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2019 Consumer Directed Health Plan

Plan Type
Medical

The Consumer Directed Health Plan (CDHP) is a qualified high-deductible plan that provides health coverage and allows individuals to contribute pretax to a health savings account. The Princeton CDHP is integrated with the Prescription Drug Plan.

Features
  • Lowest employee contribution rate offered.
  • Aetna Choice POS II (open access) Network.
  • In-network preventive services e.g. annual exams, colonoscopies, and mammograms covered at 100%.
  • Prescriptions for certain chronic conditions are covered before deductible.
  • After the annual deductibles are met, coverage begins for all other medical services and prescriptions.
  • Once the out-of-pocket maximums (OPMs) are reached, services are covered at 100%.
  • In-network preferred providers deliver services at the lowest cost followed by in-network non-preferred and out-of-network providers. All out-of-network costs are subject to reasonable and customary limits.
  • Primary care physician (PCP) is not required but is highly recommended and does not introduce referral requirements.
  • Referral not required to see a specialist.

To minimize costs, consider using the following providers and resources:

Coverage Options
In-Network
Out-of-Network
Plan Design
Employee
$20.00
Employee & Children
$60.00
Employee & Spouse
$80.00
Family
$120.00
In-Network
Individual
$1,500.00
Family
$3,000.00
Out-of-Network
Individual
$3,000.00
Family
$6,000.00
Out-of-Network
Individual
$6,000.00
Family
$12,000.00
In-Network
Individual
$3,000.00
Family
$6,000.00
Physician Visits

Telemedicine (Offered through Teladoc)

In-Network
$40 until deductible is met, then 20% after deductible
Out-of-Network
NA

Telemental Health (Offered through Teladoc)

In-Network
20% after deductible
Out-of-Network
NA

Primary Care Physician (PCP)

In-Network
20% after deductible
Out-of-Network
50% after deductible

Preventive Care & Immunizations

In-Network
$0
Out-of-Network
50% after deductible
Specialists

Standard Specialists

In-Network
20% after deductible
Out-of-Network
50% after deductible

Tiered Specialists

In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
Emergency & Urgent Care Services

Urgent Care Center

In-Network
$0 after deductible
Out-of-Network
50% after deductible

Emergency Room (No coverage for non-emergencies)

In- or Out-of-Network
$0 after deductible
Inpatient Services

Medical & Surgical Procedures

In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible

Mental Health

In-Network
20% after deductible
Out-of-Network
50% 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

Laboratory

In-Network (Preferred)
$0 after deductible
In-Network (Non-Preferred)
40% after deductible
Out-of-Network
Not covered

Radiology (X-Ray)

In-Network
$0 after deductible (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

Mental Health

In-Network
20% after deductible
Out-of-Network
25% after deductible

Annual Eye Exam

In- or Out-of-Network
Not covered

Prescription Eyeglasses and/or Contact Lenses

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

Speech Therapy / Occupational Therapy / Pulmonary & Cardiac Rehabilitation (100 visits per calendar year)

In-Network
20% after deductible
Out-of-Network
50% after deductible

Chiropractic Care (20 visits per calendar year)

In-Network
20% after deductible
Out-of-Network
50% after deductible

Acupuncture (20 visits per calendar year)

In-Network
20% after deductible
Out-of-Network
50% 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

Delivery

In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible

Post-Partum Visits

In-Network (Preferred)
10% after deductible
In-Network (Non-Preferred)
20% after deductible
Out-of-Network
50% after deductible
Additional Information

All benefits-eligible employees can elect coverage under the CDHP except those on a J-1 Visa.

Employees here on a J-1 Visa may not elect this plan. They may only elect the HMO Plan or the J-1 Visa Plan.

ID cards will be mailed to home addresses within three to four weeks following enrollment in or changes to medical coverage. Individuals can view ID cards on the provider’s website or app or within the CastLight app. A separate ID card is issued for the Prescription Drug Plan, and individuals can print or view them on the OptumRx website or app.

Disclaimer

If there are any discrepancies between the information in this publication, verbal representations, and the plan documents, the plan documents always govern. Although Princeton intends to continue these benefits, the University reserves the right to amend or terminate these plans at any time.