Aetna J-1 Visa Health Care Plan

The J - 1 Visa Plan is available only to those who are non - U.S. citizens on a J - 1 Visa.
 
The J-1 Visa Medical Plan is a passive PPO Plan. Although you can utilize any hospital, facility or physician of your choice, if you utilize a provider in Aetna's Open Choice PPO network, you could be able to take advantage of Aetna's negotiated rates, which might lower your out-of-pocket expenses.
 
You can 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.
 
This plan is an indemnity, also known as a fee-for-service, allows you to:
  • select any doctor or hospital
  • be reimbursed through this plan after you reach your annual deductible
  • submit a claim form to be reimbursed for your expenses

This plan also requires pre-admission review of inpatient hospital admissions. No preexisting condition exclusion applies.

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. 

Plan Overview

The chart below provides a brief overview of the benefits offered. For more details contact the Benefits Team at 258-3302 or benefits@princeton.edu.
 
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.
Individual: $500
 
Family: $1,000
Coinsurance (Out-of-Pocket Expense)
The percentage of medical expenses shared by you and the plan after you meet your deductible
20% 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
Individual: $2,500
 
Family: $5,000
Non-Notification/Non-Compliance Penalty
The amount your 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
Unlimited
Physician Services Performed in an Office Setting
Office visits for routine care; diagnosis and treatment of an illness or injury (includes maternity).
20% after deductible1
Preventive Physicals
Routine adult physical exams
 
1 exam per  year for members 18 years of age or older
20% after deductible1
 
Preventive Care
Well baby visits; maximum seven exams in first 12 months of life
20% after deductible1
 
 
Scheduled immunizations
20% after deductible1
Inpatient Hospital Services
Medical/surgical care, including maternity
20% after deductible1
Urgent Care Facility
20% after deductible1
Emergency Room Care
Services administered for conditions meeting the definition of an emergency.  You must call (800) 535-6689 within two business days of emergency room visit.
20% after deductible1
Surgery (Inpatient/Outpatient)
Anesthesia and use of an operating room or related facility in a hospital or authorized institution
20% after deductible1
Outpatient Mental Health and Substance Abuse
Outpatient treatment, crisis intervention, detoxification
20% after deductible1
Inpatient Mental Health and Substance Abuse
20% after deductible1
Outpatient Physical Rehabilitation
Short-term physical, occupational or speech therapies
 
Maximum of 30 visits per therapy per calendar year.
 
20% after deductible1
Dialysis, Chemo, and Radiation Services
20% after deductible1
Hospice Care
Room and board in a licensed facility or in your home; services of medical personnel; other services and supplies
 
Inpatient: Limited to 180 days per lifetime
Outpatient: Unlimited maximum
 Inpatient:20% after deductible1

Outpatient:20% after deductible1
Chiropractic Services
20 visits per calendar year limit
20% after deductible1
Nutritional Counseling
Limited to 12 visits per calendar year with referral and/or script by your physician
 
Coinsurance, deductible or copayment will apply
20% after deductible1
Hearing Exam
1 exam per calendar year; coinsurance, deductible or copayment will apply
20% after deductible1
Hearing Aids
Covered at 100% up to a maximum reimbursement of $1,500 every 3 years
Covered at 100% up to $1,500
 
Routine Eye Exam
Not covered
Prescription Glasses or Contact Lenses
Not covered
Supplemental Benefits
Medical evacuation to the member's home country
 
Repatriation provision for transport of deceased to home country
 
Maximum of $10,000
 
 
Maximum of $7,500

1 You pay 20% after you meet the required deductible and any amounts over reasonable and customary; the plan will pay 80% of reasonable and customary after you meet the required deductible.

J-1 Visa Health Care Plan (Aetna) Member Information

You should receive your Aetna ID card in approximately 30 days. Aetna provides a "family" ID card. Rather than each Aetna member receiving an ID card, the family will receive two cards with all members information listed on them.
 
The Aetna 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 Benefits Team at 258–3302, or you can provide them with the following information: 
Group number
811281
Member ID #
Will be system generated
Phone number
(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.