Updated Aetna AFA IMQ Requirements for NJ

Posted on October 14, 2024

Aetna has advised that effective immediately ACA clients with 5+ enrolling can get AFA quotes using census underwriting. 

ACA clients with 2-4 enrolling will still need medical apps/individual medical questionnaires.

Here’s how this change fits into Aetna’s other quoting thresholds in NJ:

Incumbent plan type	When IMQs are required
ACA Fully Insured	2-4 enrolled employees
Level Funded	2-4 enrolled employees
No incumbent (a startup/virgin group)	2-50 enrolled employees*

As usual, a group with more than 5 enrolled employees could need to do medical questionnaires if they don’t get enough hits from census underwriting.

*Clients with 51-100 eligible employees and no incumbent coverage will use the same IMQ threshold as ACA fully insured plans.