A review of healthcare providers is completed every three years to ensure that CMSD and employees are receiving the best services through the most cost-effective contracts. This process has been scheduled so that these contracts can be implemented by January 1, 2025.
These provider changes would become effective on January 1, 2025. Employees will be able to make elections through Open Enrollment between November 1 and November 30, 2024.
You will have an opportunity to select your medical coverage (and make other changes) as well as enroll in the FSA during the Open Enrollment period from November 1st through November 30th.
If an employee does not complete an Open Enrollment event in November, the District will transition the employee to the most comparable plan available.
Medical Mutual enrollees will default to Aetna Choice POS II
Anthem enrollees will default to Aetna Choice POS II
Contigo enrollees will default to Aetna Select Open Access (Note: this is a University Hospital provider network only)
Members need to visit the open enrollment website through Workday to enroll or change plans or coverage. If members do nothing, they will be rolled into a plan that best matches the plan they have today. We would like to encourage members to go into the OE site and enter their benefit options. The Aetna Choice POS II plan is the broadest and members have the option of seeing a variety of providers.
The only time this form is needed is if going from in network provider to out of network provider. In general, members won’t need transition of care forms for conditions such as diabetes.
Yes, Aetna has a toll-fee dedicated Health Concierge phone line that will be able to answer general questions about the new coverage. They can assist members in finding a network provider, verifying if their current provider is in network and assist with many other questions. CMSD employees are encouraged to reach out to the Health Concierge line for all questions. The toll-free number is 1-833-469-0409.
There is a benefits site which contains information about the changes including videos for both Aetna and WEX which explain the benefits. Please visit www.mycmsdbenefits.com
Aetna will be the sole insurance provider; however, members will continue to enjoy a selection from three (3) medical coverage plan options. The Aetna Choice POS II option is Aetna broadest PPO network (similar to the current MMO and Anthem networks), Aetna Whole Health – is Aetna’s Cleveland Clinic Network, which is a PPO plan in which all Cleveland Clinic providers will be in network all other providers (UH, Metro, etc.) would be covered at the Non-network benefit level, and Aetna Select Open Access – is the University Hospital provider network which will be similar to the current Contigo Health plan.
Some of the benefits will include more choices for employees, specifically with the addition of a Cleveland Clinic Network. Aetna is also providing free employee access to CVS ExtraCare+ Program, $0 Copays to CVS Minute Clinics, and $10 in monthly rewards to CMSD employees.
Aside from the network, the Cleveland Clinic plan has a navigation team that can assist members on where to get care. All benefits (copays, etc.) are the same. Choice POS II has a broader network.
No, unfortunately it cannot apply towards prescription drugs or prescription drug copays. The rewards are available for other store items except alcohol, lottery tickets, milk.
Aetna is targeting members to receive ID Cards by the end of December. Members should talk to their providers to inform the providers their insurance is changing to Aetna on January 1, 2025. All network providers are responsible for obtaining prior authorization of services through Aetna.
Besides the difference in the provider networks, another difference would be the member cost. The Aetna Select Open Access (UH only providers) will continue to be the lowest cost option for employee premium contributions. The Aetna Whole Health plan is the Cleveland Clinic network option and still provides in and out of network benefits. The monthly employee premium cost share will be less than the Aetna Choice POS II, which is the broadest network and the most similar to the current Anthem and MMO plans.
No, the age limit for their own login would be age 21. If a dependent between ages 18 and 21 would like to have their own login, they would need to speak with an Aetna representative after January 1st to obtain a HIPAA form which would initiate the process of setting up their own account.
You will receive new ID cards at the end of December. Make sure to show your new ID cards to your providers, especially after 1/1/25. Also inform your provider that your insurance is changing to Aetna.
More than 99% of claims were identified as having been impacted by a transition from current providers to Aetna. Claims billed in the prior year were compared between provider networks to identify where a medical provider would now be out-of-network where they were previously in-network (measured in terms of ‘disruption’) to identify this impact. In addition to over 99% of claims remaining in-network, Aetna also confirmed that there are additional providers who were out-of-network who will now be in-network.
Aetna Choice POS II – This plan will be a PPO (Preferred Provider Organization) plan providing both in and out of network benefits. This option will align to the current MMO and Anthem PPO plan options previously available to employees.
Aetna Whole Health – This plan is a new offering, which is also a PPO plan. However, this plan will provide the highest level of benefits when services are received through any of the Cleveland Clinic Hospitals and providers. There is still a non-network benefit.
Aetna Select Open Access (UH option) – This is the plan that is replacing the Contigo Health option. It provides a University Hospital system network only benefit. There is no non-network benefit coverage.
The Aetna Choice POS II is the broadest network; providers are everywhere and would be the best option for employees who have dependents that live outside of Ohio or who are going to college in another state. Children are covered to age 26. (Note: for those currently on the MMO plan, MMO utilizes the Aetna network for services outside the state of Ohio.)
Remaining fund balances on Flexible Spending Accounts will be transferred directly to WEX, with a new debit card issued by January 1, 2025. The prior funds will be available on the WEX card by June 1, 2025
There is a benefits site which contains information about the changes including videos for both Aetna and WEX which explain the benefits. Please visit www.mycmsdbenefits.com
