2025 Retiree Aetna Consumer Directed Health Plan

Plan Type
Medical

The Retiree Consumer Directed Health Plan (CDHP) is a qualified high-deductible plan. The CDHP is integrated with the Prescription Drug Plan.

For individuals living in New Jersey and Southeastern PA, the CDHP will utilize a high-performing network, the Aetna Premier Care Network Plus (APCN+) This network has distinct tiers that offer different levels of coverage:

  • Tier 1 — maximum savings; using this tier reduces your costs in most instances
  • Tier 2 — standard savings; using this tier increases your costs in most instances
  • Tier 3 — out-of-network 

When you receive care, you will receive the highest level of coverage — tier 1 — when utilizing doctors in the APCN+ network. All other in-network doctors will be covered at tier 2.   

Individuals living in New York or other states (other than NJ or Southeastern PA) will utilize Aetna's standard broad network of providers, which is the Choice POS II network. In-network providers in the the Choice POS II network will be covered at the tier 1 cost share.

For more details, visit Aetna APCN+ Network.

Features
  • 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 providers deliver services at the lowest cost.
  • Out-of-network reimbursements are limited; rates are determined by our insurance carriers using data provided by Medicare. Review the Summary Plan Description for more information.
  • Primary care physician (PCP) is not required but is highly recommended and does not introduce referral requirements.
  • Referral not required to see a specialist.
  • 24/7 Nurse Line available to speak with a registered nurse about health issues or questions; available at no cost. Call 1-800-556-1555 for assistance.

Medical Services

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

Mental Health Services

  • Teladoc Mental Health
  • AbleTo
  • Inpathy, Aetna's in-network telemental health services provider (also known as Televideo): Call (800) 442-8938. Residents outside of New Jersey, New York, or Pennsylvania should call (800) 535-6689. Visits are covered at the same cost as in-network mental health visits under the Princeton medical plan.
Coverage Options
In-Network
In-Network (Tier 1)
In-Network (Tier 2)
Out-of-Network
Plan Design
In-Network (Tier 1)
Individual
$1,650
Family
$3,300
In-Network (Tier 2)
Individual
$2,450
Family
$4,900
Out-of-Network
Individual
$3,200
Family
$6,400
In-Network (Tier 1)
Individual
$3,000.00 (employee only coverage) or $3,300 (famliy coverage)
Family
$6,000.00
In-Network (Tier 2)
Individual
$4,000.00
Family
$8,000
Out-of-Network
Individual
$6,000
Family
$12,000
Physician Visits

Telemedicine (Offered through Teladoc)

In-Network
$56 until deductible is met, then $10 copayment
Out-of-Network
NA

Telemental Health (Offered through Teladoc)

In-Network
$10 copayment after deductible
Out-of-Network
NA

Primary Care Physician (PCP)

In-Network (Tier 1)
$15 copayment after deductible
In-Network (Tier 2)
30% after deductible
Out-of-Network
50% after deductible

Preventive Care & Immunizations

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

Specialists

In-Network (Tier 1)
$25 copayment after deductible
In-Network (Tier 2)
30% after deductible
Out-of-Network
50% after deductible
Emergency & Urgent Care Services

Urgent Care Center

In-Network
$30 copayment after deductible
Out-of-Network
50% after deductible

Emergency Room (No coverage for non-emergencies)

In- or Out-of-Network
$175 copayment after deductible
Maternity

Prenatal Care Visits

In-Network (Tier 1)
$15 copayment after deductible for the first visit, $0 for subsequent visits
In-Network (Tier 2)
30% after deductible for the first visit, $0 for subsequent visits
Out-of-Network
50% after deductible

Delivery

In-Network (Tier 1)
10% after deductible
In-Network (Tier 2)
30% after deductible
Out-of-Network
50% after deductible

Post-Partum Visits

In-Network (Tier 1)
$15 copay after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
30% after deductible
Inpatient Services

Medical & Surgical Procedures

In-Network (Tier 1)
10% after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
30% after deductible

Mental Health

In-Network (Tier 1)
10% after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
13% after deductible
Outpatient Services

Surgical Procedures

In-Network (Tier 1)
$250 copayment after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
30% after deductible

Laboratory

In-Network (Tier 1)
$10 copayment after deductible
In-Network (Tier 2)
$30 copayment after deductible
Out-of-Network
Not covered

Radiology (X-Ray)

In-Network (Tier 1)
$15 copayment after deductible
Out-of-Network
Not covered
In-Network (Tier 2)
30% after deductible

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

In-Network (Tier 1)
$15 copayment after deductible
Out-of-Network
Not covered
In-Network (Tier 2)
30% after deductible

Mental Health

In-Network
$10 copayment 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

In-Network (Tier 1)
10% after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
30% after deductible

Speech Therapy / Occupational Therapy / Pulmonary & Cardiac Rehabilitation

In-Network (Tier 1)
10% after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
30% after deductible

Chiropractic Care (20 visits per calendar year)

In-Network (Tier 1)
$25 copayment after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
30% after deductible

Acupuncture (20 visits per calendar year)

In-Network (Tier 1)
$25 copayment after deductible
Out-of-Network
50% after deductible
In-Network (Tier 2)
30% after deductible
Additional Information

Over 65 dependents of under 65 retirees must elect Medicare Parts A and B as their primary coverage. The CDHP will provide secondary coverage.

Employees here on a J-1 Visa may not elect this 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.

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.