Aetna is implementing a new guideline requiring 60 percent participation for new and existing Small Group health insurance (2-50 lives) in New York. The guideline is effective May 1, 2012.

Beginning 5/1/2012, Aetna will require a minimum of 2 subscribers to enroll. Upon meeting that threshold, Aetna defines “participation” as a minimum of 60 percent of the group being enrolled with Aetna, excluding valid waivers.

*Note* This new requirement will affect all Aetna Small Group Traditional medical plans [Aetna Open Access® Managed Choice® (OA MC) and Aetna Open Access Elect Choice® (OA EPO)]. HMO-based medical products are not affected, including their NYC Community Plans.

How participation change affects waivers

In addition, Aetna will no longer accept a waiver for a 2-person group – both group members will now need to enroll with Aetna. The following waivers remain valid for groups of 2 or more enrolled:

-Spousal group coverage

*Individual coverage, and/or other coverage through the same employer, is not considered a valid waiver.


If you have questions about these changes and how it may impact your health insurance policy renewal with Aetna, contact a New York health insurance broker.