Health Benefits
Explore healthcare benefits under the current Con Edison Retiree Health Program. Open enrollment information and program updates are mailed every November.
Plan Year 2017
|
|
Retiree Health Program |
|
|
|---|---|---|---|
|
|
Retiree Health Program CIGNA Hospital / Medical / Vision Plan Highlights |
|
|
|
|
Retiree Health Program 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 |
|
|
|
Retiree Health Program In-Network |
Out-of-Network |
Medicare Eligible |
|
Annual Inpatient Hospital Deductible |
Retiree Health Program 50 percent of Medicare Part A deductible |
50 percent of Medicare Part A deductible |
50 percent of Medicare Part A deductible |
|
Annual Medical Deductible*** |
Retiree Health Program $200 per person $600 per family |
$650 |
$650 |
|
Inpatient Hospital/Skilled Nursing Facility Admission* |
Retiree Health Program 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 |
Retiree Health Program $100 copay; waived if admitted |
$100 copay; waived if admitted |
$100 copay; waived if admitted |
|
Co-insurance |
Retiree Health Program 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 |
Retiree Health Program $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 |
Retiree Health Program $800 per person $2400 per family |
$800 per person $2400 per family $3,200 per person |
$800 per person $2400 per family $3,200 per person |
|
Routine Physical Exams and Immunizations** |
Retiree Health Program Not Covered |
Not Covered |
Not Covered |
|
Routine Mammograms |
Retiree Health Program Plan pays 100 percent, no copay |
Plan pays 100 percent no deductible |
Plan pays 100 percent, no deductible |
|
Outpatient Surgery |
Retiree Health Program Plan pays 100 percent, no copay |
Plan pays 100 percent no deductible |
After medical deductible, plan pays 100 percent |
|
Outpatient Mental Health |
Retiree Health Program After $35 office visit copay, plan pays 100 percent |
After medical deductible, plan pays 70 percent |
After medical deductible, plan pays 70 percent |
|
Vision |
Retiree Health Program 1 routine eye exam, 1 pair eyeglasses every 24 months |
1 routine eye exam, 1 pair eyeglasses every 24 months |
1 routine eye exam, 1 pair of eyeglasses every 24 months. No need to coordinate with Medicare |
|
Plan payments for covered health services are based on usual and customary charges. |
Retiree Health Program |
|
|
|
* Custodial care is not a covered health service ** Shingles vaccination is covered *** Out-of-Network & Medicare Eligible is $650 per person and $1,950 per family |
Retiree Health Program |
|
|
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