Aetna Group Health Plans in Illinois

Aetna, now part of CVS Health, is one of the nation’s three largest group health insurers and maintains a significant presence in the Illinois employer market. The integration of Aetna’s insurance capabilities with CVS Health’s retail pharmacy, MinuteClinic locations, and specialty pharmacy services creates a distinctive value proposition for Illinois employers — particularly those whose employees value convenient access to primary care and pharmacy benefits.

CVS Health and Aetna: What the Integration Means for Members

Since CVS Health’s acquisition of Aetna in 2018, the combined company has pursued a strategy of integrating clinical care delivery with health insurance. For Illinois employers and their employees, this means:

• Access to MinuteClinic locations inside CVS Pharmacy stores for low-acuity primary care, vaccinations, and health screenings — often at lower copays than traditional office visits
• CVS Caremark pharmacy benefit management with integrated claims data between medical and pharmacy benefits
• Specialty pharmacy management through CVS Specialty for high-cost biologic and specialty medications
• Health Hubs at select CVS locations, offering expanded clinical services including chronic disease management, mental health, and audiological services

For employers with high pharmaceutical spend — particularly specialty drugs — the CVS Caremark integration can be a meaningful cost management advantage.

Aetna Group Plan Types in Illinois

Plan Product	Type	Best For
Aetna HMO	HMO	Cost-conscious groups in Aetna HMO network areas
Aetna Open Choice PPO	PPO	Maximum flexibility, in- and out-of-network access
Aetna HDHP	High Deductible / HSA	Lower premiums with HSA savings vehicle for employees
Aetna Whole Health	ACO / Narrow Network	Employers wanting accountable care outcomes with cost savings
Aetna Funding Advantage (AFA)	Level Funded	Groups 10–200 employees seeking surplus refund potential

Aetna Funding Advantage (AFA): Level Funded for Groups 10–200

Aetna Funding Advantage is Aetna’s flagship level funded product for the Illinois mid-market. AFA combines a predictable fixed monthly payment with the potential for a year-end claims surplus refund, stop-loss insurance, and access to Aetna’s standard provider networks. Groups that run significantly below their expected claims budget receive a refund of a portion of their unused claims funds. AFA also provides quarterly claims reporting so employers can track spending trends and take corrective action before renewal. This product has become one of the most popular level funded options among Illinois brokers due to Aetna’s competitive stop-loss pricing and the strength of their Illinois provider network.

Aetna Whole Health: Accountable Care Organization Model

Aetna Whole Health pairs members with a specific health system or ACO network and incentivizes care coordination and quality outcomes. In Illinois, Aetna has ACO arrangements with select health systems that deliver measurable quality benchmarks. Members who stay within the ACO network receive enhanced benefits and lower cost-sharing. Employers benefit from better per-member-per-month costs when clinical care is coordinated and preventive care utilization is high.

Behavioral Health and EAP

All Aetna group plans include behavioral health coverage, and Aetna’s behavioral health network has been substantially expanded in recent years in response to increased demand. Aetna also offers an Employee Assistance Program (EAP) that provides confidential counseling sessions, financial guidance, legal consultation, and work-life resources. EAP services are typically available to employees and their household members at no cost, separate from the medical deductible.

Contact Illinois Health Agents for current Aetna rate quotes for your group. Premiums vary by group size, age distribution, plan selection, and Illinois zip code.