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Plan accountability

What you need to know about: Plan accountability 

What accountability measures are built into the new Aetna Medicare Advantage PPO plan?

Aetna is subject to steep financial penalties if they do not meet certain benchmarks, such as member outreach, customer service, enrollment, timely reimbursements, provider acceptance of the new plan, data reporting and more.

Major aspects of the retiree Aetna plan will be monitored and reviewed by a newly formed accountability committee, made up of representatives from the MLC and the city, and their respective consultants. Aetna will provide requested data and the committee will regularly evaluate the effectiveness of the plan in terms of member access, quality, and service.

Any issues or areas for improvement will be identified and addressed by the accountability committee to ensure that the new healthcare plan is meeting the needs of members and delivering the best possible outcomes.

How will we hold Aetna accountable?

  • Retiree dispute resolution process with an arbitrator
  • Joint committee which monitors data and reports
  • Financial performance guarantees: Aetna will pay steep penalties if the plan falls short of their promises, both for implementation and on an ongoing basis
  • Pre- and post-implementation audit to ensure transparency and the accuracy of plan rollout.
  • Cost-saving measures, such as drug rebates/discounts, will be requested on an ongoing basis.