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Aetna Inc  (AET)
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    Sector  Financial    Industry Accident & Health Insurance
 
 


Aetna Inc Segments

 
Health Care
   96.14 % of total Revenue
Group Insurance
   3.77 % of total Revenue
Large Case Pensions
   0.09 % of total Revenue
 

Business Segments (Sep. 30, 2015)
Revenues
(in millions $)
III. Quarter
%
(of total Revenues)
(Sep. 30, 2015)
Income
(in millions $)
III. Quarter
%
(Profit Margin)
Health Care
14,202.30 96.14 % 675.40 4.76 %
Group Insurance
557.50 3.77 % 25.60 4.59 %
Large Case Pensions
13.00 0.09 % 4.40 33.85 %
Total
14,772.80 100 % 705.40 4.77 %

• View Income Statement • View Competition by Segment • View Annual Report

Growth rates by Segment (Sep. 30, 2015)
Y/Y Revenue
%
III. Quarter
Q/Q Revenue
%
(Sep. 30, 2015)
Y/Y Income
%
III. Quarter
Q/Q Income
%
Health Care
2.19 % -1.49 % 7.96 % -4.6 %
Group Insurance
-0.36 % -1.43 % -46.56 % -42.86 %
Large Case Pensions
85.71 % 42.86 % -10.2 % -29.03 %
Total
2.13 % -1.46 % 3.98 % -7.06 %

• View Growth rates • View Competitors Segment Growth • View Market Share

To get more information on Aetna Inc's Health Care, Group Insurance, Large Case Pensions, Total segment. Select each division with the arrow.

  Aetna Inc's

Business Segments Description



Health Care:

Health and dental benefit products (including health maintenance organization, point-of-service, preferred provider organization and indemnity products)

Group Insurance:

Group insurance products (including life, disability and long-term care insurance products)

Large Case Pensions:

Retirement products (including pension and annuity products) primarily for defined benefit and defined contribution plans

1. Health Care

Products and Services

Health Care consists of health, dental and pharmacy plans offered on both a risk basis (where the Company assumes all or a majority of the financial risk for health care costs) (“Risk”) and an employer-funded basis (where the plan sponsor under an administrative services contract, and not the Company, assumes all or a majority of this risk) (“ASC”). Health plans include health maintenance organization (“HMO”), point-of-service (“POS”), preferred provider organization (“PPO”) and indemnity benefit products (“Indemnity”).

HMO plans offer comprehensive benefits generally through contracts with participating network physicians, hospitals and other providers. When an individual enrolls in one of the Company’s HMOs, he or she generally selects a primary care physician (“PCP”) from among the physicians participating in our network. PCPs generally are family practitioners, internists, general practitioners or pediatricians who provide necessary preventive and primary medical care, and are generally responsible for coordinating other necessary health care, including making referrals to participating network specialists. Preventive care is emphasized in these plans. The Company also offers an open access HMO plan in certain markets that provides for the full range of benefits available to HMO members without the requirements of PCP selection or PCP referrals.

POS plans blend the characteristics of HMO and indemnity plans. Members can have comprehensive HMO-style benefits for services received from participating network providers with minimum co-payments, but also have coverage, generally at higher co-payment or co-insurance levels, for services received outside the network.

PPO plans offer coverage for services received from any health care provider, with benefits paid at a higher level when care is received from a participating network provider. Coverage typically is subject to deductibles and co-payments or coinsurance.

Provider Networks

The Company contracts with physicians, hospitals and other health care providers for services provided to its health plan members. The participating providers in the Company’s networks are independent contractors and are neither employees nor agents of the Company, except for providers in the Company’s new mail order pharmacy facility.

The Company uses a variety of techniques designed to help reduce inappropriate utilization of medical resources and maintain affordability of quality coverage. In addition to contracts with health care providers for negotiated rates of reimbursement, these techniques include the development and implementation of standards for the appropriate utilization of health care resources and working with health care providers to review data in order to help them improve consistency and quality. The Company also offers, directly or in cooperation with third parties, a variety of disease management programs related to specific conditions such as asthma, diabetes, congestive heart failure and lower back pain.

Provider Network Contracting

Primary Care Physicians

The Company compensates PCPs on both a fee-for-service and capitated basis, with capitation generally limited to HMO products. In a fee-for-service arrangement, network physicians are paid for health care services provided to the member based upon a fee schedule. Under a capitation arrangement, physicians receive a monthly fixed fee for each member, regardless of the medical services provided to the member. In recent years, the Company has eliminated or reduced the use of capitation arrangements in many areas.

Specialist Physicians

Specialist physicians participating in the Company’s networks are generally reimbursed at contracted rates per visit or procedure.

Integrated Delivery Systems and Delegated Arrangements

In select markets the Company has developed contractual relationships with independent practice associations, integrated delivery systems and other third parties for the provision of certain health care services. Under some of these arrangements, the Company pays a fixed, per member fee or a percentage of premium and may delegate to the third party associated claim processing, utilization management and/or provider relations activities. Most providers participating in these arrangements have agreed to look solely to the third party for payment, but if the third party fails to pay, the Company may be exposed to demands for reimbursement.

The Company’s HMO and POS plans typically employ capitated payment arrangements for most mental and behavioral health, substance abuse and freestanding laboratory services. These services are generally reimbursed on a contracted, fee-for-service basis under the Company’s other products.

Hospitals

The Company typically enters into contracts with hospitals that provide for per diem and/or per case rates, often with fixed rates for ambulatory surgery and emergency room services. The Company has some hospital contracts that pay a percentage of billed charges.

The Company’s plans generally require notification of elective hospital admissions, and the Company monitors the length of hospital stays. Participating physicians generally admit their HMO and POS patients to participating hospitals using referral procedures that direct the hospital to contact the Company’s patient management unit, which confirms the patient’s membership status while obtaining pertinent data. This unit also assists members and providers with related activities, including the subsequent transition to the home environment and home care, if necessary. Case management assistance for complex or “catastrophic” cases is provided by a special case unit.

Quality Assessment

The Company’s quality assessment programs begin with the initial review of health care practitioners. Each practitioner’s license and education are verified and work history is collected by the Company or in some cases by the practitioner’s affiliated group or organization. A committee of participating practitioners in each region reviews this information before the practitioner can participate in the network. Participating practitioners also periodically undergo a recredentialing process. Participating hospitals are required to have CMS and Joint Commission on Accreditation of Healthcare Organizations accreditation or undergo a detailed site assessment by the Company’s quality management staff.

Recredentialing of practitioners may include an analysis of member grievances filed with the Company, interviews, member surveys, and analysis of drug prescription and other utilization patterns. Committees composed of a peer group of participating practitioners review participating practitioners being considered for recredentialing.

The Company also offers quality and outcome measurement programs, quality improvement programs and health care data analysis systems to providers and purchasers of health care.

2. Group Insurance

Principal Products

Group Insurance consists primarily of the following:

Group Life consists principally of renewable term coverage, the amounts of which may be fixed or linked to individual employee wage levels. Basic and supplemental term coverage and spouse and dependent coverages are available. Group universal life and accidental death benefit coverages are also available.

Group Disability provides employee income replacement benefits for both short-term disability and long-term disability. The Company also offers disability products with additional case management features. Group disability benefits are offered on both an insured and employer-funded basis.

Long-Term Care provides benefits for long-term, custodial care expenses in a nursing home, adult day care or home setting. Long-term care benefits are offered primarily on an insured basis. The product is available on both a service reimbursement and disability basis.

3. Large Case Pensions

Principal Products

Large Case Pensions manages a variety of retirement products (including pension and annuity products) offered to Internal Revenue Code Section 401 qualified defined benefit and defined contribution plans. Contracts provide nonguaranteed, experience-rated and guaranteed investment options through general and separate account products. Large Case Pensions’ products that use separate accounts provide contractholders with a vehicle for investments under which the contractholders assume the investment risk. Large Case Pensions earns a management fee on these separate accounts.


   

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