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NYC Health Benefits Program
Aetna Medicare Advantage PPO Plan
On September 1, 2023, the City will discontinue the GHI/EBCBS Senior Care Plan and all other retiree health plans. The health plans offered will be:
- Aetna Medicare Advantage PPO Plan, and
- HIP VIP
On September 1, 2023, all Medicare-eligible retirees and Medicare-eligible dependents, with the exception of HIP VIP members, will be automatically enrolled in the Aetna Medicare Advantage PPO Plan.
Retirees who do not wish to be enrolled in the Aetna Medicare Advantage PPO Plan can Opt Out and enroll in HIP VIP
HIP VIP is available in the following service areas: Manhattan, Brooklyn, Bronx, Staten Island, Queens, Nassau, Suffolk, Westchester, Rockland and Orange counties.
Retirees who wish to participate in HIP VIP instead of the Aetna Medicare Advantage PPO Plan may do so by contacting Aetna at 1-855-648-0389 or by visiting Aetna's website at CONY.AetnaMedicare.com and indicating that they wish to "opt out" of Aetna Medicare Advantage PPO Plan. No opt-out form will be required. Retirees can call the Aetna NYC Retiree dedicated call center at 1-855-648-0389 (TTY: 711), Monday to Friday, 8 a.m. to 9 p.m. between May 1, 2023, and June 30, 2023 in order to opt-out of the Aetna Medicare Advantage PPO Plan and be enrolled in HIP VIP.
Retirees who are currently in HIP VIP and wish to enroll in the Aetna Medicare Advantage PPO Plan
HIP VIP members who wish to leave HIP VIP and enroll in the Aetna Medicare Advantage PPO Plan must complete the Health Benefits Program Retiree Special Enrollment/Waiver Form. Completed forms should be returned to the NYC Health Benefits Program.
Retirees who are currently in HIP VIP and wish to REMAIN in HIP VIP
Retirees who are currrently enrolled in HIP VIP do not have do to anything. They will remain in HIP VIP and will NOT be enrolled in the Aetna Medicare Advantage PPO Plan.
Retirees who do not wish to be enrolled in the Aetna Medicare Advantage PPO Plan or HIP VIP can waive City health coverage
Retirees must complete the Health Benefits Program Retiree Special Enrollment/Waiver Form to waive City health coverage. Completed forms should be returned to the NYC Health Benefits Program.
- Retirees who waive health coverage are not eligible for Medicare Part B reimbursement.
- Retirees who waive their City health coverage can re-enroll should they experience a loss of coverage or during the annual Retiree Transfer Period.
When to contact Aetna
Contact Aetna directly, between May 1, 2023, and June 30, 2023, if you are opting out of the Aetna Medicare Advantage PPO Plan. You will automatically be enrolled in HIP VIP, effective September 1, 2023.
- Online: Once on the Aetna website, scroll down to the About the Aetna Medicare Advantage PPO Plan section and click on “Opting Out Online”. You will need to “Register” in order to be verified as a City of New York Retiree.
- By phone: You can also call the Aetna NYC Retiree dedicated call center at 1-855-648-0389 (TTY: 711), Monday to Friday, 8 a.m. to 9 p.m.
When to use the Health Benefits Program Retiree Special Enrollment/Waiver Form
Use the Health Benefits Program Retiree Special Enrollment/Waiver Form, between May 1, 2023, and June 30, 2023, for any of the following reasons:
- For current HIP VIP members who wish to enroll in the Aetna Medicare Advantage Plan
- To add the Aetna Medicare Rx Drug Rider for prescription drug coverage if your union welfare fund is subject to a benefit maximum or you are no longer eligible for other Medicare Part D drug plans*
- To add the HIP VIP Rx Drug Rider for prescription drug coverage if your union welfare fund is subject to a benefit maximum or you are no longer eligible for other Medicare Part D drug plans*
- To waive City Health Benefits coverage
If you presently have the Rx drug rider in your current plan and wish for it to continue in the Aetna MA PPO plan, this form is not needed. It will occur automatically.
*If you are unsure if your union welfare fund is subject to a benefit maximum, please call them.
More 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 4/28/2023
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
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to learn more about the Aetna Medicare Advantage (PPO) plan
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to look up providers
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for information on upcoming teleconferences, webinars and in-person meetings
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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 Read More
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.
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.
Your Responsibilities
It is important that you know how your health plan works and what is required of you.Read More
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 themRead More
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. Read More
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. Read More
(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. Read More
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
