Aetna HMO Plan

This plan is available to you if you are a non - U.S. citizen on a J - 1 Visa.

In an HMO Plan, the primary care physician manages all health care. You must select a Primary Care Physician (PCP) and complete the Aetna HMO Election Form. The selection of a primary care physician and hospital is limited to those affiliated with the HMO. Health care is only covered when provided by the HMO or when permission is received for emergency care elsewhere. It has no exclusions for preexisting conditions.

Other features include:

  • a copayment for office visits
  • a referral is required to visit a Specialist
  • no claim forms

For a current Physician Directory, visit Aetna HMO's website and select "Aetna Standard Plans/HMO**."

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama on March 23, 2010. Princeton University believes the active health care plan is a "grandfathered health plan" under the PPACA.
 
For more information about these plan benefits or details on services not listed, call Aetna HMO's Customer Service Department toll free at (888) 287 - 4296. 

Plan Overview

The chart below provides a brief overview of the benefits offered. Please review the Aetna HMO Plan package for more details, or call the Benefits Team at 258-3302.  
 
Compare the rates for this and each plan offered. The Prescription Drug Program is included with this plan.

Plan Provision

You Pay

Deductible
The amount you pay each year before the plan begins covering particular medical expenses.
None
Coinsurance (Out - of - pocket expense)
The percentage of medical expenses shared by you and the plan after you meet your deductible.
Not applicable
Coinsurance Limit (Maximum Out - of - P ocket Expense)
The amount you pay each year before the plan pays 100% of your medical expenses, including your deductible and coinsurance; excludes copayments.
Not applicable
Lifetime Maximum
Medical/surgical/mental health
Not applicable
Physician Services Performed in an Office Setting
Office visits for routine care, diagnosis and treatment of an illness or injury
$20 copayment per PCP office visit

$25 copayment per specialist visit
Preventive Care
Preventive physicals, well - child care, including scheduled immunizations
 
Plan pays for up to seven visits during first year for well-child care, PSA and PAP tests, and well - woman care office visits.
$0
Office Visits for Maternity Care
$25 copayment for first  office visit only
Inpatient Hospital Services
Medical/surgical care, including maternity
$0
Urgent Care Facility $25 copayment
Emergency Room Care
Services administered for conditions meeting the definition of an emergency

You must follow the instructions on your member ID card.
$60 copayment. If you are admitted, the copayment is waived.
 
No coverage for non-emergencies
Surgery (Inpatient/Outpatient)
Anesthesia and use of an operating room or related facility in a hospital or authorized institution.
$0
Outpatient Mental Health and Substance Abuse
Outpatient treatment, crisis intervention, detoxification
$25 copayment per office visit
Inpatient Mental Health and Substance Abuse
 
$0
Substance Abuse
Detoxification
$0
Outpatient Physical Rehabilitation
Short - term physical, speech, occupational or pulmonary and cardio rehabilitation therapies.
 
Maximum of 50 visits per therapy per calendar year.
$25 copayment per office visit
Dialysis, Chemo, and Radiation Services
$0
Hospice Care
Room and board in a licensed facility or in your home; services for medical personnel; other services and supplies
Inpatient:  $0

Outpatient: $0
Chiropractic 
20 visits per calendar year
$25 copayment per office visit
Nutritional Counseling
Limited to 12 visits per calendar year with referral and/or script by your physician
 
Copayment will apply.
$20 copayment per PCP office visit

$25 copayment per specialist visit
Hearing Exam
1 exam per calendar year
 
Copayment will apply.
$20 copayment per PCP office visit
 
 
$25 copayment per specialist visit
Hearing Aids
Covered at 100% up to a maximum reimbursement of $1,500 every three years
Covered at 100% up to $1,500
Routine Annual Eye Exam
$25 copayment
Prescription Glasses or Contact Lenses
$70 reimbursement every 2 years, plus discounts at participating providers

Aetna HMO Plan Member Information

You should receive your Aetna HMO ID card within 30 days of enrollment. Aetna provides a family ID card.  Rather than each Aetna member receiving an ID card, the family will receive two cards with all of the members information listed on them. The ID card should be used to access medical care.
 
If a doctor's office and/or hospital needs to verify coverage, they can call the Office of Human Resources at (609) 258 – 3302 or you may provide them with the following information:
Group number
3015
Member number
Will be system generated
Phone number
(888) 287 - 4296

You can count on support from knowledgeable and responsive HR staff when you have a benefits question or problem. Just call or e-mail us. We’re here to help! 

While the University intends to continue each of the benefit plans, the University reserves the right to terminate or amend any plan, at any time, and for any reason.