Lawmaker raises concerns over Aetna contract

Rep. Stanley Torres (Ind-Saipan) has raised some concerns about the rate plans offered by health insurance carrier Aetna Global for retirees and members of the NMI Retirement Fund.

Torres told Saipan Tribune yesterday that he wrote to Fund board chair Sixto K. Igisomar and Fund administrator Richard Villagomez more than a month ago for clarification on the new rates but he has yet to receive a response from the two.

According to Torres’ Nov. 1 letter to the Fund, he said the insurance carrier has disregarded the mandates of the Public Health Service Act, which provide insurance coverage for adult children up to age 26, rescissions, and prohibition of lifetime limits.

Torres said that since Villagomez was part of the parties that negotiated the contract with Aetna, “it is imperative that this issue be placed on the agenda for resolution.”

“The high costs of medical services especially with serious conditions such as cancer, heart, and other diseases place families under grave financial predicament. The lifetime limit of $1 million for patients with these conditions is inadequate,” Torres stated in his letter, adding that the Public Health Service Act has restricted lifetime limits such as this.

Torres said that several of his constituents are in this predicament and have sought his help on this matter. Some of these constituents have even moved to the U.S. mainland to seek better medical services, he added.

Igisomar told Saipan Tribune yesterday that Torres’ concerns have already been considered and are in fact incorporated in the new rate options approved by the Fitial administration. He apologized for not immediately responding to Torres and assured that a letter indicating the same will be sent soon.

The Department of Commerce, headed by Igisomar, approved Aetna Global’s rate hike proposals early this month, boosting members’ premium payments from 8 to 18 percent.

This decision was made after being informed by the Department of Health and Human Services (which was earlier asked to review Aetna’s options pursuant to the Patient Protection and Affordable Care Act) that Aetna is classified as a large group plan and is not subject to federal review because it is not included in the categories stipulated in the federal act.

Under the new plan, government employees will have two options to choose from: the high option and the low option. In the high option, which has 80/20 percent sharing between government and the member, an increase of 18.54 percent was approved. For the low option, which has sharing of 70/30 percent, it reflects an 8.73 percent increase.

Among other benefits under the new options are the no annual maximum, no lifetime plan maximum, and the coverage of dependents up to age 26 regardless of student/residence/marital status. The new plan also adds service providers such as St. Luke’s Medical Center, Makati Medical Center, and others.