STPAetna MedicareSMPlansDo you want more choices to meet your health care needs?We can help with plans that give you more options than what Original Medicare offers. Some plans include wellness programs and savings on a wide range of products and services. Medicare Advantage plans (Part C) Medicare Supplement Insurance plans (Medigap) Medicare prescription drug plans (Part D) Aetna Medicare Advantage Plans (Part C)Our Medicare Advantage plans offer you the same type of services as Original Medicare (Parts A and B). And some plans offer coverage foradditional benefits, such as dental, vision, hearing and wellness. You get all your benefits in one plan, with or without prescription drug coverage (Part D). You choose whats right for you. Aetna Medicare Supplement Plans (Medigap)These plans will help cover some of the health care costs that Original Medicare doesnt cover. Get the freedom to visit any doctor or hospital that accepts Medicare by choosing Medicare Supplement insurance. Prescription drug coverage (Part D) isnt included, but stand-alone Part D plans are available.See if we offer Medigap plans in your state. Aetna Medicare RxPlans (Part D)You can choose from a variety of plans that offer preferred pharmacy benefits for additional savings. Or plans that offer greater flexibility with standard savings, including $0 deductible and gap coverage plans. You can add these pharmacy benefits to your Original Medicare (Parts A and/or B), and Medicare Supplement plans (Medigap). Private Fee-for-Service plans (PFFS) Medicare Medical Savings Account plans (MSA) Some Medicare cost plansPostisioning strategyhttps://books.google.co.in/books?id=_QwAAAAAMBAJ&pg=PA42&lpg=PA42&dq=positioning+strategy+of+Aetna&source=bl&ots=mOQYfr2ypO&sig=M66oTG-6ydPd_6AeQDq4AB_GOOY&hl=en&sa=X&ei=c80oVZDhOoKtuQTMl4DoCg&ved=0CD4Q6AEwBQ#v=onepage&q=positioning%20strategy%20of%20Aetna&f=falseProactive strategiesPHOENIX, August 26, 2014 Aetna (NYSE:AET) and Banner Health Network (BHN) today announced that their accountable care collaboration resulted in a shared savings of approximately $5 million on Aetna Whole Health fully-insured commercial membership in 2013 and a five percent decline in average medical coston the members. At the same time, Aetna and BHN improvedcancer screening rates, blood sugar management in diabetic members and reduced avoidable hospital admissions. The results demonstrate thatpatients benefit when physicians and health plans share resources and work together in accountable care models.Further, Aetna and BHN saw savings and improved medical cost trend on additional membership outside the Aetna Whole Health product.An accountable care collaboration is a group of health care providers who assume responsibility for the quality and cost of care for a group of patients. The collaboration between BHN and Aetna gives consumers and employers better health care options. Consumers who receive care in this new model save money by using providers in BHN. They also benefit from a more coordinated, personalized experience that is designed to produce better overall health outcomes.Through care coordination by a clinical team and proactive management of patients needs, rather than episode-based treatment of illness, providers in accountable care models can provide more efficient and cost-effective care. Health plans support the practice with relevant patient care data, analysis and quality measurement along with financial rewards for improved care quality.Aetna and BHN have a collaborative relationship that is to the benefit of our members and employers, said Chuck Lehn, BHNs Chief Executive Officer. These results are rewarding because they validate our model -- it is possible to deliver quality care at more affordable prices.Aetna and BHN began their accountable care collaboration in 2011 and the tools and learning from this relationship supported BHNs Medicare Pioneer Accountable Care Organization (ACO) model in 2012. Aetna and BHN offer the Aetna Whole Health plans ACO-centered health plan products to employers and individuals in the Phoenix area. The products are also available to individuals on the public exchange. In addition, Aetna care management and technologies support BHN in delivering patient-centered, accountable care to its Pioneer Medicare beneficiaries as well as Banner Health employees in seven states.The success of this collaboration demonstrates that insurance carriers and providers can work together in a unified approach to provide quality, coordinated care while reducing health care costs, said Tom Dameron, Aetnas local market president for Arizona. We look forward to continuing our relationship with Banner to help our members live healthier, more productive lives.Significant results seen during the second full year of the accountable care collaboration between Aetna and BHN include: Improvements in cancer screening rates, including cervical and colorectal cancer screening; Reductions in the percent of diabetic members with poorly controlled blood sugar levels; Reductions in radiology services of approximately 9 percent; Increases in generic prescribing rate by almost 4 percent; and Reductions in avoidable admissions by approximately 9 percent.Aetna is working with health care organizations across the country to develop products and services that support value-driven, patient-centered care for all health care consumers. Nationally, more than 2.3 million members are served by value-based health care models.About Banner Health NetworkBanner Health Network was designed to provide a highly coordinated patient care experience for beneficiaries of government and private sector insurance plans. BHN is comprised of 3,000 Banner Health-affiliated providers, caring for 300,000 covered lives. With a population health management focus, and a sophisticated health information technology as support, Banner Health Network seeks to provide high quality care at an affordable price. Parent company, Banner Health, is one of the largest nonprofit health systems in the country, with operations in seven states. For more information go towww.BannerHealth.comAbout AetnaAetna is one of the nations leading diversified health care benefits companies, serving an estimated 45 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers compensation administrative services and health information technology products and services. Aetnas customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates.Learn more about Aetnas journeyto make quality health care more affordable and accessible for all.www.aetna.com@aetna

Challenging situations

Fines, lawsuits and settlements[edit]1999[edit] A jury in California awarded $116 million inpunitive damagesfor "malice,oppressionandfraud" to a patient's widow who contended he died after a subsidiary of Aetna delayed approving treatment forstomach cancerthat its own doctors had recommended. Lawyers on both sides called it the largest such verdict against ahealth maintenance organization. In 2001 a settlement was reached.[56][57][58]2000[edit] TheU.S. Court of Appealsaffirmed a $1,855,000 federal jury award for Brokerage Concepts Inc. (BCI) against Aetna U. S. Healthcare (formerly U. S. Healthcare), its Pennsylvaniasubsidiary, and one of its former senior executives, Richard Wolfson. In its suit, BCI accused Aetna U. S. Healthcare oftortious interferencewith contractual relations. BCI alleged themanaged-carecompany used its economic power in the business ofprescription drugsales tocoerceone BCI's clients, the "I Got It at Gary's"pharmacychain, into using another Aetna U. S. Healthcare subsidiary, Corporate Health Administrators, as its health benefits management firm. According to the suit, Aetna U. S. Healthcare threatened to drop "I Got it at Gary's" from its pharmacy network if the company didn't switch to Corporate Health Administrators.[59]2001[edit] The MarylandInsurance Commissionerordered five Maryland health plans to pay a total of $1.4 million in penalties for failing to comply with the state's claims payment practices; Aetna was cited twice and ordered to pay the largest fine of $850,000.[60] The State of Texas fined Aetna $1.15 million for failing to promptly pay doctors and hospitals for services. Texas Insurance Commissioner Jose Montemayor also ordered Aetna to payrestitutionto physicians and health care providers who did not receive timely payment for claims.[61]2002[edit] TheNew York Department of Insurancefined Aetna US Healthcare andUnitedHealthcarea total of $2.5 million, citing a litany of bungled claims, improper treatmentdenials, unlicensed healthinsurance agents, and poorly performing claims processors using out-of-datesoftware.[62] Aetna agreed to streamline communications, reduce administrative complexity, and improve the quality of the health care system, endinglitigationbetween Aetna and 700,000physiciansand medical societies. The physicians'lawsuit, settled for $470 million, charged Aetna with systematically reducing payments to physicians and overriding their treatment decisions.[63]2003[edit] Aetna and theAmerican Dental Association(ADA) announced a class-action settlement by dentists who accused Aetna of interfering with dental procedures to cut costs and forcing dentists to comply with excessive paperwork. The settlement called for Aetna to pay $4 million to 40,000 to 50,000 dentists and $1 million to the ADA Foundation, acharitablegroup.[64] Georgia Insurance CommissionerJohn W. Oxendinefined Aetna's Prudential Health Plan $100,000 for violating Georgia's prompt pay law by delaying claims payments. Aetna companies had been fined four previous times by Oxendine's office, in 2000 and again in 2002, for a total of $411,200.[65]2007[edit] The New Jersey Department of Banking and Insurance filed an administrative order levying a $9.5 million fine against Aetna for refusing to appropriately cover certain services provided by out-of-network providersincludingemergency treatmentin violation of New Jersey rules and regulations.[66]2009[edit] Former Aetna employee Cornelius Allison ofDarby, Pa., filedsuitagainst Aetna in U. S. District Court in Pennsylvania afterhackersgained access to a companyWeb siteholding personal data for 450,000 current and former employees as well as job applicants. The suit charged Aetna withnegligence,breach of contract,negligent misrepresentationandinvasion of privacy.[67] The Arizona Department of Insurance fined Aetna Life Insurance Company and Aetna Health, Inc. after examination of their practices exposed multiple violations of Arizona insurance laws. The department found that Aetna violated significant state laws governing important areas of health insurance operations, including Aetna's: failure to provide policyholders with information about their rights onappealsof medical claims or services denials; failure to acknowledge receipt of policyholder appeals; failure to notify policyholders about appeal decisions/outcomes; and, in some appeals involving the denial of services for potentially life-threatening conditions, failure to inform policyholders of their decision within the required, expedited time frames.[68]2010[edit] Aetna paid a $750,000 fine as part of a settlement with theNew York Insurance Departmentrelated to the company administering an affordable healthcare plan for the state. Aetna's violations included failing to provide a required 30-day notice of rate increases to about 946 members in 2007, failing to provide notice to 1,406 terminated workers of their rights to convert to another policy, failing to report enrollment data from May 2007 through August 2008, and failing to respond to Insurance Department requests for data in March 2008.[69]Life insurance policies on slaves[edit]In 2000 Deadria Farmer-Paellmann, head of the nonprofit Restitution Study Group of Hoboken, New Jersey, disclosed that from approximately 1853 to approximately 1860 Aetna had issued life insurance policies to slaveowners covering the lives of their slaves.[70]Aetna acknowledged that concrete evidence exists for Aetna issuing coverage for the lives of slaves and released a public apology.[71]In 2002, Farmer-Paellmann brought suit against Aetna and two other companies in federal court asking for reparations for the descendants of slaves. The lawsuit said Aetna,CSXand Fleet were "unjustly enriched" by "a system that enslaved, tortured, starved and exploited human beings. " It argued thatAfrican-Americansare still suffering the effects of 2 centuries of enslavement followed by more than a century of institutionalized racism. The complaint blamed slavery for present-day disparities between blacks and whites in income, education, literacy, health, life expectancy and crime.[16]This suit was denied, and the denial largely upheld on appeal.[72][73]In 2006, Farmer-Paellmann announced a nationwideboycottof Aetna over the issue ofreparationsfor its policies covering slaves. Aetna stated that its commitment to diversity in the workplace and its investment of over 36 million dollars in such areas as education, health, economic development, community partnerships, andminority-owned businessinitiatives in the African-American community is more effective at aiding descendants of slaves and African-Americans in general than making restitutions for Aetna's life insurance policies on slaves.[74][75][76][77][78][79]

Marketing Research Process ( change according to your Company)Marketing Research process By Express ScriptsProblem Definition: When specialty drugs started coming in the market , Express scripts had to change the way they were dealing in providing drugs. Research Design: In depth interviews were done for the various segments such as for children being treated for ADHD the parents were interviewed for adherence levels in children for therapy.Data Collection: Data collection is done on a regular basis.Data Analysis: graphs are used for analyzing the trends and decision models are used for formulating new techniques. They hire different organizations for market research.Report: Express Scripts adjusts again to offer payers and patients solutions to effectively manage the distribution and utilization of these medications while also providing patients with clinical support and expertise to help them take their medications safelyFollow Up: follow up is done via feedback and frequently asked questions over a period of time to know more about the products and services being offered.LAunchhttps://news.aetna.com/news-releases/?s=launchBrand developmenthttp://www.siegelgale.com/services_detail/brand-development/

After Sales Serviceshttp://www.aetnagroup.com/bom/downloadfree.asp?lib=Files&ID=5074&UT_ID=

http://www.aetna.com/investors-aetna/assets/documents/2013%20Investor%20Conference/2013-Investor-Conference-Presentation.pdfDistribution channelAbout Swiss Life NetworkSwiss Life Network is a global association of 60 leading local life insurance companies and business partners. Through this network, Swiss Life offers comprehensive employee benefit solutions, including life insurance, pension and health solutions for over 400 multinational corporations in 70 countries and territoriesworldwide. The Swiss Life Network, founded 1962, is the leading global employee benefits network and a pioneer of the international risk pooling concept. Swiss Life Network has the objective to provide top-quality employee benefit solutions to multinational corporations around the globe for their international and local employee benefit needs. For more information, seewww.swisslife-network.com.

The health insurance industry operates through two types of organizations: independent insurance companies and managed care organizations. Independent insurance companies offer traditional plans where acertain amount or percentage of medical costs arereimbursed in exchange for regular monthly payments to the company, which is called apremium.Unlike traditional insurance providers, managed care organizations (XLV) enter into a contract with a set of health care providers, called the plans network, to provide care for members at reduced costs.

PhysiciansAetna reimburses the PCPs participating in its network on both a fee-for-service basis and capitation basis. In a fee-for-service payment method, physicians are paid for services provided to members at a fixed rate for the services provided.Capitation is a form of risk sharing arrangement where the physician receives a monthly fixed fee for each member. This method closely aligns the financial incentives of the physician and the managed care organization, as lower medical costs help physicians earn higher profits. Aetna, however, uses capitation only in certain geographic areas and in case of HMO offerings.Managed care organizations such as Aetna (AET), Humana (HUM), Cigna (CI), and Anthem (ANTM) use capitation payment methodology to pay PCPs because they act as gatekeepers in an HMO network. Individuals enrolled in an HMO can seek specialty care only if their PCPs refer them, thus making the PCPs directly responsible for the HMOs medical service utilization. Aetna reimburses its specialist physicians at contracted rates per visit or per procedure.HospitalsAetna typically pays the hospitals in its network on a per-day or per-case basis and generally has fixed rates for ambulatory, surgery, and emergency services. The company also monitors the length of stay of the patients to control wasteful usage of services. Aetna uses the fee-for-service model to pay laboratory, imaging, urgent care, and other freestanding health facility providers.

Private label?The term private-label health plan derives from the common retailing practice in which a well-known manufacturerperhapsa clothingmanufacturerallows a retailer to sell its product under a label selected by the retailer.

What it isIn its basic form, Aetnas private-label health plan is a limited or tiered network benefit plan where Aetna holds the insurance license and performs its traditional insurer functions while the health system acts as the leading in-network provider.Private-label plans are intended to capitalize on the characteristics of limited network plans. We use traditional benefit design strategies and steering mechanisms such as copayment differentials to financially reward the individual for staying within the network, says Kennedy.Aetna is looking to form private plans with the dominant health systems or physician organizations in a market. We attempt to pick a provider that an employer would buy, says Kennedy.

USPhttp://www.summit-re.com/files/published/Administrative_Services_Only.pdfEthicshttp://www.aetna.com/investors-aetna/assets/documents/code-of-conduct.pdfCSrhttp://www.aetna.com/investors-aetna/assets/documents/code-of-conduct.pdfSustainable pg 27CVPhttp://thesavvystrategist.com/2011/03/28/making-a-good-customer-value-proposition-better-3/Customer satisfaction surveyhttp://insurancecompanyreviews.about.com/od/Insurance_Company_Reviews/fr/Aetna-Health-Insurance-Company-Review.htmhttp://articles.latimes.com/2013/mar/11/business/la-fi-mo-health-insurance-rankings-20130311