The Benefits Comparison Tool provides a side-by-side comparison of the medical and dental plans offered by Princeton University, including premium amounts and covered services. This is only an estimation of benefits; for more details about covered services, refer to the Summary Plan Descriptions.
Select plan type you want compare:
2020 Consumer Directed Health Plan
2020 Health Maintenance Organization (HMO) Plan
2020 J-1 Visa Plan
2020 Princeton Health Plan
2020 Basic Option PPO Plan
2020 DMO Plan
2020 High Option PPO Plan
2020 Vision Plan
Annual Deductibles
In-Network
Individual: None
Family: None
Individual: None
Family: None
Out-of-Network
Individual: $50
Family: $150
Individual: $50
Family: $150
In-Network
Individual: $1,500.00
Family: $3,000.00
Individual: $1,500.00
Family: $3,000.00
Out-of-Network
Individual: $3,000.00
Family: $6,000.00
Individual: $3,000.00
Family: $6,000.00
In-Network
Individual: $0.00
Family: $0.00
Individual: $0.00
Family: $0.00
In-Network
Individual: $0
Family: $0
Individual: $0
Family: $0
In- or Out-of-Network
Individual: $50.00 (basic and major services)
Family: $150.00 (basic and major services)
Individual: $50.00 (basic and major services)
Family: $150.00 (basic and major services)
In- or Out-of-Network
Individual: $500.00
Family: $1,000.00
Individual: $500.00
Family: $1,000.00
In-Network
Individual: $200.00
Family: $400.00
Individual: $200.00
Family: $400.00
Out-of-Network
Individual: $750.00
Family: $1,500.00
Individual: $750.00
Family: $1,500.00
—
Employee Monthly Contributions
Employee:
$20.69
Employee & Child: $48.16
Family: $72.62
Employee & Spouse: $44.19
Employee & Child: $48.16
Family: $72.62
Employee & Spouse: $44.19
Employee:
$20.00
Employee & Child: $60.00
Family: $120.00
Employee & Spouse: $80.00
Employee & Child: $60.00
Family: $120.00
Employee & Spouse: $80.00
Employee:
$25.15
Employee & Child: $49.05
Family: $70.09
Employee & Spouse: $50.72
Employee & Child: $49.05
Family: $70.09
Employee & Spouse: $50.72
Less than $75,000
Employee:
$74.00 Employee & Child: $216.00
Family: $446.00
Employee & Spouse: $290.00
$75,001–150,000
Employee:
$77.00 Employee & Child: $226.00
Family: $464.00
Employee & Spouse: $303.00
$150,001 and over
Employee:
$81.00 Employee & Child: $235.00
Family: $483.00
Employee & Spouse: $316.00
Employee:
$67.79
Employee & Child: $132.84
Family: $188.96
Employee & Spouse: $136.80
Employee & Child: $132.84
Family: $188.96
Employee & Spouse: $136.80
Employee:
$0.00
Employee & Child: $269.00
Family: $544.00
Employee & Spouse: $357.00
Employee & Child: $269.00
Family: $544.00
Employee & Spouse: $357.00
Employee:
$121.00
Employee & Child: $334.00
Family: $629.00
Employee & Spouse: $424.00
Employee & Child: $334.00
Family: $629.00
Employee & Spouse: $424.00
Employee:
$15.16
Employee & Child: $24.83
Family: $40.04
Employee & Spouse: $24.38
Employee & Child: $24.83
Family: $40.04
Employee & Spouse: $24.38
Out-of-Pocket Maximum (OPM)
In- or Out-of-Network
Individual: $2,000.00
Family:
Individual: $2,000.00
Family:
In-Network
Individual: $3,000.00
Family: $6,000.00
Individual: $3,000.00
Family: $6,000.00
Out-of-Network
Individual: $6,000.00
Family: $12,000.00
Individual: $6,000.00
Family: $12,000.00
In-Network
Individual: None
Family:
Individual: None
Family:
In-Network
Individual: $2,500.00
Family: $5,000.00
Individual: $2,500.00
Family: $5,000.00
In-Network
Individual: $2,000.00
Family:
Individual: $2,000.00
Family:
Out-of-Network
Individual: $1,500.00
Family:
Individual: $1,500.00
Family:
In- or Out-of-Network
Individual: $2,500.00
Family: $5,000.00
Individual: $2,500.00
Family: $5,000.00
Less than $75,000
In-Network Individual: $1,550
Family: $3,100
$75,001–150,000
In-Network Individual: $2,350
Family: $4,700
$150,001 and over
In-Network Individual: $3,100
Family: $6,200
Less than $75,000
Out-of-Network Individual: $4,500
Family: $9,000
$75,001–150,000
Out-of-Network Individual: $4,700
Family: $9,400
$150,001 and over
Out-of-Network Individual: $6,200
Family: $12,400
—
Services
Exam (Once every calendar year)
Comprehensive Vision Exam
—
—
—
—
—
—
—
In-Network
$10 copayment
Out-of-Network
100% with reimbursement up to $45
$10 copayment
Out-of-Network
100% with reimbursement up to $45
Prescription Lenses (Once every calendar year)
Single Vision
—
—
—
—
—
—
—
In-Network
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $30
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $30
Lined Bifocals
—
—
—
—
—
—
—
In-Network
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $50
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $50
Progressives
—
—
—
—
—
—
—
In-Network
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $50
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $50
Lined Trifocals
—
—
—
—
—
—
—
In-Network
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $65
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $65
Lenticular
—
—
—
—
—
—
—
In-Network
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $100
$10 copayment / Applied to lenses and frames / If purchasing lenses and frames together, one $10 copayment applies
Out-of-Network
100% with reimbursement up to $100
Frames (Once every calendar year)
All
—
—
—
—
—
—
—
In-Network
100% with coverage up to $155 after a $10 copayment / 100% with coverage up to $85 after a $10 copayment at Costco, Walmart, or Sam's Club / If purchasing lenses and frames together, on $10 copayment applies
Out-of-Network
100% with reimbursement up to $70
100% with coverage up to $155 after a $10 copayment / 100% with coverage up to $85 after a $10 copayment at Costco, Walmart, or Sam's Club / If purchasing lenses and frames together, on $10 copayment applies
Out-of-Network
100% with reimbursement up to $70
Prescription Contact Lenses (Once every calendar year)
Evaluation Fees
—
—
—
—
—
—
—
In-Network
Copayment not to exceed $60
Out-of-Network
Not covered
Copayment not to exceed $60
Out-of-Network
Not covered
Fitting Costs
—
—
—
—
—
—
—
In-Network
Copayment not to exceed $60
Out-of-Network
Not covered
Copayment not to exceed $60
Out-of-Network
Not covered
Materials
—
—
—
—
—
—
—
In- or Out-of-Network
100% reimbursement up to $140
100% reimbursement up to $140
Preventive & Diagnostic Services
Examinations & Visits
In- or Out-of-Network
Reimbursement based on 100% of in-network charge
Reimbursement based on 100% of in-network charge
—
In-Network
$0
$0
—
In-Network
$0
Out-of-Network
$0
$0
Out-of-Network
$0
—
—
—
X-Ray Services
In- or Out-of-Network
Reimbursement based on 100% of in-network charge
Reimbursement based on 100% of in-network charge
—
In-Network
$0
$0
—
In-Network
$0
Out-of-Network
$0
$0
Out-of-Network
$0
—
—
—
Cleanings
In- or Out-of-Network
Reimbursement based on 100% of in-network charge
Reimbursement based on 100% of in-network charge
—
In-Network
$0
$0
—
In-Network
$0
Out-of-Network
$0
$0
Out-of-Network
$0
—
—
—
Flouride Treatments
In- or Out-of-Network
Reimbursement based on 100% of in-network charge
Reimbursement based on 100% of in-network charge
—
In-Network
$0
$0
—
In-Network
$0
Out-of-Network
$0
$0
Out-of-Network
$0
—
—
—
Basic Services
Amalgam (Silver) Fillings
In- or Out-of-Network
Reimbursement based on 50% of in-network charge
Reimbursement based on 50% of in-network charge
—
In-Network
$0
$0
—
In-Network
20%
Out-of-Network
30%
20%
Out-of-Network
30%
—
—
—
Root Canal Therapy (Anterior Teeth)
In- or Out-of-Network
Reimbursement based on 50% of in-network charge
Reimbursement based on 50% of in-network charge
—
In-Network
$0
$0
—
In-Network
20%
Out-of-Network
30%
20%
Out-of-Network
30%
—
—
—
Root Canal Therapy (Molars)
In- or Out-of-Network
Reimbursement based on 50% of in-network charge
Reimbursement based on 50% of in-network charge
—
—
—
In-Network
20%
Out-of-Network
30%
20%
Out-of-Network
30%
—
—
—
Composite Fillings (Anterior Teeth)
In- or Out-of-Network
Reimbursement based on 50% of in-network charge
Reimbursement based on 50% of in-network charge
—
In-Network
$0
$0
—
In-Network
20%
Out-of-Network
30%
20%
Out-of-Network
30%
—
—
—
Stainless Steel Crowns
In- or Out-of-Network
Reimbursement based on 50% of in-network charge
Reimbursement based on 50% of in-network charge
—
In-Network
$0
$0
—
In-Network
20%
Out-of-Network
30%
20%
Out-of-Network
30%
—
—
—
Uncomplicated Extractions
In- or Out-of-Network
Reimbursement based on 50% of in-network charge
Reimbursement based on 50% of in-network charge
—
In-Network
$0
$0
—
In-Network
20%
Out-of-Network
30%
20%
Out-of-Network
30%
—
—
—
Major Services
High Noble Metal & Porcelain Inlays
In- or Out-of-Network
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
—
In-Network
40%
40%
—
In-Network
40%
Out-of-Network
50%
40%
Out-of-Network
50%
—
—
—
High Noble Metal Restorations
In- or Out-of-Network
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
—
In-Network
40%
40%
—
In-Network
40%
Out-of-Network
50%
40%
Out-of-Network
50%
—
—
—
Crowns
In- or Out-of-Network
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
—
In-Network
40%
40%
—
In-Network
40%
Out-of-Network
50%
40%
Out-of-Network
50%
—
—
—
Root Canal Therapy (Molars)
—
—
In-Network
40%
40%
—
—
—
—
—
Implants
In- or Out-of-Network
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
—
In-Network
40%
40%
—
In-Network
40%
Out-of-Network
50%
40%
Out-of-Network
50%
—
—
—
Orthodontia
Orthodontics
In- or Out-of-Network
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
Not covered / May receive up to 35% discount from in-network provider / Check with the provider prior to receiving treatment
—
In-Network
50% / No lifetime maximum / Covers children and adults
50% / No lifetime maximum / Covers children and adults
—
In-Network
50% / Lifetime maximum benefit of $2,000 / Covers children and adults
Out-of-Network
50% / Lifetime maximum benefit of $1,500 / Covers children and adults
50% / Lifetime maximum benefit of $2,000 / Covers children and adults
Out-of-Network
50% / Lifetime maximum benefit of $1,500 / Covers children and adults
—
—
—
Basis of Reimbursement
Reimbursement
In- or Out-of-Network
Maximum allowable charge
Maximum allowable charge
—
In-Network
Negotiated fee
Negotiated fee
—
In-Network
Negotiated fee
Out-of-Network
80th percentile of reasonable and customary charges
Negotiated fee
Out-of-Network
80th percentile of reasonable and customary charges
—
—
—
Physician Visits
Telemedicine (Offered through Teladoc)
—
In-Network
$40 until deductible is met, then 20% after deductible
Out-of-Network
NA
$40 until deductible is met, then 20% after deductible
Out-of-Network
NA
—
In-Network
$0
$0
—
In- or Out-of-Network
$40 until deductible is met, then 20% after deductible
$40 until deductible is met, then 20% after deductible
In-Network
$0
Out-of-Network
NA
$0
Out-of-Network
NA
—
Telemental Health (Offered through Teladoc)
—
In-Network
20% after deductible
Out-of-Network
NA
20% after deductible
Out-of-Network
NA
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$30 copayment
Out-of-Network
NA
$30 copayment
Out-of-Network
NA
—
Primary Care Physician (PCP)
—
In-Network
20% after deductible
Out-of-Network
50% after deductible
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$20 copayment
$20 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$20 copayment
Out-of-Network
40% after deductible
$20 copayment
Out-of-Network
40% after deductible
—
Preventive Care & Immunizations
—
In-Network
$0
Out-of-Network
50% after deductible
$0
Out-of-Network
50% after deductible
—
In-Network
$0
$0
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$0
Out-of-Network
40% after deductible
$0
Out-of-Network
40% after deductible
—
Specialists
—
—
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
—
—
Emergency & Urgent Care Services
Urgent Care Center
—
In-Network
$0 after deductible
Out-of-Network
50% after deductible
$0 after deductible
Out-of-Network
50% after deductible
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$30 copayment
Out-of-Network
40% after deductible
$30 copayment
Out-of-Network
40% after deductible
—
Emergency Room (No coverage for non-emergencies)
—
In- or Out-of-Network
$0 after deductible
$0 after deductible
—
In-Network
$175 copayment (waived if admitted)
$175 copayment (waived if admitted)
—
In- or Out-of-Network
20% after deductible
20% after deductible
In- or Out-of-Network
$175 copayment (waived if admitted)
$175 copayment (waived if admitted)
—
Inpatient Services
Medical & Surgical Procedures
—
In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$175 copayment
$175 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
40% after deductible
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
40% after deductible
—
Mental Health
—
In-Network
20% after deductible
Out-of-Network
50% after deductible
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$175 copayment
$175 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
10% after deductible
Out-of-Network
40% after deductible
10% after deductible
Out-of-Network
40% after deductible
—
Outpatient Services
Surgical Procedures
—
In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$0 (Independent Facility) / $75 copayment (Hospital)
$0 (Independent Facility) / $75 copayment (Hospital)
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network (Preferred)
10% after deductable
In-Network (Non-Preferred)
20% after deductable
Out-of-Network
40% after deductable
10% after deductable
In-Network (Non-Preferred)
20% after deductable
Out-of-Network
40% after deductable
—
Laboratory
—
In-Network (Preferred)
$0 after deductible
In-Network (Non-Preferred)
40% after deductible
Out-of-Network
Not covered
$0 after deductible
In-Network (Non-Preferred)
40% after deductible
Out-of-Network
Not covered
—
In-Network
$0
$0
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network (Preferred)
$0
In-Network (Non-Preferred)
40%
Out-of-Network
Not covered
$0
In-Network (Non-Preferred)
40%
Out-of-Network
Not covered
—
Radiology (X-Ray)
—
In-Network
$0 after deductible (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
$0 after deductible (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
—
In-Network
$0 (Independent Facility) / $50 copayment (Hospital)
$0 (Independent Facility) / $50 copayment (Hospital)
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$0 (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
$0 (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
—
Hi-Tech Radiology (MRI, CAT, etc.)
—
In-Network
$0 after deductible (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
$0 after deductible (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
—
In-Network
$0 (Independent Facility) / $100 copayment (Hospital)
$0 (Independent Facility) / $100 copayment (Hospital)
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network (Preferred)
$0 (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
$0 (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered
—
Mental Health
—
In-Network
20% after deductible
Out-of-Network
25% after deductible
20% after deductible
Out-of-Network
25% after deductible
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$30 copayment
Out-of-Network
25% no deductible
$30 copayment
Out-of-Network
25% no deductible
—
Annual Eye Exam
—
In- or Out-of-Network
Not covered
Not covered
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
Not covered
Not covered
In- or Out-of-Network
Not covered
Not covered
—
Prescription Eyeglasses and/or Contact Lenses
—
In- or Out-of-Network
Not covered
Not covered
—
In-Network
$70 reimbursement every 2 years
$70 reimbursement every 2 years
—
In- or Out-of-Network
Not covered
Not covered
In- or Out-of-Network
Not covered
Not covered
—
Physical Therapy (100 visits per calendar year)
—
In-Network
20% after deductible
Out-of-Network
50% after deductible
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$15 copayment
$15 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
10% after deductible
Out-of-Network
50% after deductible
10% after deductible
Out-of-Network
50% after deductible
—
Speech Therapy / Occupational Therapy / Pulmonary & Cardiac Rehabilitation (100 visits per calendar year)
—
In-Network
20% after deductible
Out-of-Network
50% after deductible
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
10% after deductible
Out-of-Network
40% after deductible
10% after deductible
Out-of-Network
40% after deductible
—
Chiropractic Care (20 visits per calendar year)
—
In-Network
20% after deductible
Out-of-Network
50% after deductible
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$30 copayment
Out-of-Network
40% after deductible
$30 copayment
Out-of-Network
40% after deductible
—
Acupuncture (20 visits per calendar year)
—
In-Network
20% after deductible
Out-of-Network
50% after deductible
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network
$30 copayment
Out-of-Network
40% after deductible
$30 copayment
Out-of-Network
40% after deductible
—
Maternity
Prenatal Care Visits
—
In-Network (Preferred)
10% after deductible for the first visit, $0 for subsequent visits
In-Network (Non-Preferred)
20% after deductible for the first visit, $0 for subsequent visits
Out-of-Network
50% after deductible
10% after deductible for the first visit, $0 for subsequent visits
In-Network (Non-Preferred)
20% after deductible for the first visit, $0 for subsequent visits
Out-of-Network
50% after deductible
—
In-Network
$25 copayment for first visit, $0 for subsequent visits
$25 copayment for first visit, $0 for subsequent visits
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network (Preferred)
$30 copayment for the first visit, $0 for subsequent visits
In-Network (Non-Preferred)
$60 copayment for the first visit, $0 for subsequent visits
Out-of-Network
40% after deductible
$30 copayment for the first visit, $0 for subsequent visits
In-Network (Non-Preferred)
$60 copayment for the first visit, $0 for subsequent visits
Out-of-Network
40% after deductible
—
Delivery
—
In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$175 copayment
$175 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
40% after deductible
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
40% after deductible
—
Post-Partum Visits
—
In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
—
In-Network
$25 copayment
$25 copayment
—
In- or Out-of-Network
20% after deductible
20% after deductible
In-Network (Preferred)
$30 copayment
In-Network (Non-Preferred)
$60 copayment
Out-of-Network
40% after deductible
$30 copayment
In-Network (Non-Preferred)
$60 copayment
Out-of-Network
40% after deductible
—