UnitedHealthcare Choice Plus Point of Service Plan (POS)

Summary of Benefits

This plan is not available to you if you are a non-U.S. citizen on a J-1 Visa.
 
The UnitedHealthcare Point of Service (POS) Plan features both an in-network and out-of-network component.
 
The UnitedHealthcare Choice Plus POS plan features both an in-network  and out-of-network component and features no deductible, no claim forms and a copayment for office visits. The in-network approach allows members to seek care without having to designate a primary care physician (PCP).  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, but a greater cost. No preexisting condition exclusion applies.
 
For a current Physician Directory, visit the UnitedHealthcare's website. At "Select a Product," choose UnitedHealthcare Choice Plus from the drop-down menu.
 
The chart below provides a brief overview of the benefits offered. Please review the UnitedHealthcare Plan package, call UnitedHealthcare for Princeton University toll free at (877) 609-2273 or call the Benefits Team at (609) 258-3302 for more details. 
 
Plan Provision
In-Network Service
Out-of-Network Service
Deductible
The amount you pay each year before the plan begins covering particular medical expenses.
 
Family deductible is cumulative.
Not applicable
Individual : $ 900
Family : $1,800
Coinsurance (Out-of-pocket expense)
The percentage of medical expenses shared by you and the plan after you meet your deductible.
The plan pays 100% after you pay the required copayment or 10%.
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 medical expenses. 
 
Includes your deductible and coinsurance, excludes copayments
Individual : $1,500
Family : $3,000
 
In-network/out-of-network coinsurance limit cross applies2
Individual : $4,500
Family : $9,000
 
In-network/out-of-network coinsurance limit cross applies2
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 are inclusive to the surgical charge for delivery.
$20 copayment per PCP office visit

$25 copayment per specialist office visit
30% after deductible1
Physician Services Performed in a Hospital
10%
30% after deductible1
Physician Services Performed in an Ambulatory Surgical Center
10%
30% after deductible1
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  PAP tests and well-woman care office visits.
$20 copayment per PCP office visit

$25 copayment per specialist office visit
30% after deductible1
Scheduled immunizations
$20 copayment per PCP office visit

$25 copayment per specialist office visit
30% after deductible1
Inpatient Hospital Services
Medical/Surgical Care (includes maternity)
10%
30% after deductible1
Urgent Care Facility $25 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 for all medically necessary treatment.
 
If you are admitted, copayment is waived.
Surgery (Inpatient)3
Anesthesia and use of an operating room or related facility in a hospital or authorized institution.
10%
30% after deductible1
Surgery (Outpatient)
No charge
30% after deductible1
Outpatient Lab and X-Ray Services for Diagnosis or Treatment
No charge
30% after deductible1
Inpatient Mental Health/Substance Abuse3
 
10%
30% after deductible1
Outpatient Mental Health/Substance Abuse 
$25 copayment
30% (no deductible required)
Skilled Nursing Facility/
Inpatient Rehabilitation Facility Services

Limited to 60 days per calendar year,
combined in-network/out-of-network
10%
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
$25 copayment
30% after deductible1

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

180 days per calendar year, combined in-network/out-of-network

Inpatient: no charge

Outpatient: no charge
Inpatient: 30% after deductible1

Outpatient: 30% after deductible1 
Chiropractic Services
20 visits per calendar year limit
$25 copayment
30% 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 copayment per PCP office visit

$25 copayment per specialist office visit
30% after deductible1
Hearing Exam
1 exam per calendar year; coinsurance, deductible or copayment will apply
$20 copayment per PCP office visit

$25 copay per specialist office visit
30% after deductible1
Hearing Aids
Combined in-network/out-of-network limit of $1,500 reimbursement every three 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.
 
2 The term "cross applies" means that in-network payments count toward your out-of-network payment limits if you decide to use out-of-network services. Likewise, out-of-network payments count toward your in-network payment limits if you decide to use in-network services.
 
3 These services require precertification through United Healthcare. You must call UnitedHealthcare at (877) 609-2273 at least 14 days in advance of nonemergency treatment to request precertification or you will have to pay a $200 penalty per procedure and/or admission. 

Point of Service Plan Member Information

You should receive your UnitedHealthcare Choice Plus ID card at the end of December 2011. 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. The 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 Office of Human Resources at (609) 258-3302 or you can provide them with the following information:
 
Group number
196484
Member ID #
Will be system generated
Phone number
(877) 609-2273
 
If you need to request additional ID cards, have a question regarding eligibility, policies or want to select a new primary care physician, please call UnitedHealthcare's Service Center for Princeton University toll free at (877) 609-2273.
 
 
 
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.