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Health Benefits
HMOs > Aetna HMO



Aetna HMO

Aetna is available to City of New York employees and non-Medicare retirees in the following regions: 

  • The five boroughs in New York City
  • Dutchess county
  • Nassau county
  • Orange county
  • Putnam county
  • Rockland county
  • Suffolk county
  • Sullivan county
  • Ulster county
  • Westchester county
  • The entire states of New Jersey, Connecticut, and Delaware
  • A number of counties in Georgia, Maryland, Massachusetts, North Carolina, Pennsylvania, and Washington, DC

Each Aetna member selects a participating primary care physician to coordinate his/her care and issue specialist and hospital referrals. Preventative care exams such as routine Adult Physical Exams and Immunizations, Well-Child Exams and Immunizations are covered at 100%. 

There are no deductibles to pay.  Additionally, members have access to:

Aetna NavigatorTM, Aetna’s member website that provides a single source for online health and benefits information 24 hours a day, 7 days a week at www.aetna.com. Through Aetna Navigator, members can change their primary care physician, replace an ID card, research Aetna’s products and programs, contact Aetna directly and access a vast amount of health and wellness information. Aetna Navigator also includes secure, personalized features for members who register on the site including access to claim and benefit status. Additionally, members can contact their designated member services team and customize their home page to meet their individual health needs.

DocFind®, an online provider list located at www.aetna.com; InteliHealth®, an online consumer health information network located at www.intelihealth.com; and Informed Health® Line, a telephonic nurse line available 24 hours a day, 7 days a week.

Aetna Special Medical Programs

Disease Management -- Specific programs are aimed at slowing or avoiding complications of certain diseases through early detection and treatment to help improve outcomes and quality of life. The programs include: Low Back Pain, Asthma, Heart Failure and Diabetes.

The Moms-to-Babiesâ„¢ Maternity Management Program-- A management program to help identify at-risk pregnancies, which are given special attention from nurse case managers.

Natural Alternatives-- A program that offers contracted discounted rates for alternative types of health care (e.g., chiropractors [for chiropractic care not covered under the medical plan], acupuncturists, massage therapists and nutritional counselors), all available without a referral or precertification.

Vision One® Discount Program -- A program that offers significant discounts on eye care needs, such as prescription eyeglasses, contact lenses, non-prescription sunglasses, contact lens solutions and eye care accessories. Members can call 1-800-793-8618 to find the Vision One®locations nearest to them. This benefit is in addition to, not in place of, members’ union welfare fund vision benefits.

Prescription Drugs
An Optional Rider benefit is available for prescription drug coverage with a three-tier copay structure: $10 for generic drugs/30% for formulary drugs/50% for non-formulary drugs, for a 30-day supply, mandatory generic, available at retail pharmacy.  Mail Order Delivery for prescription drugs is  $20/30%/50% for a 31-90 day supply.  Once maximum is met there are no copays or coinsurance. 

Cost
Please see rate chart for payroll and pension deductions.
See the rate page

For More Information
For more details, refer to the City of New York/Aetna Commercial packet. To speak to a customer service representative, call (800) 445-8742, 8:00 am - 6:00 pm, Monday through Friday. You can send your questions in writing to:

Aetna
99 Park Avenue
New York, NY 10016
Attn: City of New York Department
Visit the Plan Web site

Updated to reflect health plan changes effective January 1, 2008. 

 

 

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