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2019 Health Maintenance Organization (HMO) Plan

Plan Type
Medical

The Health Maintenance Organization (HMO) Plan limits coverage to care from in-network doctors. These types of plans provide integrated care and focus on prevention and wellness by requiring that a primary care physician (PCP) be selected and referrals be required for visits to a specialist. The Princeton HMO Plan includes the Prescription Drug Plan.

Features
  • Employee contributions are based on annual salary.
  • Aetna HMO in-network providers only.
  • In-network preventive services e.g. annual exams, colonoscopies, and mammograms, are covered at 100%.
  • No annual deductibles; coverage begins immediately for all medical services.
  • Once the out-of-pocket maximums (OPMs) are reached, services are covered at 100%.
  • A primary care physician (PCP) must be selected from the provider network.
  • A referral is required to see a specialist.

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

Coverage Options
In-Network
Plan Design
Less than $75,000
Employee
$73.00
Employee & Children
$212.00
Employee & Spouse
$284.00
Family
$437.00
$75,001–150,000
Employee
$74.00
Employee & Children
$218.00
Employee & Spouse
$293.00
Family
$448.00
$150,001 and over
Employee
$78.00
Employee & Children
$227.00
Employee & Spouse
$305.00
Family
$467.00
In-Network
Individual
$0
Family
$0
In-Network
Individual
$2,500.00
Family
$5,000.00
Physician Visits

Telemedicine (Offered through Teladoc)

In-Network
$0

Telemental Health (Offered through Teladoc)

In-Network
$25 copayment

Primary Care Physician (PCP)

In-Network
$20 copayment

Preventive Care & Immunizations

In-Network
$0

Specialists

In-Network
$25 copayment
Emergency & Urgent Care Services

Urgent Care Center

In-Network
$25 copayment

Emergency Room (No coverage for non-emergencies)

In-Network
$175 copayment (waived if admitted)
Inpatient Services

Medical & Surgical Procedures

In-Network
$175 copayment

Mental Health

In-Network
$175 copayment
Maternity

Prenatal Care Visits

In-Network
$25 copayment for first visit, $0 for subsequent visits

Delivery

In-Network
$175 copayment

Post-Partum Visits

In-Network
$25 copayment
Outpatient Services

Surgical Procedures

In-Network
$0 (Independent Facility) / $75 copayment (Hospital)

Laboratory

In-Network
$0

Radiology (X-Ray)

In-Network
$0 (Independent Facility) / $50 copayment (Hospital)

Hi-Tech Radiology (MRI, CAT, etc.)

In-Network
$0 (Independent Facility) / $100 copayment (Hospital)

Mental Health

In-Network
$25 copayment

Annual Eye Exam

In-Network
$25 copayment

Prescription Eyeglasses and/or Contact Lenses

In-Network
$70 reimbursement every 2 years

Physical Therapy (100 visits per calendar year)

In-Network
$15 copayment

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

In-Network
$25 copayment

Chiropractic Care (20 visits per calendar year)

In-Network
$25 copayment

Acupuncture (20 visits per calendar year)

In-Network
$25 copayment
Additional Information

All benefits-eligible employees, including those on a J-1 Visa, can elect coverage under the HMO Plan, except those residing in California. Residents of California who are not on a J-1 Visa can elect coverage under the CDHP or the PHP. Residents of California on a J-1 Visa can elect coverage under the J-1 Visa Plan.

The U.S. government requires that J-1 visa holders and their dependents have health insurance coverage while at Princeton University as an exchange scholar. If medical coverage is waived at Princeton, J-1 visa holders must be covered for health insurance through their home country, institution, or own private policy. The health insurance must provide J-1 visa holders and their dependents with the following coverage:

Medical benefits of at least $100,000 per accident or illness with a deductible not to exceed $500 per accident or illness;

At least $50,000 for expenses associated with a medical evacuation to the home country; and

At least $25,000 for the repatriation of remains.

Princeton will provide up to $50,000 toward expenses associated with a medical evacuation to an individual’s home country, and up to $25,000 for the repatriation of remains.

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.