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School districts in New Jersey offer Aetna and BCBS plans for employees to choose from. While Aetna is a bit higher, for almost the same coverage, across the diversity of plans (guess they did not do a good job on bidding), it is a reasonable difference.

However, a tactic that is used by local School Districts makes it cost prohibitive to select any Aetna plan. Specifically, the local district will only pay up to the amount of the Direct15 plan (BCBS) and the employee is responsible for the entire (100%) of the difference, not just their percentage if they choose any other plan.

So, for example if an employee is in a tier that they have to pay 35% of the monthly premium, and BCBS is $ 1,000 a month (not really, however its an easy number to use), then the employee has to pay $350. In the same example, if the Aetna plan is $ 1,100 a month, you would expect that the employee would have to pay 35% of the $1,100 or $385 (only $35 more per month)

However, with the local education rule that they only pay for BCBS Direct15 plans, require you to pay 100% of the difference in the plans, so the employe has to pay the $350 (35% of $1,000) PLUS the full difference ($100) of the difference of the BCBS Direct15 and Aetna Freedom 15 plan, or $450.

So, if Aetna is trying to figure out why their business has dropped off, it's because the local education boards have rules that make it cost prohibitive to have a real comparative choice.


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