Life, death, health, or injury -- Aetna's got an insurance policy to cover it. The company, one of the largest health insurers in the US, also offers life and disability insurance, as well as retirement savings products. Its health care division offers HMO, PPO, point of service (POS), health savings account (HSA), and traditional indemnity coverage, along with dental, vision, behavioral health, and Medicare and Medicaid plans, to groups and individuals. The health care segment covers some 24 million medical members. Aetna's group insurance segment sells life and disability insurance nationwide, and its large case pensions segment offers pensions, annuities, and other retirement savings products.
The company operates through three primary segments: Health Care, Group Insurance, and Large Case Pensions.
Aetna's Health Care segment accounts for about 85% of sales. About two-thirds of Aetna's plans are provided on an administrative services contract (ASC) basis, where employer groups take on the medical cost risks, while the remaining third are fully insured contracts. Medical products include HSA's and Aetna HealthFund's consumer-directed health plans.
The company's health care plans include behavioral health and employee assistance; Aetna Health Connections' disease management, and Cofinity, which manages provider networks for other health plans and employer groups. Outside its core medical plan offerings, Aetna is one of the largest dental insurance providers in the country, serving some 15 million members. It also provides vision plans, while prescription benefit management (PBM) services are provided through a contract with Caremark.
The much smaller Group Insurance segment primarily offers life and disability coverage. Its products include basic and supplemental group term life, group universal life, supplementary or voluntary programs, and accidental death and dismemberment coverage.
Finally, the Large Case Pensions segment manages a variety of retirement products, primarily for tax-qualified pension plans.
In 2015, the company signed 18 new accountable care organization (ACO) agreements, raising its total ACO collaborative agreement numbers; it now serves some 900,000 members. It has collaborations under contract with such companies as Carilion Clinic, Banner Health, Inova Health System, and Memorial Hermann.
Altogether, Aetna estimates that it provides benefits, information, and resources to more than 45 million individuals.
Aetna offers traditional health plans, dental plans, Medicare prescription drug coverage (known as Part D), and Medicare PPO group accounts nationwide, with a care network encompassing more than 1 million doctors and 5,600 hospitals. The company also provides privately administered Medicare Advantage health plans in about 40 states and Washington, DC, and it offers Medicaid services in about 15 states.
Group insurance products are offered in 49 states; Washington, DC; Canada, Puerto Rico, and the US Virgin Islands. Network-based HMO and/or PPO plans are offered in 40 states and Washington, DC.
Overseas, the company manages a health plan provider in India and offers coverage for expatriates (Americans working overseas) through Aetna International. Though its international operations currently account for a small fraction of sales, Aetna International has grown to serve about 400,000 customers in more than 100 nations.
The company operates in the greater Hartford, Connecticut, area; Bethesda, Maryland; and Bluebell, Pennsylvania. It also has various field locations throughout the US and in several foreign countries.
Sales and Marketing
Aetna's health plan products are marketed primarily to corporate groups through direct sales representatives and independent brokers, agents, and consultants. The company targets its marketing efforts towards small, midsized, and large (multi-site) national employer groups.
Aetna also provides services to other insurance companies, governmental units, and labor groups, as well as individual customers including college students, part-time workers, and families. Its Medicare and Medicaid plan offerings make the US government Aetna's largest customer, accounting for 30% of revenues.
Revenues have been climbing for the past five years. In 2015 it rose 4% to $60.3 billion due to growth in the largest segment, Health Care. Commercial and government premiums increased that year, as did health care fees and higher ASC membership numbers. Net income has also been on the rise and, in 2015, it increased 17% to $2.4 billion due to the higher revenue and an absence of loss on early extinguishment of long-term debt
Cash flow from operations also rose that year, increasing 15% to $3.9 billion.
Aetna's strategic goals include integrating the recently acquired Coventry business, increasing customer engagement and partnerships, managing technology improvements, and improving its relationships with health care providers. In 2016 it expanded its operations to 1,093 counties in 39 states and Washington, DC. On the other hand, the company has diminished its participation in Affordable Care Act insurance exchanges.
Though Aetna primarily provides insurance through large, employer-sponsored programs, the shifting US health care landscape has also prompted Aetna to step up its marketing efforts to individuals and small businesses in response to increasing product demand in these segments. In addition, Aetna is expanding its Medicare and Medicaid operations by expanding its coverage into new states and regions through organic and acquisitive means.
The company is also working to expand its health plan offerings in ways that mitigate rising health care costs for clients by shifting risk and decision-making responsibility onto patients. For instance, its HealthFund consumer-directed offerings combine high-deductible plans with medical expense funds (such as HSAs). Aetna is also working to grow its health information technology (HIT) operations through its ACS division, which aims to reduce unnecessary medical expenses through IT and patient management systems. The ACS division is focused on partnering with care providers to help them set up accountable care organizations (ACOs) under new government health laws.
In 2015 the company introduced its Aetna Whole Health plan in Washington. It had launched the same product in Austin, Texas, the year before.
Also in 2015, Aetna formed a new accountable care agreement with Value Care Alliance in Connecticut.
Aetna is also looking to join a larger industry trend of health insurers heading overseas to create revenue in the face of US health care reform laws. The Aetna International unit is widening coverage of expatriates by creating new plan options and by entering new service territories, especially in emerging markets such as India, China, and Africa.
Mergers and Acquisitions
Aetna's planned $34 billion acquisition of smaller rival Humana was torpedoed by a US judge in early 2017 on antitrust grounds. Aetna is slated to pay Humana $1 billion in breakup fees.
In 2014, Aetna expanded its international presence when it acquired the InterGlobal Group (now operating under the Aetna brand), which specializes in international private medical insurance for groups and individuals in the Middle East, Asia, Africa, and Europe. Later that year it acquired bSwift, which provides a technology platform offering retail shopping for health insurance exchanges and employees across the US. bSwift also provides benefit administration technology and services to employers.