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Information and updates regarding the Aetna Medicare Advantage PPO Plan - August 11, 2023

There is no Opt-Out or Waiver deadline in effect due to an injunction issued by the court.

  • All current health plans remain in effect. No retiree will be moved into the new Medicare Advantage PPO Plan.
  • No opt-out requests made through Aetna via their call center or website will be processed at this time.
  • No waiver of City health benefits, enrollment into the Aetna Medicare Advantage PPO Plan or adding the prescription drug rider that has been submitted on the Retiree Special Enrollment/Waiver Form will be processed at this time.

Please check back frequently for additional information and updates.




Information about the Aetna Medicare Advantage PPO Plan

The City of New York, working with the Municipal Labor Committee, intends to implement a Medicare Advantage program for City retirees and their eligible dependents age 65 and over as of September 1, 2023. The new program, which will be provided by Aetna, is currently undergoing the remaining steps of the City’s contract approval process. Pending those steps, we are providing notice and information about the plan to ensure that you have sufficient advance notice about the anticipated new program and to provide information about the program's expected implementation.

Read the Announcement Letter from Commissioner Campion (this letter is also being mailed to all retirees) - PDF

View the Side-by-Side Comparison Chart of Plan Benefits - PDF

View the Side-by-Side Comparison Chart of Prescription Drug Riders - PDF

View the Aetna Cover Letter to Informational Packet - PDF

Aetna Informational Packet - PDF

View the Aetna Medicare Advantage PPO Summary of Benefits - PDF

View the Evidence of Coverage - PDF

View the Frequently Asked Questions (FAQs) - PDF  Updated 6/22/2023

For Your Doctor Brochure - PDF

Prior Authorization Information - PDF

Note: When contacting your doctor, please be sure to refer to plan name as the Aetna Medicare Advantage PPO Plan


Learn about the Aetna Continuity of Care plan

Continuity of Care cover letter - PDF

Continuity of Care brochure - PDF

Continuity of Care transition assistance form - PDF


Learn more about the Aetna Medicare Rx plan (Continental US)

Aetna cover letter with Rx plan (US) - PDF

Aetna Informational Packet with Rx (US) - PDF

Aetna Medicare Rx offered by SilverScript Evidence of Coverage (EOC) (US) - PDF

Aetna Medicare Rx offered by SilverScript Benefit Summary (US) - PDF

Aetna Medicare Rx - SilverScript Formulary - PDF


Learn more about the Aetna Medicare Rx plan (US Territories)

SilverScript Cover Letter - PDF

SilverScript Informational Packet - PDF

SilverScript Summary of Benefits - PDF

SilverScript Evidence of Coverage - PDF


Aetna Meeting Invitation - PDF


Visit Aetna’s website at CONY.AetnaMedicare.com

  • to learn more about the Aetna Medicare Advantage (PPO) plan

  • to look up providers

  • for information on upcoming teleconferences, webinars and in-person meetings

  • to obtain other important information about the plan 



For additional information and questions

Contact the Aetna NYC Retiree dedicated call center at 1-855-648-0389 (TTY: 711), Monday to Friday, 8 a.m. to 9 p.m.

Aetna will work with you to resolve any questions about the benefits, the network, or clinical transition questions.


Please visit this site frequently for updates and additional information that will be posted.



Information and Update regarding the $15 co-pay for the GHI/Empire BlueCross BlueShield Senior Care plan


Senior Care members, EmblemHealth has suspended the $15 co-pay for certain services offered through the GHI Senior Care Plan due to on-going litigation and pursuant to court order.

Until further notice, no $15 copay will be required for the services listed below.

  • Office visits (PCPs)
  • Office visits (Specialists)
  • Urgent Care
  • Allergy Testing/Injections
  • Chiropractic Services
  • Podiatry (non-Routine)
  • Cardiac Rehab
  • Pulmonary Rehab
  • Vision Care (Medicare-covered)
  • PT, OT & Speech therapy
  • Diagnostic lab/X-ray (including Hi Tech Imaging)
  • Radiation therapy
  • Partial Hospitalization - Mental Health
  • Partial Hospitalization - Substance Abuse

Previously, retirees were mailed a letter in December 2021 regarding changes to the GHI/Empire BlueCross BlueShield Senior Care plan.  View the letter



Retiree Responsibilities and Assistance


IRMAA or Medicare Part B Reimbursements

Information about Medicare and IRMAA Reimbursement  Learn More

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Medicare Part B 2022 Reimbursement

Medicare-eligible retirees and their Medicare-eligible dependents will be reimbursed annually for the standard Medicare Part B amount of $170.10 per month ($170.10 x 12 months = $2,041.20), excluding any penalties and late enrollment fees, and subject to be pro-rated. 

Medicare Part B 2022 reimbursements will be issued in April 2023. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.

If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually.

Medicare Part B 2021 Reimbursement

Medicare-eligible retirees and their Medicare-eligible dependents will be reimbursed annually for the standard Medicare Part B amount of $148.50 per month ($148.50 x 12 months = $1,782), excluding any penalties and late enrollment fees, and subject to be pro-rated. 

Medicare Part B 2021 reimbursements were issued in April 2022. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.

If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually.



IRMAA 2022 Reimbursement

IRMAA 2022 annual reimbursements will be issued during the 3rd week of October 2023. 

Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount of $170.10 per month. If you did not pay more than the standard amount then you are not eligible for IRMAA.  

  • If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should receive a check in the mail.
  • Please submit the IRMAA 2021 Reimbursement Application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net


IRMAA 2021 Reimbursement

IRMAA 2021 annual reimbursements were issued during the 3rd week of October 2022. 

Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount of $148.50 per month. If you did not pay more than the standard amount then you are not eligible for IRMAA.  

  • If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should receive a check in the mail.
  • Please submit the IRMAA 2021 Reimbursement Application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net

IRMAA 2020 Reimbursement

IRMAA 2020 reimbursements were issued in October 2021.

  • If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement was deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should have received a check in the mail.
  • Please submit the IRMAA 2020 Reimbursement Application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net



The Medicare Part B Reimbursement Program video provides information about the different types of Medicare Part B reimbursements that the City provides, as well as information to help you to see whether you qualify to receive these payments, and how to apply.

Play the video


Please note that if you were Medicare-eligible prior to 2016, you must complete the Medicare Part B Differential Form for 2019 in order to receive the Medicare Part B differential payment. The payment is based on the amount that you paid in 2019.

If you were enrolled in Medicare Part B effective after 2016, then you are already receiving the full payment and do not need to complete the Medicare Part B Differential Form.

Learn more


Your Responsibilities

It is important that you know how your health plan works and what is required of you.  Learn More

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Here are some important things that you need to remember:

  • Complete an enrollment form to add new dependents (newborn, adoption, marriage) within 30 days after the event;
  • Notify the NYC Health Benefits Program and your health plan in writing when your address changes;
  • Review your pension check to ensure appropriate premiums are deducted;
  • Know your rights and responsibilities under COBRA continuation coverage.

If You Need Assistance

Who you should contact for assistance and when you should contact them  Learn More

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Retirees with questions about benefits, services, or claims should write or call their health plan.

When writing to the plan, give your certificate number, name and address.

The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.

Retirees contacting the Health Benefits Program should always include the following information (please print clearly):

Name, Address and Telephone Number
Complete Social Security Number
Pension Number

Inquiries and questions can be emailed to: healthbenefits@olr.nyc.gov


Who Do I Contact After Retirement?

Find out who you should contact after retirement.  Learn More

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Retirees can contact the Health Benefits Program:

  • For questions concerning eligibility and enrollment
  • For questions regarding deductions for health benefits taken from your pension check
  • For Transfer Period information
  • To obtain applications to make changes to your coverage such as adding/dropping dependents, adding/dropping the optional rider, waiving health coverage and to change plans (excluding Medicare HMOs, which require a special application from the health plan).
  • For notification of enrollment in Medicare
  • For questions regarding Medicare Part B premium reimbursements
  • To obtain information and an application for COBRA benefits
  • To change your address
  • If health coverage has been terminated for you and/or your dependents

When Should I Contact My Health Plan?

Find out when you should contact your Health Plan.  Learn More

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(Refer to your health plan identification card or plan booklet for telephone numbers.)

  • If you have questions regarding covered services
  • To obtain written information about covered services
  • For information about the status of pending claims or claim disputes
  • For claim allowances (How much will a plan pay towards a claim?)
  • For health plan service areas

When writing to a health plan, include your name and address, certificate number, date(s) of service, and claim number(s), if applicable. Some plans also allow inquiries through their web sites.


When Should I Contact My Union/Welfare Fund?

Find out when you should contact your Union/Welfare Fund.  Learn More

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For information about:

  • Prescription drug coverage (if applicable)
  • Vision benefits
  • Dental benefits
  • Life Insurance (if applicable)

The Health Benefits Program is also available to provide service and information to City retirees who have questions about or problems with their health benefits or pension check deductions.

Retirees contacting the Health Benefits Program should always include the following information (please print clearly):

Name, Address and Telephone Number
Complete Social Security Number
Pension Number

Inquiries and questions can be emailed to healthbenefits@olr.nyc.gov

 

Visit the Contact Us page

Health Plan Rate Chart for Retirees