Dickerson - February 15, 2024

Aetna has released important ACA updates and highlights of plan information for 1-100 size groups in California. Q2 2024 rate change* HMO: 2.4%; OAMC/PPO: 3.5% *actual rate changes may vary by network and rating area. Aetna Small Group has two formularies: Aetna Health Exchange Plan - California – HMO, Aetna Health Exchange Plan - California - OA Managed Choice® POS, Open Choice® PPO When accessing Aetna's formulary website, you will choose a plan year and plan then click view pharmacy plan. You will then select a state - California, the site will expand to show both formulary options. Formulary update: Humira to be replaced by biosimilar products Starting on April 1, 2024, the Advanced Control Plan – Aetna formulary will no longer include Humira (adalimumab). Instead, members will have coverage for a selection of biosimilar adalimumab products. These products are lower cost than Humira. This change impacts all Small Group Aetna Funding AdvantageSM and Aetna® Fully Insured 51-100 plans , which all use the Advanced Control Plan – Aetna formulary. Members’ prior authorizations will automatically transfer to an available biosimilar product for any claims after April 1st, 2024. A new prescription for the biosimilar will be needed, but many pharmacies, including CVS Specialty® Pharmacy, will contact the provider to handle the change on the member’s behalf. Over-the-Counter Health Solution: Updated member account registration instructions With the Over-the-Counter (OTC) Health Solution, members get a $25 allowance each quarter to spend on hundreds of CVS® brand non-prescription health and wellness support products.* Members can still use their in-store benefit as usual, but will need to create an account to access program catalogs, track allowance balances online and use the OTC Health Solution app. To register, members will need to provide: • A valid email address • Basic personal information • Aetna member ID #: including the suffix identifying which subscriber or dependent they are on the plan. *$25 allowance each quarter to use on select CVS Health® brand products. Unused allowance does not carry over to the next quarter. This benefit is available to: AFA groups with effective dates of 9/1/23 or later, 51-100 Fully Insured groups in FL, KS and TX starting with October 1, 2023 effective or renewal dates and 51-100 Fully Insured groups in AZ, CT, DC, DE, GA, IA, IL, MA, MD, ME, MI, NC, NE, OH, OK, PA, SC, TN, VA, WV starting with April 1, 2024 effective or renewal dates. This benefit is not available to Fully Insured groups in MO or NJ. Fully Insured 51 – 100 product portfolio updates To offer more consistency in our Fully Insured portfolios across different markets, Aetna has updated and added new plans designs. Availability includes: • Starting with 10/1/23 effective and renewal dates in FL, KS, MO, and TX • Starting with 4/1/24 effective and renewal dates in AZ, CT, DC, DE, GA, IA, IL, MA, MD, ME, MI, NC, NE, NJ, OH, OK, PA, SC, TN, VA, and WV However, there are still differences between states, so be sure to check benefit grids and plan design documents for more state details. The member program updates pertain to the following products: • Over-the-Counter Health Solution®* • $0 CVS Health Virtual Care™** • $0 CVS Health Virtual Primary Care™*** • $0 preferred diabetic benefit† Refer to the flyer for details on the program offerings. *$25 allowance each quarter to use on select CVS Health® brand products. Unused allowance does not carry over to the next quarter. This benefit is not available in MO or NJ. **Not available on plans offered to groups based in AZ; certain locally based network plans in FL, KS, MO, and TX; or indemnity plans. Applicable plan cost sharing applies to groups located in CT and IL. ***Not available on plans offered to groups based in AZ or IL; certain locally based network plans; or Health Network Only/Open HMO and indemnity plans. Applicable plan cost sharing applies to groups located in CT. †Not available in CT, DC, DE, IL, MD, ME, NJ, OK, TX, VA, or WV. For Help Quoting Aetna, Please Contact Your Dickerson Sales Rep Today!

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