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Benefits Comparison Tool

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
Out-of-Network
Individual: $50
Family: $150
In-Network
Individual: $1,500.00
Family: $3,000.00
Out-of-Network
Individual: $3,000.00
Family: $6,000.00
In-Network
Individual: $0.00
Family: $0.00
In-Network
Individual: $0
Family: $0
In- or Out-of-Network
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
In-Network
Individual: $200.00
Family: $400.00
Out-of-Network
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: $20.00
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
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: $0.00
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: $15.16
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:
In-Network
Individual: $3,000.00
Family: $6,000.00
Out-of-Network
Individual: $6,000.00
Family: $12,000.00
In-Network
Individual: None
Family:
In-Network
Individual: $2,500.00
Family: $5,000.00
In-Network
Individual: $2,000.00
Family:
Out-of-Network
Individual: $1,500.00
Family:
In- or Out-of-Network
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

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

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

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

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

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

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

Prescription Contact Lenses (Once every calendar year)

Evaluation Fees

In-Network
Copayment not to exceed $60
Out-of-Network
Not covered

Fitting Costs

In-Network
Copayment not to exceed $60
Out-of-Network
Not covered

Materials

In- or Out-of-Network
100% reimbursement up to $140

Preventive & Diagnostic Services

Examinations & Visits

In- or Out-of-Network
Reimbursement based on 100% of in-network charge
In-Network
$0
In-Network
$0
Out-of-Network
$0

X-Ray Services

In- or Out-of-Network
Reimbursement based on 100% of in-network charge
In-Network
$0
In-Network
$0
Out-of-Network
$0

Cleanings

In- or Out-of-Network
Reimbursement based on 100% of in-network charge
In-Network
$0
In-Network
$0
Out-of-Network
$0

Flouride Treatments

In- or Out-of-Network
Reimbursement based on 100% of in-network charge
In-Network
$0
In-Network
$0
Out-of-Network
$0

Basic Services

Amalgam (Silver) Fillings

In- or Out-of-Network
Reimbursement based on 50% of in-network charge
In-Network
$0
In-Network
20%
Out-of-Network
30%

Root Canal Therapy (Anterior Teeth)

In- or Out-of-Network
Reimbursement based on 50% of in-network charge
In-Network
$0
In-Network
20%
Out-of-Network
30%

Root Canal Therapy (Molars)

In- or Out-of-Network
Reimbursement based on 50% of in-network charge
In-Network
20%
Out-of-Network
30%

Composite Fillings (Anterior Teeth)

In- or Out-of-Network
Reimbursement based on 50% of in-network charge
In-Network
$0
In-Network
20%
Out-of-Network
30%

Stainless Steel Crowns

In- or Out-of-Network
Reimbursement based on 50% of in-network charge
In-Network
$0
In-Network
20%
Out-of-Network
30%

Uncomplicated Extractions

In- or Out-of-Network
Reimbursement based on 50% of in-network charge
In-Network
$0
In-Network
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
In-Network
40%
In-Network
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
In-Network
40%
In-Network
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
In-Network
40%
In-Network
40%
Out-of-Network
50%

Root Canal Therapy (Molars)

In-Network
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
In-Network
40%
In-Network
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
In-Network
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

Basis of Reimbursement

Reimbursement

In- or Out-of-Network
Maximum allowable charge
In-Network
Negotiated fee
In-Network
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
In-Network
$0
In- or Out-of-Network
$40 until deductible is met, then 20% after deductible
In-Network
$0
Out-of-Network
NA

Telemental Health (Offered through Teladoc)

In-Network
20% after deductible
Out-of-Network
NA
In-Network
$25 copayment
In- or Out-of-Network
20% after deductible
In-Network
$30 copayment
Out-of-Network
NA

Primary Care Physician (PCP)

In-Network
20% after deductible
Out-of-Network
50% after deductible
In-Network
$20 copayment
In- or Out-of-Network
20% after deductible
In-Network
$20 copayment
Out-of-Network
40% after deductible

Preventive Care & Immunizations

In-Network
$0
Out-of-Network
50% after deductible
In-Network
$0
In- or Out-of-Network
20% after deductible
In-Network
$0
Out-of-Network
40% after deductible

Specialists

In-Network
$25 copayment
In- or Out-of-Network
20% after deductible

Emergency & Urgent Care Services

Urgent Care Center

In-Network
$0 after deductible
Out-of-Network
50% after deductible
In-Network
$25 copayment
In- or Out-of-Network
20% after deductible
In-Network
$30 copayment
Out-of-Network
40% after deductible

Emergency Room (No coverage for non-emergencies)

In- or Out-of-Network
$0 after deductible
In-Network
$175 copayment (waived if admitted)
In- or Out-of-Network
20% after deductible
In- or Out-of-Network
$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
In-Network
$175 copayment
In- or Out-of-Network
20% after deductible
In-Network (Preferred)
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
In-Network
$175 copayment
In- or Out-of-Network
20% after deductible
In-Network
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
In-Network
$0 (Independent Facility) / $75 copayment (Hospital)
In- or Out-of-Network
20% after deductible
In-Network (Preferred)
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
In-Network
$0
In- or Out-of-Network
20% after deductible
In-Network (Preferred)
$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
In-Network
$0 (Independent Facility) / $50 copayment (Hospital)
In- or Out-of-Network
20% after deductible
In-Network
$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
In-Network
$0 (Independent Facility) / $100 copayment (Hospital)
In- or Out-of-Network
20% after deductible
In-Network (Preferred)
$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
In-Network
$25 copayment
In- or Out-of-Network
20% after deductible
In-Network
$30 copayment
Out-of-Network
25% no deductible

Annual Eye Exam

In- or Out-of-Network
Not covered
In-Network
$25 copayment
In- or Out-of-Network
Not covered
In- or Out-of-Network
Not covered

Prescription Eyeglasses and/or Contact Lenses

In- or Out-of-Network
Not covered
In-Network
$70 reimbursement every 2 years
In- or Out-of-Network
Not covered
In- or Out-of-Network
Not covered

Physical Therapy (100 visits per calendar year)

In-Network
20% after deductible
Out-of-Network
50% after deductible
In-Network
$15 copayment
In- or Out-of-Network
20% after deductible
In-Network
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
In-Network
$25 copayment
In- or Out-of-Network
20% after deductible
In-Network
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
In-Network
$25 copayment
In- or Out-of-Network
20% after deductible
In-Network
$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
In-Network
$25 copayment
In- or Out-of-Network
20% after deductible
In-Network
$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
In-Network
$25 copayment for first visit, $0 for subsequent visits
In- or Out-of-Network
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

Delivery

In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
In-Network
$175 copayment
In- or Out-of-Network
20% after deductible
In-Network (Preferred)
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
In-Network
$25 copayment
In- or Out-of-Network
20% after deductible
In-Network (Preferred)
$30 copayment
In-Network (Non-Preferred)
$60 copayment
Out-of-Network
40% after deductible