Welcome to your Exclusive Provider Organization (EPO) plan
Aetna Elect Choice® EPO (Open Access) Plan

Plan overview

Here’s a plan that lets you visit any doctor and hospital in or out of the Aetna network — and you don’t need a referral

With the Aetna Elect Choice EPO (Open Access) offered by the City of New York, you get access to tools, tips, programs and services. Use them to find network doctors, estimate cost and more. You'll get benefits such as:

100% preventative in-network care coverage

No referrals

No plan deductible

$0 copay when you visit a PCP or in-network provider for annual checkups, certain screenings and immunizations

Large national network of doctors and hospitals

100% coverage for Emergency care worldwide

Hearing/Vision discount

An available pharmacy option

Enrollment in Aetna health benefits and insurance plans puts you in reach of cost-saving features and benefits for good health and exceptional member services.

“17,000 Aetna members in the NY area are already taking advantage of our great health benefits.”*

*Based on current membership data. Limitations and exclusions apply

Health and wellness benefits

Aetna can help you feel your best and also be easier on your budget.

  • Get the guaranteed lowest rates at your choice of over 10,000 gyms
  • Get a free guest pass at most gyms
  • Flexible membership options
  • Easy billing options through your bank account or major credit card
  • Save on home exercise equipment
  • Try an at-home weight loss program

Start feeling great and take advantage of these savings on some of today’s most popular weight-loss programs and meal plans.

  • Learn to control your weight long term with CalorieKing
  • Save with Jenny Craig
  • Lose weight and learn how to keep it off with Nutrisystem
  • Find out more about a medical test or procedure
  • Get help preparing for a doctor’s visit

* Plus the cost of food and the cost of shipping (if applicable). Offer applies to initial enrollment fee only and is valid only at participating centers and through Jenny Craig At Home. Each offer is a separate offer and can be used only once per member. No cash value. Restrictions may apply.

Get solid support managing your condition with the help of the disease management program.

  • Includes support for over 35 conditions including diabetes, heart disease, cancer and digestive conditions
  • Work one-on-one with a registered nurse
  • Our smart technology keeps your online personal health record up to date and compares that information to current care guidelines
  • Gain access to online resources to help supplement your progress

Learn what’s best for a healthy pregnancy and give your baby a healthy start.

  • Get educational material on prenatal care, signs of preterm labor, what to expect before and after delivery, and newborn care
  • For “high-risk” pregnancies, your nurse case manager will follow up with you with two phone calls to make sure you and baby are doing fine
  • Compare costs for doctors and health care facilities

Learn more about Aetna’s Women’s Health.

  • Great rates on vision exams, contacts, eyeglasses and LASIK
  • With Hearing Care Solutions and HearPO®, you have two options to serve your hearing needs including savings on several styles of hearing aids, a two-year supply of batteries, and much more

Save money on your health and wellbeing

  • Discounts on health and wellness products like yoga equipment, over-the-counter vitamins, and homeopathic remedies.
  • Savings on online medical consultations for several conditions in the Vital Health Network.
  • Massage therapy, acupuncture, chiropractic and nutrition services discounts through the ChooseHealthy® program.

Aetna Prescription Drug Plan

The Aetna national pharmacy network provides members with access to over 60,000 pharmacies.

And with no annual maximum limit on your coverage, here’s what you’ll pay for a 30-day supply:

  • $10 for generic medications
  • 30 percent of the total cost of the drug for formulary brandname medications, plus the difference between the formulary and generic price
  • 50 percent of the total cost of the drug for nonformulary brand-name medications, plus the difference between the nonformulary brand-name and generic price
  • For a 90-day supply through mail-order delivery, you pay a $20 copay for generic medications

Tools and resources

You’ll also get access to online tools and member services like Aetna Navigator® to make it easy for you to get answers to your health care questions — 24/7 including:

Find a doctor

Compare costs for office visits, tests and procedures

Store and share your personal health history

Track your health goals

Get instant access to claims and Explanation of Benefits statements

Research prescription drugs

Find and print ID cards and forms

Plus — your membership includes access to a wide variety of products and services. All these extras come with your coverage, so you can use them immediately by registering with Aetna Navigator®.

Questions and answers

You can use City of New York’s custom DocFind® search tool. This is the most up-to-date resource for finding participating doctors, hospitals, pharmacies and other medical providers and services.

You don’t have to choose a PCP, but you may want to. That’s because PCPs do more than provide checkups. They know you, your medical history, and they can help guide you and direct your care.

Your copay information is printed on your Aetna member ID card. You can also look in your member enrollment materials. See the Summary of Benefits Chart on pages 4 – 5 in this brochure (PDF), as well as in the Certificate of Coverage. If you can’t find the information you need, you can call Member Services at 1-800-445-8742. For the hearing impaired, call (TDD) 1-877-301-5038.

An emergency medical condition means your symptoms are sudden and severe. If you don’t get help right away, an average person with average medical knowledge will expect that you could die or risk your health. For a pregnant woman, that includes her unborn child. You do not have to get approval for emergency services.

Plan members, including covered dependents away from home, are covered for emergency and urgent care when outside their normal or home service area. (For a description of what Aetna considers an emergency, see previous question.)

You can get emergency and urgent care from a doctor, a walk-in clinic, an urgent care center or an emergency facility. In case of an accidental injury or life-threatening medical emergency where you are admitted to an inpatient facility, you (or someone on your behalf) should notify your PCP (if you have one) as soon as possible.

If you have any questions about our worldwide, 24-hour emergency coverage, please contact Member Services at 1-800-445-8742. For the hearing impaired, call (TDD) 1-877-301-5038.

You can print a temporary ID card from your secure member website.

  • Log in or register with Aetna at www.aetna.com
  • Look under “Request & Changes”
  • Select “ID card”
  • Print your temporary ID card

You can also display a digital copy of your Aetna ID card through the Aetna Mobile app.

Find what you need — wherever, whenever — with Aetna Mobile. To download your free Aetna Mobile app

To have a permanent card mailed to you, just call Member Services at 1-800-445-8742. For the hearing impaired, call (TDD) 1-877-301-5038.

*Standard text messaging rates may apply.

Go to www.aetna.com and log in or register. The Claims tab shows a quick view of the most recent claims on file. Each claim line includes the date of service, and patient and provider name. Click on the “details” link to access the Claim Details screen and view more information about the selected claim. There is also a link to search for other claims on file. Or you can call Member Services at 1-800-445-8742. For the hearing impaired, call (TDD) 1-877-301-5038.

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