2025 Retiree Aetna Point of Service Plan (POS)

Plan Type
Medical

Under the Aetna Point of Service Plan, 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 POS Plan includes the Prescription Drug Plan.

For individuals living in New Jersey and Southeastern PA, the Plan 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 be using Aetna's standard broad network of providers, which is the Choice POS II network. As long as a provider is in-network in the Choice POS II network, the tier 1 cost share will apply. 

For more details, visit Aetna APCN+ Network.

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

Features
  • Highest contribution offered.
  • Aetna Choice POS II (open access) Network of providers.
  • 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.
  • In-network Tier 1 providers deliver coverage 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 additional information.
  • 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.
  • 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)
Out-of-Network
Plan Design
In-Network (Tier 1)
Individual
$100
Family
$200
In-Network (Tier 2)
Individual
$500
Family
$1,000
Out-of-Network
Individual
$1,500.00
Family
$3,000.00
In-Network (Tier 1)
Individual
$2,500
Family
$5,000
In-Network (Tier 2)
Individual
$3,200
Family
$6,400
Out-of-Network
Individual
$6,000
Family
$12,000
Physician Visits

Telemedicine (Offered through Teladoc)

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

Telemental Health (Offered through Teladoc)

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

Primary Care Physician (PCP)

In-Network (Tier 1)
$20 copayment
Out-of-Network
40% after deductible
In-Network (Tier 2)
$35 copayment

Preventive Care & Immunizations

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

Specialists

In-Network (Tier 1)
$30 copayment
Out-of-Network
40% after deductible
In-Network (Tier 2)
$45 copayment
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)
Maternity

Prenatal Care Visits

In-Network (Tier 1)
$20 copayment for the first visit, $0 for subsequent visits
Out-of-Network
40% after deductible
In-Network (Tier 2)
$35 copayment for the first visit; $0 for subsequent visits

Delivery

In-Network (Tier 1)
10% after deductible
Out-of-Network
40% after deductible
In-Network (Tier 2)
30% after deductible

Post-Partum Visits

In-Network
$20 copayment
Out-of-Network
40% after deductible
In-Network (Tier 2)
$35 copayment
Inpatient Services

Medical & Surgical Procedures

In-Network (Tier 1)
10% after deductible
Out-of-Network
40% after deductible
In-Network (Tier 2)
30% after deductible

Mental Health

In-Network (Tier 1)
10% after deductible
Out-of-Network
40% after deductible
In-Network (Tier 2)
30% after deductible
Outpatient Services

Surgical Procedures

In-Network (Tier 1)
$250 copay after deductible
Out-of-Network
40% after deductible
In-Network (Tier 2)
$500 copay after deductible

Laboratory

In-Network (Tier 1)
$20 copayment
In-Network (Tier 2)
$40 copayment
Out-of-Network
Not covered

Radiology (X-Ray)

In-Network (Tier 1)
$20 copay
Out-of-Network
Not covered
In-Network (Tier 2)
30% after deductible

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

In-Network (Tier 1)
$20 copayment
Out-of-Network
Not covered
In-Network (Tier 2)
30% after deductible

Mental Health

In-Network
$20 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

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)
$30 copayment
Out-of-Network
40% after deductible
In-Network (Tier 2)
$45copayment

Acupuncture (20 visits per calendar year)

In-Network (Tier 1)
$30 copayment
Out-of-Network
40% after deductible
In-Network (Tier 2)
$45copayment
Additional Information

All benefits-eligible employees can elect coverage under the POS except those on a J-1 Visa. Over 65 dependents of under 65 retirees must elect Medicare Parts A and B as their primary coverage. The POS 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.