PRE-AUTHORIZATION REQUIREMENTS FOR OFF-CAMPUS CARE

When You Need a Pre-Authorization

The Princeton University Student Health Plan (SHP) requires that students initiate care at University Health Services (UHS) before being referred for off-campus medical care except for emergency illnesses or injuries during the plan year (September 1st through August 31st).

The SHP requires that UHS provide a pre-authorization every 12 months for off-campus medical care.  If you have been referred to an off-campus community provider by a UHS clinician during the 2012-13 plan year, you will need to contact UHS to check when and if you need an updated pre-authorization if you plan to continue with any ongoing medical services as an enrollee of the SHP in the upcoming plan year starting September 1, 2013. As an example, if you received a pre-authorization from a UHS clinician to see an off-campus specialist in November of 2012, you will need to secure an updated authorization for services being received in November of 2013. If you do not remember the last time you received a pre-authorization for off-campus services, please contact Aetna Student Health directly at: 1-877-437-6511. If you find that your pre-authorization has expired or is expiring in the near future, please be sure to call UHS this summer to make arrangements for securing your pre-authorization at 1-609-258-3141.  Care rendered without pre-authorization by UHS, is not covered by the SHP.

When You Do Not Need a Pre-Authorization

If you have a life threatening emergency illness or injury and require hospitalization or emergency room services

• If you choose to use your $125 preventative dental visit, you would not need a pre-authorization.
• Dependents under the age of 16 are not required to obtain a pre-authorization for off-campus care.
• Enrollees and dependents are not required to obtain a pre-authorization for off-campus care during published Princeton University break periods (e.g., fall recess, spring recess, and summer).
• When continuing with mental health services with an established off-campus mental health provider.
• Students who maintain in absentia status do not require a pre-authorization if they are not within a reasonable proximity to the University (i.e., outside Mercer, Middlesex and Somerset Counties in NJ and Bucks County in PA) or if UHS is closed.

We do ask that you contact UHS prior to receiving any elective surgery procedures during recess periods or the summer so your medical chart may be properly updated. Enrollees needing a pre-authorization for medical care should contact UHS at 1-609-258-3141.  

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 www.aetnastudenthealth.com for more information regarding the plan or for claim assistance.