REFERRAL REQUIREMENTS FOR OFF-CAMPUS CARE
When a Referral is Required
The Princeton University Student Health Plan (SHP) requires enrollees ages 16 and over to initiate care at University Health Services (UHS) located in the McCosh Health Center before receiving off-campus medical care. Exceptions are listed below (see When a Referral is Not Required).
Medical Care Referrals
The SHP requires that UHS provide a referral every 12 months for off-campus medical care. Enrollees referred to an off-campus medical provider by a UHS clinician during the plan year will need to contact UHS at (609) 258-3141 to make an appointment if an updated referral is needed before continuing with any ongoing medical services in the subsequent plan year. Enrollees may also contact Aetna Student Health directly at (877) 437-6511 to inquire about their referral status. If your referral has expired or is expiring in the near future, please be sure to call UHS to make arrangements to secure an updated referral at (609) 258-3141 (medical referrals only). Medical care rendered without a referral from UHS is not covered by the SHP except as noted below.
Referrals for Counseling Services
The SHP recommends that UHS provide an initial referral for off-campus counseling care if you are not already established with an off-campus mental health provider. If you receive an initial referral or if you have already received a referral in a prior year, you will not have to obtain an additional mental health referral while you are an SHP enrollee. You may continue to see your mental health provider as an SHP enrollee per our plan provisions which include either 30 inpatient days or 30 outpatient visits (or any combination thereof for a total of 30) per plan year which begins each September 1st and ends on August 31st.
When a Referral is Not Required
- In the event of a life threatening emergency illness or injury requiring hospitalization or emergency room services.
- To use the $125 preventative dental visit benefit.
- For dependents under the age of 16.
- When off-campus care is needed during published Princeton University break periods (for example, fall recess, spring recess, and summer break).
- When an enrollee is continuing with mental health services with an established off-campus mental health provider.
- For student enrollees who maintain in absentia status (and their enrolled dependents) when receiving services outside of Mercer County, New Jersey.
- When enrollees are provided with a 90 days' extension of benefits for a medical disability.
Enrollees should contact UHS prior to receiving any elective surgery procedure during recess periods or over the summer so that their medical chart can be updated.
Enrollees are responsible for becoming familiar with all SHP benefits, limitations, and exclusions. Students should contact Aetna Student Healh at: 1-877-437-6511 or go to www.aetnastudenthealth.com for more information regarding the plan or for claim assistance.