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Aetna Sanctions Q&A

As previously communicated, the Centers for Medicare & Medicaid Services (CMS) has imposed intermediate sanctions on Aetna suspending the enrollment of and marketing to new members of all Aetna Medicare Advantage and Standalone Prescription Drug Plan Contracts effective April 21, 2010.

The Q&A below should help answer some of your additional questions regarding Aetna-related marketing, enrollment and compensation issues.

1. When will Aetna stop processing applications?
Applications received by Aetna on or before April 20, 2010, regardless of the enrollment period or enrollment mechanism (i.e., paper forms, on-line, telephonic) must be processed to completion, for individual products. (See question 7 below regarding group products.) This includes requests received on or before April 20, 2010 by an agent or broker employed by or contracting with Aetna, and enrollment requests received via the on-line enrollment center (OEC) with an OEC date stamp on or before April 20, 2010.

2. For Medicare sales meetings and sponsorships (providers, community centers, etc.), can producers continue to be present and utilize the venue for member education vs. sales & marketing?
No. Producers must cancel all Medicare sales meetings, sponsorships, and other community activities.

3. When is the sanction most likely going to be released?
We do not know the duration of the suspension. Aetna is fully cooperating with CMS to ensure we quickly address the issues raised.

4. Does the sanction provide a "special enrollment period" allowing individuals who elected Aetna to switch to another plan?

5. How should producers respond to requests for home visits after 4/21?
Home visits cannot be scheduled after 4/21. Individuals who directly request home visits must be told the following: “We are unable to provide a home visit to you at this time because CMS has required Aetna to temporarily suspend marketing and enrollment in their Medicare Advantage and Prescription Drug products."

6. Can existing MA Groups continue to add enrollees post 4/21?
Yes. CMS has notified Aetna that it has granted us a limited waiver of the marketing and enrollment suspension that will take effect on April 21, 2010. The waiver allows producers to continue enrolling newly eligible retirees/members into existing, contracted Aetna Medicare Advantage Plans and Standalone Medicare Part D Prescription Drug plans.

7. Is Medicare Supplement impacted?
Medicare Supplement products are not impacted during the suspension period.

8. Will producers be compensated for May 1 effectives? Will they be compensated for applications that may already be in-house for June or July 1 effective? (Prospects can enroll 3 months in advance.)
Yes, producers will be compensated for applications that are received on or before April 20, 2010, and result in an enrolled member. If the application is received on or before April 20th, Aetna will enroll the beneficiary as of the future effective date.

9. How will Aetna handle applications mailed in by prospects during the sanction period?
Applications received on or after 4/21/2010 will be denied. Beneficiaries will receive an enrollment denial notice.

10. Can Aetna process a plan change request for current Aetna Medicare members?
Plan changes (from one Plan Benefit Package to another within the same contract) received on or after April 21, 2010, are considered enrollments and therefore must be denied. Aetna must accept and process all valid requests for disenrollment from our plan to another plan.

11. Can producers be trained on MAPD and PDP products during the sanction period?
Producers can be trained but cannot market or sell Aetna Medicare MAPD and PDP products during the sanction period.

12. Can producers become licensed and appointed with Aetna during the sanctions period?
Producers can be licensed and appointed but cannot market or sell Aetna Medicare MAPD and PDP products during the sanction period.

13. Can producers become contracted with Aetna during the sanctions period?
Producers can be contracted but cannot market or sell Aetna Medicare MAPD and PDP products during the sanction period.

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