Aetna J-1 Visa Plan

The J-1 Visa Plan is available only to those who are non-U.S. citizens on a J-1 Visa.

The Aetna J-1 Visa Medical Plan is a passive PPO Plan which means that while you may utilize any hospital, facility or physician of your choice, if you utilize a provider in Aetna’s Open Choice PPO network, you may be able to take advantage of Aetna’s negotiated rates which may lower your out-of-pocket expenses. You may search for participating physicians, facilities and hospitals by logging onto Aetna’s website. Click on Aetna’s “Find a Doctor” and choosing a plan, please select "Open Choice PPO".

This plan is an indemnity (fee-for-service) plan that allows you to select any doctor or hospital. Reimbursement through this plan, however, will not begin until an annual deductible is reached and you must submit a claim form to be reimbursed for expenses. This plan also requires pre-admission review of inpatient hospital admissions. No pre-existing condition exclusion applies.

The chart below provides a brief overview of the benefits offered. For more details contact the Office of Human Resources at 609-258-3302. Compare the rates for this and each plan offered.

Plan Provisions	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 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
Feature/Service	You Pay
Physician Services Performed in an Office Setting Office visits for routine care; diagnosis and treatment of an illness or injury, including maternity	20% after deductible¹
Preventive Care Well-baby visits; maximum seven exams in first 12 months of life	20% after deductible¹
Preventive physicals Routine adult physical exam; 1 exam per year for members 18 years of age or older	20% after deductible¹
Scheduled immunizations	20% after deductible¹
Inpatient Hospital Services Medical/Surgical Care (includes 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 2 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 each type per calendar year	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 dedcutible¹ Outpatient: 20% after deductible¹
Chiropractic Services 20 visits per calendar year limit	20% after deductible¹
Nutritional Counseling Limited to three visits per calendar year with referral and/or script by your physician; coinsurance, deductible or copayment will apply	20% after deductible*
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 three 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 (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 by the end of December 2011. 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. The Aetna ID card should be used to access medical care. If a doctor's office 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 seek medical treatment before you receive your ID card, please refer the provider to the following information:

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

Prescription Drug Program

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.

Aetna J-1 Visa Plan

Plan Provisions

You Pay

Feature/Service

You Pay

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