Aetna One comes in three tiers: Essentials, Flex and Choice, with rising clinical touch.
Aetna describes Aetna One in three tiers called Essentials, Flex and Choice. The tiers differ by how much clinical support is wrapped around the member.
What the program is and what members do.
Essentials
Aetna calls Essentials a more cost-effective solution for major health events. The carrier says it focuses on acute, short-term care episodes and support to help avoid hospital admissions.
Flex
Aetna says Flex takes it a step further to help spot potential chronic conditions before they begin. The carrier describes a single nurse for the family for acute and chronic care and an expanded care team.
Choice
Aetna says Choice features the highest level of clinical touch. The carrier lists group coaching, integrated utilization management and expanded staffing, all wrapped around a single nurse model for acute and chronic care management.
Eligibility, funding and plan design.
Who can use it
Aetna’s care management page addresses employers and their employees and does not state a line of business or group size. A related Aetna page describes the three-tiered Aetna One program under commercial plans. Confirm eligibility for the group.
How it is funded or sold
The page does not state how any tier is priced or sold. Aetna calls Essentials more cost-effective, which is relative positioning and not a number. Ask for the fee, if any, for each tier.
Where it fits in plan design
The choice of tier is a choice of how much clinical support to attach to the medical plan. It does not change benefits or cost sharing on this evidence. We would match the tier to the group’s claims profile and workforce rather than default to the highest level.
What to settle before relying on it.
Which tier is in our proposal, and why?
We would ask Aetna which tier it has priced for the group, what the others would add, and whether moving between tiers mid-year is allowed.
What does each tier cost?
The page gives no pricing. We would ask for the fee by tier, whether it is per employee or built into the rate, and how it appears on the renewal.
What staffing and reporting come with the tier?
Aetna mentions expanded staffing and an expanded care team in the higher tiers. We would ask who the group’s nurses are, where they sit and what reporting the employer receives.
Common questions about this program.
What is the difference between the tiers?
Aetna describes Essentials as focused on acute, short-term episodes, Flex as adding chronic condition support and a single nurse for the family, and Choice as the highest clinical touch with group coaching.
Does Aetna publish tier pricing?
Not on the page we read. Ask for it in the proposal.
Can any group choose any tier?
The page does not say. Confirm with Aetna which tiers are available for the group’s size and funding arrangement.
Where these details come from.
This page summarizes what Aetna publishes. Programs change, so confirm current details with the carrier before relying on them.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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