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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.

Plan Year 2018

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

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

CIGNA Hospital, Medical, Vision Plan Highlights

OPEN ACCESS PLUS COPAY PLAN  Under 65 or Non-Medicare Eligible Under 65 or Non-Medicare Eligible Over 65 or Under 65 and on Medicare 
  In-Network  Out-of-Network  Medicare Eligible 
Annual Inpatient Hospital Deductible 50 percent of Medicare Part A deductible 50 percent of Medicare Part A deductible 50 percent of Medicare Part A deductible 

Annual Medical Deductible

$200 per person, $600 per family

$650, $1,950 per family

$650, $1,950 per family

Inpatient Hospital/skilled Nursing Facility Admission*

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

After hospital deductible, plan pays 70 percent of Semi-private room and board up to 365 days per diagnosis  After hospital deductible, plan pays 100 percent of Semi-private room and board up to 365 days per diagnosis
Emergency Room Visit $100 copay; waived if admitted $100 copay; waived if admitted  $100 copay; waived if admitted 
Co-Insurance After in-network medical deductible, plan pays 90 percent  After out-of-network deductible, plan pays 70 percent  After out-of-network deductible, plan pays 70 percent 
Physician Office Visits; Specialist Office Visits $25 copay; $35 copay  After annual medical deductible, plan pays 70 percent  After annual medical deductible, plan pays 70 percent 
Annual Out-Of-Pocket Max $800 per person; $2400 per family  $3,200 per person  $3,200 per person 
Routine Physical Exams And Immunizations**  Plan pays 100%, no copay   Not Covered  Plan pays 100%, no copay
Routine Mammograms Plan pays 100 percent, no copay  Plan pays 100 percent, no deductible  Plan pays 100 percent, no deductible 
Outpatient Surgery Plan pays 100 percent, no copay  Plan pays 100 percent, no deductible  After medical deductible, plan pays 100 percent 
Outpatient Mental Health After $35 office visit copay, plan pays 100 percent  After medical deductible, plan pays 70 percent  After medical deductible, plan pays 70 percent 
 Vision 1 routine eye exam, 1 pair eyeglasses every 12 months  1 routine eye exam, 1 pair eyeglasses every 12 months  1 routine eye exam, 1 pair of eyeglasses every 12 months. No need to coordinate with Medicare 
Preventive Care Free wellness exam for you and spouse  Not eligible  Free wellness exam for you and spouse 
Preventive Care Exam With Affiliated Physicians

1-212-935-8725

affiliatedphysicians.com
Free wellness exam for you and spouse  Not eligible  Free wellness exam for you and spouse 

 

Visit MetLife to review details about their dental insurance programs.

* Custodial care is not a covered health service

** Shingles vaccination is covered

 

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