Disability Management

Through its partnership with Aetna Life Insurance Company, a wholly owned subsidiary of Aetna Inc., Broadspire offers leave of absence (LOA), FMLA/state leaves, short-term disability and long-term disability programs. As one of the nation's leading diversified benefits companies, serving approximately 28.3M people, Aetna is an industry leader in the delivery of disability administration, absence management and integrated benefits.

Aetna's core disability services provide market-leading claim management and reporting capabilities from its state-of-the-art Workability® system. As all disabilities are health events related to injury or illness, Aetna takes a return-to-health/return-to-work approach to managing disability claims. The company's clinically based disability model ensures that duration guidelines are fact-based with objective benchmarks.

The return-to-work evaluation process begins at the initial assessment of the claim. From the first notification of an absence to a successful return to work, Aetna's clinically focused claim management process helps employees return to optimal health and back to work as soon as it is safe and appropriate.

Every disability claim is reviewed by members of the Aetna team, which includes nurses, physicians, medical directors, behavioral health specialists and vocational rehabilitation experts, to help ensure that applied case management resources are best suited to meet the claimant's needs.

Family and Medical Leave Act (FMLA) Administration

Aetna understands the nuances of leave management as evidenced in its expertise in managing all types of leaves including federal and state leave, sick leave, paid time off (PTO), vacation, jury duty, intermittent leave and other incidental absences.

For the convenience of our client base, Aetna uses all four types of calendars in its leave management administration: calendar year, fiscal year that is off calendar year basis, rolling 12 month period beginning with start of FMLA, and rolling 12 month period beginning at the end of FMLA.

Federal, state and company leave of absence intake is available 24 hours a day, seven days a week through Aetna's interactive voice response system (IVR) and Workability, the company's Web-based absence management system. The Workability claim administration system can track time away from work down to increments of one minute.

It also houses updated state FMLA leave laws related to each state's specific benefit, time available and benefit period. Workability automatically keeps updated account balance information based on this data. The system also houses state-specific FMLA reason and relationship laws.

Leave of Absence

Aetna provides a variety of leave types for our clients including many non-benefited leaves that have differing eligibility/approval parameters and durations. The Workability system is used to receive leave of absence claims, administer claims, and provide reports to our clients.

Aetna uses in-house resources to address the complexity of psychiatric and psychological disabilities. Individuals with mental illness disabilities will have intensive case management including direct contact by Behavioral Health Unit (BHU) specialists. The BHU also addresses claims that involve multiple providers, frequent interventions, medication management, and complex return to work issues.

Other unique case management issues include dealing with employees who become a threat to themselves or others, employees who go out on disability as a result of work conflicts or job dissatisfaction, as well as treating providers who have difficulty submitting objective evidence to support a psychiatric disability.

Aetna's in-house Behavioral Health Unit includes a licensed master's level director, two licensed master's level supervisors, eight registered nurses with psychiatric expertise and fifteen master's degreed mental health specialists (licensed social workers and licensed mental health counselors) who have an extensive range of mental health clinical expertise.