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2019 Princeton Health Plan

Plan Type
Medical

The Princeton Health Plan (PHP) is a point-of-service plan where costs are less when using providers in the plan’s network. Individuals can access doctors, hospitals, and providers outside of the network without a referral for an additional cost. The PHP includes the Prescription Drug Plan.

Features
  • Highest contribution offered.
  • Choice of the Aetna Choice POS II (open access) Network or the UnitedHealthcare Choice Plus Network.
  • In-network preventive services e.g. annual exams, colonoscopies, and mammograms covered at 100%.
  • Prescriptions and copayment services e.g., office visits, telemedicine, and urgent care, are covered before deductible.
  • After meeting the annual deductibles, coverage begins for all other medical services.
  • After reaching the out-of-pocket maximums (OPMs), services are covered at 100%. OPMs are based on the employee’s annual base salary as of January 1 or the date of hire, if later.
  • In-network preferred providers deliver coverage 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 is 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
$117.00
Employee & Children
$323.00
Employee & Spouse
$410.00
Family
$608.00
In-Network
Individual
$200.00
Family
$400.00
Out-of-Network
Individual
$750.00
Family
$1,500.00

Less than $75,000

In-Network
Individual
$1,550
Family
$3,100
Out-of-Network
Individual
$4,500
Family
$9,000

$75,001–150,000

Out-of-Network
Individual
$4,700
Family
$9,400
In-Network
Individual
$2,350
Family
$4,700

$150,001 and over

Out-of-Network
Individual
$6,200
Family
$12,400
In-Network
Individual
$3,100
Family
$6,200
Physician Visits

Telemedicine (Offered through Teladoc)

In-Network
$0
Out-of-Network
NA

Telemental Health (Offered through Teladoc)

In-Network
$30 copayment
Out-of-Network
NA

Primary Care Physician (PCP)

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

Preventive Care & Immunizations

In-Network
$0
Out-of-Network
40% after deductible
Specialists

Standard Specialists

In-Network
$30 copayment
Out-of-Network
40% after deductible

Tiered Specialists

In-Network (Preferred)
$30 copayment
In-Network (Non-Preferred)
$60 copayment
Out-of-Network
40% after deductible
Emergency & Urgent Care Services

Urgent Care Center

In-Network
$30 copayment
Out-of-Network
40% after deductible

Emergency Room (No coverage for non-emergencies)

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
40% after deductible

Mental Health

In-Network
10% after deductible
Out-of-Network
40% after deductible
Outpatient Services

Surgical Procedures

In-Network (Preferred)
10% after deductable
In-Network (Non-Preferred)
20% after deductable
Out-of-Network
40% after deductable

Laboratory

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

Radiology (X-Ray)

In-Network
$0 (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered

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

In-Network (Preferred)
$0 (Independent Facility) / 20% after deductible (Hospital)
Out-of-Network
Not covered

Mental Health

In-Network
$30 copayment
Out-of-Network
25% no 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
10% after deductible
Out-of-Network
50% after deductible

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

In-Network
10% after deductible
Out-of-Network
40% after deductible

Chiropractic Care (20 visits per calendar year)

In-Network
$30 copayment
Out-of-Network
40% after deductible

Acupuncture (20 visits per calendar year)

In-Network
$30 copayment
Out-of-Network
40% after deductible
Maternity

Prenatal Care Visits

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
40% after deductible

Post-Partum Visits

In-Network (Preferred)
$30 copayment
In-Network (Non-Preferred)
$60 copayment
Out-of-Network
40% after deductible
Additional Information

All benefits-eligible employees can elect coverage under the PHP 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.