Health Benefits
Health Benefits
See your healthcare benefits under the current Con Edison Retiree Health Program. Open enrollment information and program updates are mailed every November. If you do not wish to make any changes to your coverage, no action is necessary during open enrollment.
For more information about the health care benefits that are available to you and your dependents, and to understand how your insurance pays claims, read the Retiree Health Program Summary Plan Description and Guide to Your Explanation of Benefits.
2024 CIGNA Hospital, Medical, Vision Plan Highlights
Printable 2024 CIGNA Plan Highlights
The Retiree Health Plan no longer has a lifetime maximum for hospital and medical benefits.
| 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 |
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| Hospital / Medical | 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 | |||
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Annual Medical Deductible |
$375 per person, $1,025 per family |
$900 per person, $2,600 per family |
$850 per person, $2,450 per family | |||
| Annual Out-Of-Pocket Max | $1,000 per person; $2,800 per family | $3,500 per person | $3,450 per person | |||
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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% | |||
| Routine Preventive Care 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 |
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You automatically receive vision benefits when you elect any of the medical/hospital plans. However, the vision plan is administered by CPS Optical. All questions and claims associated with vision benefits should be directed to CPS Optical.
Plan Year 2024 Summary of Benefits
Get a more detailed explanation of coverage for each of the plans offered under the Con Edison Retiree Health Program. If you have additional questions, please contact the health care insurance providers.
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