UnitedHealthcare Princeton Health Plan

This UnitedHealthcare Princeton Health Plan (PHP) is not available to you if you are a non - U.S. citizen on a J - 1 Visa.

The UnitedHealthcare Princeton Health Plan (PHP) has both an in-network and out-of-network component. It has no exclusions for preexisting conditions.

The in-network approach allows members to seek care without having to designate a primary care physician. As a result, it is not necessary to obtain a referral before visiting another physician or specialist.

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

For a current Physician Directory, visit UnitedHealthcare's website.  Choose "Find Physicians and Facilities" in the center of the page.  At "Select a Product," use the drop-down menu to select the plan UnitedHealthcare Choice Plus network and complete the search.

Plan Overview

The chart below provides a brief overview of the benefits offered. Please review the UnitedHealthcare Princeton Health Plan package, call UnitedHealthcare for Princeton University toll free at (877) 609-2273 or contact the Benefits Team at 258-3302 for more details. 
 
Compare the rates for this and each plan offered. The Prescription Drug Program is included with this plan.
 

Plan Provision

In-Network

Out-of-Network

Deductible

The amount you pay each year before the plan begins covering particular medical expenses. Family deductible is cumulative.

Individual: $200

Family: $400

Individual: $750

Family: $1,500

Coinsurance (Out-of-pocket expense)

The percentage of medical expenses shared by you and the plan after you meet your deductible.

10% after 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, including your deductible, coinsurance and copayments.

See Salary Band chart 

 

See Salary Band chart 

Pre-Certification Requirement

No coverage without pre-certification on services so marked

In-network provider will pre-certify with UHC

No coverage without pre-certification on services so marked

Member must pre-certify with UHC

Lifetime Maximum

Medical/surgical/mental health

Unlimited

Unlimited

Feature/Service

In-Network Service: You Pay

Out-of-Network Service: You Pay

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 office visit

 

$30 copayment per specialist visit

30% after deductible1

Physician Services Performed in a Hospital/Ambulatory Setting

10% after deductible

30% after deductible1 (surgical fees subject to R&C limits)

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 tests and well–woman care office visits

$0 copayment per office visit

30% after deductible1

 
 

Scheduled immunizations

$0 copayment per office visit

30% after deductible1

Inpatient Hospital Services2
Medical/surgical care (includes maternity)

10% after deductible

30% after deductible1

Urgent Care Facility

$30 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. If you are admitted, copayment is waived.

 

No coverage for non-emergencies

Surgery (Inpatient/Outpatient) 2

Anesthesia and use of an operating room or related facility in a hospital or authorized institution.

10% after deductible

30% after deductible1

Outpatient Lab and X-Ray Services for Diagnosis or Treatment

$0 copayment per office visit

30% after deductible1

Hi-Tech Radiology2

$0 copayment per office visit

30% after deductible1

Outpatient Mental Health and Substance Abuse

Outpatient treatment; crisis intervention; detoxification.

$30 copayment per office visit

30% (no deductible required)1

Inpatient Mental Health and Substance Abuse2

10% after deductible

30% after deductible1

Outpatient Physical Rehabilitation

Short-term physical, speech, occupational or pulmonary and cardio rehabilitation therapies.

 

Maximum of 50 visits per therapy per calendar year (combined in-network/out-of-network)

10% after deductible

30% after deductible1

Chiropractic Services

20 visits per calendar year limit, (combined in-network/out-of-network)

$30 copayment per office visit

30% after deductible1

Home Health Care

Services provided in the home by an RN, LPN or contract therapist

 

60 visits per calendar year limit (combined in-network/out-of-network)

10% after deductible

30% after deductible1

Skilled Nursing Facility/Inpatient Physical Rehabilitation

Confinement and skilled nursing services in a hospital or specialized facility

 

60 days per calendar year limit (combined in-network/out-of-network)

10% after deductible

30% after deductible1

Dialysis, Chemo, and Radiation Services

$0 after deductible

30% after deductible1

Hospice Care
Room and board in a licensed facility or in your home; services of medical personnel; others services and supplies

180 day maximum (combined in-network/out-of-network)

Inpatient: 10% after deductible

 

Outpatient: 10% after deductible

Inpatient: 30% after deductible1

 

Outpatient: 30% after deductible1

Durable Medical Equipment Purchase or Rental

Splints, braces, non-surgically implanted prostheses, specified medical equipment for use in the home

10% after deductible

Not covered

Nutritional Counseling

Limited to 12 visits per calendar year with referral and/or script by your physician; coinsurance, deductible or copayment applies

$30 copayment per office visit

30% after deductible1

Hearing Exam

1 exam per calendar year; coinsurance, deductible or copayment applies

$30 copayment per office visit

30% after deductible1

Hearing Aids

Combined in-network/out-of-network limit of $1,500 reimbursement 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.
2These services require pre-certification through United Healthcare. You must call United Healthcare at (877) 609-2273 at least 14 days in advance of nonemergency treatment to request precertification or you will have no coverage for out-of-network services. In-network providers will contact United Healthcare for pre-certification.

Salary Band Chart

Find the salary range below which includes your January 1 (or salary at date of hire, if later) base salary to determine your in-network and/or out-of-network coinsurance limit.

 
 
Base Salary Range
 

In-Network Coinsurance Limit

 

Out-of-Network Coinsurance Limit

From
To
Individual
Family
Individual
Family
$75,000
  or under
$1,550
  $3,100
$4,500
  $9,000
$75,001
$150,000
$2,350
  $4,700
$4,700
  $9,400
$150,001
or over
$3,100
  $6,200
$6,200
  $12,400
 
If you are a participating retiree, the salary used is your salary at the time of retirement.
 
Only medically necessary services are covered.
 
For information about these plan benefits please call Member Services Toll Free at (877) 609-2273.  

PHP Plan Member Information

UnitedHealthcare provides a family ID card. Rather than each UnitedHealthcare member receiving an ID card, the family will receive two cards with all of the members information listed on them. If you would like additional cards, you must contact UnitedHealthcare directly.
 
Use the UnitedHealthcare ID card used to access medical care. You will receive a separate ID card for the Prescription Drug Plan, administered through Express Scripts.
 
If a doctor's office and/or hospital needs to verify coverage, they can call the Office of Human Resources at 258-3302 or you may provide them with the following information. 
 
Group number
196484
Member ID #
Will be system generated
Phone number
(877) 609-2273
 
 
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.