Aetna Choice Point of Service Plan II (POS)

This Aetna Plan is not available to you if you are a non - U.S. citizen on a J - 1 Visa.

The Aetna Point of Service (POS) Plan has both an in - network and out - of - network component.  It has no exclusions for preexisting conditions.
 
The in - network coverage features:
  • 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. 

Plan Overview

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.

Plan Member Information

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:

Group number
811281
Member ID #
Will be system generated
Phone number
(800) 535-6689
 
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.


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.