Plan benefits and forms

Your Aetna plan benefits and forms

Knowing more about your plan can help you get the most from your benefits and covered services. Find your plan’s Summary of Benefits, Formulary (list of covered drugs) and other coverage details below. Your member ID card shows your plan’s name. See a word or term you don't know? Check our glossary


2024 Plan information


2024 City of NY plan design for NY, NJ & PA - MA
2024 City of NY plan design for NY, NJ & PA - MAPD

2024 City of NY plan design for "All Other States" - MA
2024 City of NY plan design for "All Other States" - MAPD

2024 Medicare Star Rating

Find Medicare forms

See below for helpful resources for managing your plan and how to get started with common requests.

File claims and reimbursement requests

If you were billed directly by a provider, mail us your completed form to request reimbursement. 

Reimbursement form — English | Español
Print-free reimbursement instructions — English | Español

Printer-free reimbursement instructions — English (PDF) | Español (PDF)

Give someone permission to manage your care

Call us with your caregiver or another person on the line to give them permission to speak with us (just one time, while on that call). Or you can mail us a completed Protected Health Information (PHI) form to give them permission on a regular basis.


PHI form — English (PDF) | Español (PDF)

You can choose someone to do all of the above. This person is your appointed representative. An appointment is good for one year from the date that you and your representative sign an Appointment of Representative form. 

Fill out the form below and mail it to us. Any time your representative makes a request for you, they should send us a signed copy. You'll leave Aetna Medicare and go to the Center for Medicare & Medicaid Services (CMS) website if you link to the form. 

Appointment of Representative CMS Form — English (PDF) | Español (PDF)

Exceptions, appeals and grievances

We want to be your first stop when you have a concern about your coverage or care. Call us at the number on your member ID card, or learn more here.

See how to get started

Medicare helpline and website — Get general or claims-specific Medicare information, request documents in alternate formats and make changes to your Medicare coverage. Call 1-800-MEDICARE (1-800-633-4227) or TTY: 1-877-486-2048, 7 days a week, 24 hours a day. If you need help in a language other than English or Spanish, say “Agent” to talk to a customer service representative. Or visit the Medicare website

Social Security Administration - For questions about Medicare eligibility, Social Security retirement benefits or help paying for prescription drugs. Call 1-800-772-1213 or TTY: 1-800-325-0778, Monday to Friday, 8 AM to 7 PM, or visit the Social Security website .

Most health care professionals and organizations that provide Medicare services are honest. Unfortunately, there may be some who are not. Call Medicare toll-free at 1-800-MEDICARE (1-800-633-4227) or TTY: 1-877-486-2048, 7 days a week, 24 hours a day.

We help you get medically necessary health care services in the most cost-effective way under your health plan. And we work with you and doctors to evaluate services for medical appropriateness, timeliness and cost. 


Specifically, we: 

  • Base our decisions on appropriateness of care, service and plan coverage 

  • Use nationally recognized guidelines and resources to make changes 

  • Don’t pay or reward providers, employees or others for denying coverage or care 

  • Focus on reviewing the risks of members who aren’t fully using certain services

Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device.


When we learn about a new technology, we:

  • Carefully review the latest information and ask experts for their opinions

  • Compare the information with well-known standards

  • Base all of our decisions on making sure you have the right care and services

The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations. They issue these when coverage rules change for services or prescription drugs. 

View a list of coverage determinations

Additional information

Let the City of New York know if you have a new phone number or address. Call the New York City Office of Labor Relations at 1-212-306-7200 (TTY: 711), Monday to Friday, 9 AM to 3 PM ET.