2020 Health Maintenance Organization (HMO) Plan

Plan Type
Medical

During the COVID-19 pandemic, refer to the Benefits Updates webpage for relevant information.

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.

Medical Services

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

    Mental Health Services

    Coverage Options
    In-Network
    Plan Design
    Less than $75,000
    Employee
    $74.00
    Employee & Children
    $216.00
    Employee & Spouse
    $290.00
    Family
    $446.00
    $75,001–150,000
    Employee
    $77.00
    Employee & Children
    $226.00
    Employee & Spouse
    $303.00
    Family
    $464.00
    $150,001 and over
    Employee
    $81.00
    Employee & Children
    $235.00
    Employee & Spouse
    $316.00
    Family
    $483.00
    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)
    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
    Inpatient Services

    Medical & Surgical Procedures

    In-Network
    $175 copayment

    Mental Health

    In-Network
    $175 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.