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Aetna to Provide Medical Benefits for Pennsylvania Employees

Enhanced healthcare benefits for Pennsylvania employees provided by Aetna.

News Summary

Starting January 1, 2026, Aetna will supply medical benefits to approximately 68,000 Commonwealth employees and their dependents, following a competitive bidding process. Retired employees and their dependents will also gain access to Aetna’s plans. The enhancements will improve healthcare, reducing waiting periods for new hires and expanding dental networks. These updates aim to bolster employee health and retention in the Pennsylvania state workforce.

Pennsylvania has announced that Aetna, a subsidiary of CVS Health, will provide medical benefits for around 68,000 eligible Commonwealth employees and their dependents starting January 1, 2026. The decision follows a competitive bidding process conducted in late 2024, as confirmed by the Executive Director of the Pennsylvania Employees Benefit Trust Fund (PEBTF), Don Clair.

In addition to Commonwealth employees, approximately 11,000 non-Medicare eligible Commonwealth retirees and their dependents enrolled in the Retired Employees Health Program (REHP) will also be eligible for Aetna’s medical plans. The current medical plans, Aetna PPO and Custom HMO, have been in place since 2017 and will remain unchanged until the new plans take effect.

Significantly, there will be no design changes to the PEBTF Plan of Benefits, and copayments will stay the same. Current members are not required to take any action at this time, as their existing medical plan will continue to be effective throughout 2025. An open enrollment period will be held in October 2025 for both employees and retirees, providing additional information on plan choices. Medicare-eligible retirees will also have separate open enrollment opportunities, with no alterations to their Medicare Advantage Plan.

Established in 1988, the PEBTF administers healthcare benefits for roughly 68,000 eligible employees and their dependents, alongside about 65,000 retirees and their dependents. As part of a broader strategy by Secretary of Administration Neil Weaver, enhancements to healthcare benefits have been introduced to improve employee health and bolster talent retention in state employment.

Overview of Enhanced Benefits

The enhancements include several key changes designed to improve the overall healthcare experience for Commonwealth employees:

Waiting periods for new hires have been reduced so that dependents can be added to health coverage after 30 days, instead of the previous 90 days, without the need for an additional buy-up contribution.
New hires will have the option to add prescription benefits for their dependents within the first 30 days of employment.
The dental network will expand, adding approximately 1,000 additional dentists in Pennsylvania, offering more choices to employees.
Inpatient hospice care will now be included under medical benefits for PEBTF members.
Annual maximums on dental benefits will increase from $1,500 to $2,000, while orthodontic lifetime maximums will rise from $1,750 to $2,250. Additionally, dental implants will be covered.
Vision benefits will see an increase in eyeglass frame coverage from $150 to $175, alongside the addition of coverage for transition lenses.

These recent changes mark the first adjustments to health benefits since 2020, aligning with Governor Josh Shapiro’s ongoing efforts to address workforce retention and recruitment challenges within state government. The aim is to make Pennsylvania state employment more appealing compared to the private sector, enhancing the overall employment experience for current and prospective employees.

As further developments unfold, both employees and retirees will be kept informed through the upcoming open enrollment period. This strategic enhancement to medical, prescription drug, dental, and vision benefits signifies a commitment to the health and well-being of the Commonwealth workforce.