With the NYP Aetna health plans, you'll get access to tools, tips, programs and services. Use them to find network doctors, review claims and more. You'll get benefits such as:
- Large national network of doctors and hospitals
- Coverage for emergency care worldwide
- Access to online and mobile tools
Benefits available to you
You have a choice of two medical plans:
-
EPO (In-network only)
-
POS (In- and out-of-network services)
Summary of benefits documents
Click on each Aetna plan name for a summary of benefits.
2024 NewYork-Presbyterian
2024 Hudson Valley Hospital
2023
Please note: If you receive care from an out-of-network medical provider, please complete and submit the out-of-network member reimbursement form.
Covered services include certain services and supplies for gender affirming (sometimes called sex change) treatment include:
- Gender affirming surgical procedures (precertification required)
- Physician pre-operative and post-operative hospital and office visits
- Inpatient and outpatient services (including outpatient surgery)
- Skilled nursing facility care
- Administration of anesthetics
- Outpatient diagnostic testing, lab work and radiological services
- Gender reassignment counseling by a behavioral health provider
- Pharmaceutical coverage (hormone replacement therapies)
Your plan also covers certain procedures such as:
- Facial Feminization surgery
- Electrolysis
- Voice Surgery
- Travel and Lodging
Important note:
Just log into your Aetna website for detailed information about this covered benefit, including eligibility and medical necessity requirements. You can also call your Aetna Service Advocate at 1-866-267-1091, Monday through Friday, 8 a.m. to 6 p.m. your local time.
You have a choice of two Aetna dental plans: PPO and DMO. Click on the links below each dental plan name to learn more.
- PPO
- DMO
Tele-Dentistry Orthodontia Providers
Services from the below tele-dentistry orthodontia providers are discounted for eligible dependents under the age of 24 who are enrolled in Aetna’s PPO Dental Plan* ONLY:
- Byte
- Candid
These providers deliver aligners for straightening teeth without having to visit a dentist’s office. You can use an at-home impression kit, obtain a treatment plan, and aligners are mailed directly to your home.**
*These providers DO NOT participate under the DMO plan.
**Please Note: NYP members over age 24 will have access to discounted rates when paying direct for their tele-dentistry services for these providers. Although they will not receive reimbursement for the services from the plan they will receive a discount compared to the average cost of Invisalign services with an onsite orthodontist.
SmileDirect Update: SmileDirect has announced it has shutdown effective 12/09/2023. Smile Direct Club’s official statement to those in the middle of a treatment with them is to consult a dentist for further guidance.
- Aetna advises members who were affected by this shutdown to check on their lifetime orthodontic maximum limits and available balance that could be used for future treatment.
- Aetna is working on resolution for members who have not received their aligners that were purchased with the eligible Aetna discount.
Good vision care is an important part of total well-being.
From getting an annual eye exam to identifying high-risk symptoms or simply shopping for new frames, Aetna VisionSM Preferred provides access to the right providers and care, and it costs you less.
Summary of benefits document
Click here for a summary of benefits.
Please note: Aetna members of any one of the Medical, Dental or Vision plans listed above, can enjoy a 10 percent discount from specific CVS oral care products. An exclusive member website features more than 50 CVS oral health products. Members can access the site from the Oral Care Discount page of the Aetna secure member website and enter the promo code AETNA10 at checkout. The products will be refreshed on an ongoing basis. The additional 10% off may also be applied to sale items.
Need help? Please call your Aetna Service Advocate at 1-866-267-1091.
Monday through Friday, 8 a.m. to 6 p.m. your local time.
