Caremark began to perform the administration of selected functions for the Company’s retail pharmacy network contracting and claims administration; mail order and specialty pharmacy order fulfillment and inventory purchasing and management, and certain administrative services for the Company. Aetna offers managed dental plans on an Insured and ASC basis. Through its Cofinity products, the Company provides access to regional healthcare provider networks to other insurance companies, third-party administrators, health plans and employers. Cofinity products predominantly are marketed in Michigan, Colorado and other states.
Aetna offers medical stop loss insurance coverage for certain employers who elect to self insure their health benefits. Under this product, it assumes the costs associated with large individual claims and/or aggregate loss experience within an employer's plan above a pre-set annual threshold. In January 2011, it began to offer vision benefits that provide members with access to vision networks in the United States. The Aetna Vision Preferred program can be customized with a range of benefit levels and co-payments. The Company is collaborating with EyeMed Vision Care LLC, a vision benefits company, to offer this product to its customers. The Company’s Accountable Care Solutions business creates mutually beneficial relationships with providers through a variety of methods, including alignment of financial incentives based on cost and quality, implementation of health information technology and deploying care management programs.
The Company offers a variety of other healthcare coverage products either as supplements to health products or as standalone products, such as indemnity programs, which may be offered on an Insured or an ASC basis. It also offers, directly or in cooperation with third parties, its Aetna Health Connections disease management program, which addresses over 35 chronic conditions, including asthma, diabetes, congestive heart failure and lower back pain.
In select markets, the Company offers Medicare Advantage plans, Medicare Supplement plans and prescription drug coverage for Medicare beneficiaries and participates in Medicaid and subsidized State Children's Health Insurance Programs (SCHIP). Through annual contracts with the Centers for Medicare & Medicaid Services (CMS), Aetna offers HMO and PPO products for eligible individuals in certain geographic areas through the Medicare Advantage program. It offered network-based HMO and/or PPO plans in 378 counties in 33 states and Washington, D.C. in 2011. It ceased offering its remaining Medicare private fee-for-service (PFFS) products in 2011. The Company is a provider of the Medicare Part D Prescription Drug Program (PDP) in all 50 states and Washington, D.C. to both individuals and employer groups. For certain Medicare eligible members, it offers supplemental coverage for certain healthcare costs not covered by Medicare. The Company offers healthcare management services to individuals eligible for Medicaid and SCHIP under multi-year contracts which are subject to annual appropriations.
The Company’s Group Insurance products consist primarily of life insurance products, disability insurance products and long-term care insurance products. Life insurance products consist principally of group term life insurance, the amounts of which may be fixed or linked to individual employee wage levels. It also offers voluntary spouse and dependent term life insurance, and group universal life and accidental death and dismemberment insurance. It offers life insurance products on an Insured basis. Disability insurance products provide employee income replacement benefits for both short-term and long-term disability. It also offers disability products with additional case management features. Similar to Health Care products, Aetna offers disability benefits on both an Insured and employer-funded basis. It also provides absence management services to employers, including short-term and long-term disability administration and leave management.
The Company’s long-term care insurance products provide benefits to cover the cost of care in private home settings, adult day care, assisted living or nursing facilities. Long-term care benefits were offered primarily on an Insured basis. The product was available on both a service reimbursement and disability basis. The Company no longer solicits or accepts new long-term care customers. It offers its Group Insurance products in 49 states, as well as Washington, D.C., Guam, Puerto Rico, the United States Virgin Islands and Canada. Depending on the product, the Company markets to a range of customers from small employer groups to large, multi-site and/or multi-state employer programs.
Large Case Pensions
Aetna’s Large Case Pensions manages a variety of retirement products (including pension and annuity products) primarily for tax-qualified pension plans. Contracts provide non-guaranteed, experience-rated and guaranteed investment options through general and separate account products. Large Case Pensions products that use separate accounts provide contract holders with a vehicle for investments under which the contract holders assume the investment risk. Large Case Pensions earns a management fee on these separate accounts.
The Company competes with Blue Cross/Blue Shield.
151 Farmington Avenue
HARTFORD CT 06156