2025 Retiree Aetna Exclusive Provider Organization (EPO) Plan

Plan Type
Medical

The Exclusive Provider Organization (EPO) Plan limits coverage to care from in-network doctors. Referrals for specialists are not required. While a primary care physician (PCP) is not required, you should choose a network PCP to manage your healthcare needs. The EPO Plan includes the Prescription Drug Plan.  

Individuals living in New Jersey and Southeastern PA 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

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. There is no out-of-network coverage under the EPO Plan.  

For individuals living in New York or other states (other than NJ or Southeastern PA), you will be using Aetna’s standard broad network to search for providers, which is the EPO's Open Access Select Network of providers; the APCN+ network does not apply to you and you will pay the tier 1 cost share for all services. 

For more details, visit 2025 Aetna APCN+ Network.

Refer to Retiring from Princeton for related information, including retiree healthcare plan rates.

Features
  • In-network providers only; this plan utilizes the Open Access Select Network. 
  • 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) is not required.
  • A referral is 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

Coverage Options
In-Network
In-Network (Tier 1)
In-Network (Tier 2)
Plan Design
In-Network (Tier 1)
Individual
$0
Family
$0
In-Network (Tier 2)
Individual
$200
Family
$400
In-Network (Tier 1)
Individual
$1,500.00
Family
$3,000.00
In-Network (Tier 2)
Individual
$2,000
Family
$4,000
Physician Visits

Telemedicine (Offered through Teladoc)

In-Network
$10 copayment

Telemental Health (Offered through Teladoc)

In-Network
$10 copayment

Primary Care Physician (PCP)

In-Network (Tier 1)
$15 copayment
In-Network (Tier 2)
$30 copayment

Preventive Care & Immunizations

In-Network
$0

Specialists

In-Network (Tier 1)
$20 copayment
In-Network (Tier 2)
$40 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
$15 copayment for first visit, $0 for subsequent visits
In-Network (Tier 2)
$30 copayment for first visit, $0 for subsequent visits

Delivery

In-Network (Tier 1)
$175 copayment
In-Network (Tier 2)
20% after deductible

Post-Partum Visits

In-Network (Tier 1)
$15 copayment
In-Network (Tier 2)
$30 copayment
Inpatient Services

Medical & Surgical Procedures

In-Network (Tier 1)
$175 copayment
In-Network (Tier 2)
20% after deductible

Mental Health

In-Network (Tier 1)
$175 copayment
In-Network (Tier 2)
$175 copayment after deductible
Outpatient Services

Surgical Procedures

In-Network (Tier 1)
$30 copayment
In-Network (Tier 2)
$75 copayment after deductible

Laboratory

In-Network (Tier 1)
$10 copayment
In-Network (Tier 2)
$30 copayment

Radiology (X-Ray)

In-Network (Tier 1)
$15 copayment
In-Network (Tier 2)
$35 copayment

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

In-Network (Tier 1)
$15 copayment
In-Network (Tier 2)
$50 copayment

Mental Health

In-Network
$10 copayment

Annual Eye Exam

In-Network (Tier 1)
$20 copayment
In-Network (Tier 2)
$40 copayment

Prescription Eyeglasses and/or Contact Lenses

In-Network
$70 reimbursement every 2 years

Physical Therapy

In-Network (Tier 1)
$15 copayment
In-Network (Tier 2)
$30 copayment

Speech Therapy / Occupational Therapy / Pulmonary & Cardiac Rehabilitation

In-Network (Tier 1)
$15 copayment
In-Network (Tier 2)
$30 copayment

Chiropractic Care (20 visits per calendar year)

In-Network (Tier 1)
$20 copayment
In-Network (Tier 2)
$40 copayment

Acupuncture (20 visits per calendar year)

In-Network (Tier 1)
$20 copayment
In-Network (Tier 2)
$40 copayment
Additional Information

All benefits-eligible employees, including those on a J-1 Visa, can elect coverage under the EPO Plan.

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

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.