Aetna Choice Point of Service Plan II (POS)

• no deductible
• no claim forms
• a copayment for office visits
• no referrals for specialist visits

The out - of - network portion of the plan provides the participant with the ability to see any physician, but at a greater cost.

For a current Physician Directory, visit Aetna's website. Choose “Find a Doctor or Hospital” from the Tools menu at the bottom of the screen. Complete the required sections. Under “Plan,” use the drop down menu to identify the Aetna Open Access Plan. Select the plan name "Aetna Choice II POS (Open Access)" and complete the search.

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 Service Center for Princeton University toll free at (800) 535 - 6689. 

The chart below provides a brief overview of the benefits offered. Please review the Aetna POS 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	In-Network Service	Out-of-Network Service
Deductible The amount you pay each year before the plan begins covering particular medical expenses.   The family deductible is cumulative.	Not applicable	Individual: $900 Family: $1,800
Coinsurance (Out-of-Pocket Expense) The percentage of medical expenses shared by you and the plan after you meet your deductible	The plan pays 100% after you pay the required copayment or 10%	30% after deductible1
Coinsurance Limit (Maximum Out-of-Pocket Expense) Total amount you pay out-of-pocket in one calendar year before the plan pays 100% of your eligible medical expenses, including your deductible and coinsurance; excludes copayments	Individual: $1,500 Family: $3,000   In-network/out-of-network coinsurance limit cross applies2	Individual: $4,500 Family: $9,000   In - network/out - of - network coinsurance limit cross applies2
Lifetime Maximum Medical/surgical/mental health	Unlimited	Unlimited
Physician Services Performed in an Office Setting Office visits for routine care; diagnosis and treatment of an illness or injury and initial maternity visit; pre-and post-partum care inclusive to the surgical charge for delivery	$20 copayment per PCP office visit   $25 copayment per specialist visit	30% after deductible1
Physician Services Performed in a Hospital/Ambulatory Setting	10%	30% after deductible1
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	$20 copayment per PCP office visit   $25 copayment per specialist visit	30% after deductible1
Scheduled immunizations	$20 copayment per PCP office visit   $25 copayment per specialist visit	30% after deductible1
Inpatient Hospital Services3 Medical/surgical care (includes maternity)	10%	30% after deductible1
Urgent Care Facility	$25 copayment per office visit	30% after deductible1
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 per emergency visit for all medically necessary treatment   If you are admitted, copayment is waived.
Surgery (Inpatient)3 Anesthesia and use of an operating room or related facility in a hospital or authorized institution	10%	30% after deductible1
Surgery (Outpatient)3 Anesthesia and use of an operating room or related facility in a hospital or authorized institution	No charge	30% after deductible1
Outpatient Lab and X-Ray Services for Diagnosis or Treatment	No charge	30% after deductible1
Inpatient Mental Health /Substance Abuse3	10%	30% after deductible1
Outpatient Mental Health /Substance Abuse3	$25 copayment	30% (no deductible required)
Skilled Nursing Facility/ Inpatient Rehabilitation Facility Services Limited to 60 days per calendar year (combined in-network/out-of-network)	No charge	30% after deductible1
Outpatient Physical Rehabilitation3 Short-term physical, speech, occupational or pulmonary and cardio rehabilitation therapies   Maximum of 50 visits combined therapies per calendar year limit (combined in-network/out-of-network)	$25 copayment	30% after deductible1
Hospice Care Room and board in a licensed facility or in your home; services of medical personnel; other services and supplies   180 days per calendar year (combined in-network/out-of-network)	Inpatient: No charge Outpatient:  No charge	Inpatient: 30% after deductible1   Outpatient: 30% after deductible1
Chiropractic Services 20 visits per calendar year limit	$25 copayment	30% after deductible1
Nutritional Counseling Limited to 3 visits per calendar year with referral and/or script by your physician   Coinsurance, deductible or copayment will apply.	$20 copayment per PCP office visit     $25 copayment per specialist visit	30% after deductible1
Hearing Exam 1 exam per calendar year   Coinsurance, deductible or copayment will apply.	$20 copayment per PCP office visit    $25 copayment per specialist visit	30% after deductible1
Hearing Aids Combined in-network/out-of-network limit of $1,500 every 3 years	Covered at 100% up to $1,500	Covered at 100% up to $1,500
Routine Eye Exam/Prescription Glasses or Contact Lenses	Not covered	Not covered

¹ You pay 30% after you meet the required deductible and any amounts over reasonable and customary; the plan will pay 70% of reasonable and customary after you meet the required deductible.

 

² The term "cross applies" means that in-network payments count toward your out-of-network payment limits if you decide to use out-of-network services. Likewise, out-of-network payments count toward your in-network payment limits if you decide to use in-network services.

 

³These services require precertification through Aetna. You must call Aetna Medical Management at (800) 535-6689 at least 14 days in advance of nonemergency treatment to request precertification or you will have to pay a $200 penalty per procedure and/ or admission.

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.

 

Use the Aetna ID card to access medical care. You will receive a separate ID card for the Prescription Drug Plan, administered through Medco Health.

 

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:

 

If you need to request additional ID cards, have a question regarding eligibility, policies or how to select a new primary care physician, please call Aetna's Service Center for Princeton University toll free at (800) 535-6689.

Prescription Drug Program

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!