Upcoming Health Plan Administration Services Change
By: Kathy Vosmus

4/20/2012 - CITY OF PORTLAND, MAINE

MEMORANDUM

TO: City of Portland Health Plan Participants

FROM: Mike Miles, Director of Human Resources

DATE: April 2012

SUBJECT: Upcoming Health Plan Administration Services Change

You may be aware that the City is required to periodically go through a thorough process to assess whether we are getting the best value for our dollar in third party administrative services for our health insurance. Currently the third party administrator is Anthem. As a consequence of that process, which was guided by a committee of three union leaders and three City leaders, Aetna has been awarded the contract for administering our health insurance effective July 1, 2012.

This change to Aetna does not mean that your insurance coverage will change. Janice Kimball, Benefits Manager and Elizabeth Morgan, Benefits Associate will be working with the Aetna implementation team to transfer existing eligibility information from Anthem to Aetna.

Health insurance annual enrollment and weekly premium rates will be announced in late May. You will have the month of June to make changes as to who you cover under the plan. This is the time of year when you can add or drop the coverage; add or drop dependents without the requirement of a qualifying life event.

What is a third-party administrator?
Aetna will be responsible for processing health insurance claims and managing the contract and the provider network for the Point of Service health plan. The City of Portland has had this type of arrangement with our current carrier since January 2005.

Why was the change made?
The Selection Committee unanimously ranked Aetna as the strongest candidate. After a comprehensive analysis, the results indicated that Aetna is best suited to assist the City in achieving goals of controlling healthcare costs by improving health status, maximizing quality of care and more effectively contracting with the provider community.

Will this require you to change doctors?
It is highly unlikely you will need to make a change. The Aetna participating provider network is virtually identical to Anthem’s. Most providers that contract with Anthem also contract with the other major insurance carriers like Aetna.

In May you will be receiving a welcome guide from Aetna. Please keep this information. The guide will be a tool to help you understand the resources available under the health plan. This guide will include Aetna’s Member Services toll free number and website address. Aetna’s website contains very useful information including a link to the on-line provider directory. In June you will be receiving a new Aetna health insurance ID card.

Aetna is experienced in migrating large groups and is committed to ensuring a smooth transition. If you have questions, contact either Janice Kimball or Elizabeth Morgan, and they will work in partnership with Aetna to resolve your concern.