High Deductible Plan (Aetna)

Plan Overview 

This Aetna Plan is not available to you if you are a non-U.S. citizen on a J-1 Visa.
The High Deductible Plan is an indemnity plan that is available to employees only at no charge. Coverage is not available for a spouse and/or children. This plan is designed to provide coverage in the event of a catastrophic illness or injury.
The High Deductible Plan is a passive PPO Plan, and, if you utilize a provider in Aetna's Open Choice PPO network, you may be able to take advantage of Aetna's negotiated rates that might lower your out-of-pocket expenses. You also may utilize any hospital, facility or physician of your choice, although the negotiated rates will not apply.
You may search for participating physicians, facilities and hospitals by logging onto Aetna's website. When on Aetna's "DocFind" and choosing a plan, please select Open Choice PPO.
Reimbursement through this plan will not begin until an annual deductible of $5,000 is reached and you must submit a claim to be reimbursed for expenses. There is no separate prescription drug program with this plan.
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 "grandfathered health plan" under the PPACA
If you are enrolled in this plan and also have medical coverage elsewhere, your coverage in the High Deductible Plan may be primary. You will be required to submit all claims through this plan first.
The chart below provides a brief overview of the benefits offered. For more details contact the Benefits Team at 8-3302. 
Plan Provision
You Pay
The amount you pay each year before the plan begins covering particular medical expenses.
Individual: $5,000
Coinsurance (Out-of-pocket expense)
The percentage of medical expenses shared by you and the plan after you meet your deductible.
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.  (Includes your deductible and coinsurance, but excludes copayments).
Individual:  $20,000
Non-Notification/Non-Compliance Penalty
The amount you must pay if you do not call Medical Management at (800) 535-6689 before hospitalization and certain types of surgery, or fail to follow concurrent review procedures.
$200 per procedure and/or admission
Lifetime Maximum
Medical/Surgical/Mental Health
You Pay
Physician Services Performed in an Office Setting
Office visits for routine care; diagnosis and treatment of an illness or injury (includes maternity).
30% after deductible1
Preventive Care
Preventive physicals, well-child care (including scheduled immunizations), PSA, PAP tests and well woman care office visits.
Scheduled immunizations
Not covered
Inpatient Hospital Services
Medical/Surgical Care (includes maternity).
30% after deductible1
Urgent Care Facility
30% after deductible1
Emergency Room Care
Services administered for conditions meeting the definition of an emergency.
You must call (800) 535-6689 within 2 business days of emergency room visit.
30% after deductible1
Surgery (Inpatient/Outpatient)
Anesthesia and use of an operating room or related facility in a hospital or authorized institution.
30% after deductible1
Outpatient Lab and X-Ray Services for Diagnosis or Treatment
30% after deductible1
Outpatient Mental Health and Substance Abuse
Outpatient treatment; crisis intervention; detoxification.
30% after deductible1
Inpatient Mental Health and Substance Abuse
30% after deductible1
Outpatient Physical Rehabilitation
Short-term physical, occupational or speech therapies.
Maximum of 30 visits each type per calendar year.
30% after deductible1
Dialysis, Chemo, and Radiation Services
30% after deductible1
Hospice Care
Room and board in a licensed facility or in your home; services of medical personnel; other services and supplies.
Inpatient: Maximum of 180 days per lifetime.
Outpatient: Unlimited benefit
Inpatient: 30%  after deductible1

30%  after deductible1
Chiropractic Services
20 visits per calendar year limit.
30% after deductible1
Nutritional Counseling
Limited to 12 visits per calendar year with referral and/or script by your physician; coinsurance and deductible apply
Hearing Exam
1 exam per calendar year; coinsurance and deductible apply
30% after deductible1
Hearing Aids
Covered at 100% up to a maximum reimbursement of $1,500 every three years
Covered at 100% up to  $1,500
Routine Eye Exam/Prescription Glasses or Contact Lenses
Not covered
Routine Eye Exam
Not covered
Prescription Glasses or Contact Lenses
Not covered
Prescription Drug Program
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.

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.