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Health Benefits

See your healthcare benefits under the current Con Edison Retiree Health Program. Open enrollment information and program updates are mailed every November.

For more information about the health care benefits that are available to you and your dependents, read the Guide to Your Explanation of Benefits and Retiree Health Program Summary Plan Description.

Plan Year 2021

Aetna pre-Medicare Plan (PDF) 
Aetna Medicare Plan (PDF)

Emblem pre-Medicare Plan (PDF)
Emblem Medicare Plan (PDF)

2021 CIGNA Hospital, Medical, Vision Plan Highlights

Printable 2021 CIGNA Plan Highlights

Effective June 1, 2021, the Cigna Retiree Health Plan for pre-Medicare and Medicare eligible participants no longer has a one-million-dollar limit. Please refer to the Cigna Pre-Medicare Summary of Benefits (PDF) and Cigna Medicare Summary of Benefits (PDF) for more information.  

Cigna Open Access Plus Copay Plan
Retirees Under 65 or Non-Medicare Eligible
Open Access Plus Copay Plan
Retirees Over 65 or Under 65 and on Medicare 
Hospital / Medical / Vision In-Network  Out-of-Network  Medicare Eligible 
Annual Inpatient Hospital Deductible 50% of Medicare Part A deductible 50% of Medicare Part A deductible 50% of Medicare Part A deductible 

Annual Medical Deductible

$375 per person, $1,025 per family

$900 per person, $2,600 per family

$850 per person, $2,450 per family

Inpatient Hospital/skilled Nursing Facility Admission*

After hospital deductible, plan pays 100% of semi-private room and board up to 365 days per diagnosis

After hospital deductible, plan pays 70% of semi-private room and board up to 365 days per diagnosis  After hospital deductible, plan pays 100% of semi-private room and board up to 365 days per diagnosis
Emergency Room Visit $125 copay; waived if admitted $125 copay; waived if admitted  $100 copay; waived if admitted 
Co-Insurance After in-network medical deductible, plan pays 90% After out-of-network deductible, plan pays 70% After deductible, plan pays 70%
Physician Office Visits; Specialist Office Visits $30 copay; $40 copay  After annual medical deductible, plan pays 70% After annual medical deductible, plan pays 70%
Annual Out-Of-Pocket Max $1,000 per person; $2,800 per family  $3,500 per person  $3,450 per person 
Routine Physical Exams And Immunizations**  Plan pays 100%, no copay   Not Covered  Plan pays 100%, no copay
Routine Mammograms,
PAP, PSA
Plan pays 100%, no copay  Plan pays 100%, no deductible  Plan pays 100%, no deductible 
Outpatient Surgery Plan pays 100%, no copay  Plan pays 100%, no deductible  After medical deductible, plan pays 100% 
 Vision 1 routine eye exam every 12 months;
 1 pair eyeglasses every 24 months 
1 routine eye exam every 12 months;
1 pair eyeglasses every 24 months
1 routine eye exam every 12 months;
1 pair eyeglasses every 24 months***

Note:

1) Plan payments for covered health services are based on usual and customary charges.
2) Should there be a conflict between this summary and the Plan Document, the Plan Document will be the final authority.

 

* Custodial care is not a covered health service
** Shingles vaccination is covered under Medical and Prescription Drug plans
*** No need to coordinate with Medicare

 

Although Con Edison currently sponsors the Retiree Health Program, the information above does not alter the company’s right to change or terminate the program at any time due to changes in laws governing employee benefit plans, the requirements of the Internal Revenue Code, Employee Retirement Income Security Act, or for any other reason. The company is not obligated to contribute any fixed amount or percentage of program costs.

 

Notice of Privacy Practices

 The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that requires Con Edison and the health plans sponsored by the company to protect your personal health information (PHI). As a participant under one of the health plans offered by Con Edison, we are required to notify you of the privacy practices that will be followed by the company and the plans and your rights concerning your personal health information.

 

Under the law and privacy practices, we have the responsibility to protect the privacy of your personal health information by:

 

1.    limiting who may see it
2.    limiting how we may use or disclose it
3.    explaining our legal duties and privacy practices
4.    adhering to these privacy practices
5.    informing you of your legal rights

A required notice describing participant’s rights under HIPAA and how medical information about you may be disclosed