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Changes, Coverage, and Coordination
You don't have to guess if your current doctor is in the Aetna network. You can find out right now with our online search tool.
Just click on the links below to find doctors or dentists in your area. Please note, you will need to "Continue as a guest" on the right side of the provider directory home page.
To see if your doctor is in our network, click a plan link below.
Some providers who accept Aetna may not appear in search results. If you receive a message of “No results were found” after a provider search, please call Aetna at 1-866-267-1091 to verify the provider’s network participation. We apologize for any confusion.
NYP Select Physicians is a group of physicians who have agreed to participate in the NewYork Presbyterian-Aetna plans. They do not participate in any other Aetna plan. Please review the NYP Select Physician list for your provider.
For your medical services, the NYP plan will be primary to your spouse’s.
For domestic partners or married employees who are both NYP benefit-eligible, the partner/spouse earning the higher salary is required to elect the medical coverage (Employee + Spouse/Domestic Partner or Employee + Family). If you are retired and your spouse is actively working, your spouse’s plan will be primary.
If you are both retired, the plan in which you are the subscriber will pay first unless you are of Medicare age, at which time Medicare would be primary. Your retiree plan would be secondary and your spouse’s plan would be tertiary.
Aetna understands that sometimes you do not have a choice where your labs are sent. If a participating provider sends your bloodwork to an out-of-network laboratory, Aetna will allow that laboratory at the in-network benefit level. Please note, the ordering physician’s name is not always included in the lab’s claim submission which may prevent the claim from processing correctly the first time. If you believe your claim was not processed correctly, please contact Customer Service and a representative will be happy to review it with you.
Check plan offerings for more information.
Preventive care includes but is not limited to the following:
Newborn Wellness Visits
Immunizations (some age restrictions may apply)
Mammograms (excludes family history of cancer or symptomatic diagnostic exams)
Yes, below are details to the changes for specialty medications in 2023.
Specialty Medications: 30% coinsurance for all specialty medications included in the PrudentRx program drug list.*
For medications not included in the PrudentRx solution, you will be responsible for:
|PLAN PROVISION||EXCLUSIVE PROVIDER ORGANIZATION (EPO) AND POINT OF SERVICE (POS)||POINT OF SERVICE (POS)|
|In-Network Services||Out-of-Network Services|
|Prescription Coverage||30-day supply and one refill:
Preferred Brand: $30
Non-Preferred Brand: 40% up to $120
Specialty Medications: + 30% coinsurance
|No out-of-network coverage|
|90-day supply for maintenance medications:
Preferred Brand: $40
Non-Preferred Brand: 40% up to $240
Specialty Medications: + 30% coinsurance
*Your plan includes the PrudentRx solution for certain specialty medications. This program is designed to lower your out of pocket costs by assisting you with enrollment in drug manufacturers discount copay cards/assistance programs. Once enrolled in the PrudentRx solution, your out of pocket cost will be $0 for eligible medications. If you opt out, you will be responsible for the 30% coinsurance (only the amount you pay out of pocket will apply toward your Out-of-Pocket Maximum for essential health benefit medications – non-essential health benefit medications do not apply toward Out-of-Pocket Maximum).
If you enrolled in or changed plans during open enrollment, you can expect to receive new member ID cards in late December for coverage effective January 1, 2022. For all other events, you will receive new member ID cards within two weeks of your enrollment. If you do not receive your new ID card, please call Member Services at 1-866-267-1091, Monday – Friday, 8 a.m. to 6 p.m., local time.
You can also log in to your member website and access a digital ID card or print a paper copy.
You will receive a family ID card. All covered members of your family may use the same card. If your spouse is covered by the plan, you will receive two ID cards. If you need additional ID cards, please contact Member Services 1-866-267-1091, Monday – Friday, 8 a.m. to 6 p.m., local time.
If you enrolled in or changed dental plans during open enrollment, you can expect to receive letter from Aetna. There are no member ID cards issued for the dental plans. Please note: the group number for the Aetna dental plans is 109045.
Yes. You have access to Aetna’s nationwide network of providers, regardless of where you live. The Aetna Health app is a great resource for locating providers on the go or you can click the link below to search for providers by zip code.
If your dependent is currently certified as disabled, their status will transfer to Aetna from your previous carrier without additional review.
If your dependent becomes disabled prior to the limiting age (Medical age 26, or Dental age 19) you must request that coverage continue by submitting the Request for Continuation of Coverage forms.
NYP covers dependents until the end of the year in which your dependent child turns 26. You will receive notification in the mail from your benefits team regarding COBRA plan options available prior to the plan terminating.
As long as you are actively working, your plan would be primary to Medicare for your spouse. Note: Medicare only recognizes legally married spouses. Domestic partners do not qualify and must elect Medicare when they become eligible to avoid penalties. See the Medicare Enrollment Guide for additional information.
If you are still actively employed, you are eligible for NYP benefits which will remain your primary plan until you retire. You will automatically be enrolled in Medicare Part A, however you must elect Medicare Part B during your special enrollment period once you retire, at which time Medicare will become your primary plan. See the Medicare Enrollment Guide for more information.
Medicare is a complex program, and each individual has their own unique needs. Aetna Medicare Support Services is available to provide employees and their family members with resources to help understand Medicare benefits. Contact Aetna Support Services for a personalized consultation to help understand the basics of Medicare coverage, costs, and how and when to enroll.
The Aetna representative can help with a variety of topics including — Social Security basics and benefits, how Social Security and Medicare work together, and considerations for collecting Social Security early.
Please contact your Aetna Medicare representative for personalized help:
Cell phone: 585-353-0058