This page is meant as a guide to the Student Health Plan, University Health Services, and other health-related information, written by and for graduate students. Most of the information found on this page is available in some form in the Student Health Plan documents or spread across the various webpages of UHS, Aetna, Medco, etc. However, we hope this will provide a one-stop source for some of the most commonly asked questions about healthcare at Princeton.
While we try to keep it updated, some information (especially prices) may be out of date, so always check with UHS or the Graduate School on these points.
You can find most of the locations mentioned in the answers below on this map: Graduate Student Health FAQ Google Map
Aetna, Medco, Cigna, VSP, Aetna Student Health, Chickering… who are they, and who covers what?
The Student Health Plan (SHP) provides graduate students with a combination of comprehensive medical insurance, prescription coverage, and optional dental and vision plans, all of which are administered by different entities. The basics:
- Aetna Student Health is the claims administrator for our insurance plan. Aetna Student Health is affiliated with Aetna; however, its programs are specifically tailored to colleges and universities. Aetna Student Health is a recent name change; it was previously known as The Chickering Group, a name that still appears on some paperwork.
- Medco (MedcoHealth) is the pharmacy benefit manager for the prescription plan, which is separate from the insurance plan offered through Aetna Student Health. The prescription plan has its own deductible that is separate from procedures covered by Aetna; see the Prescriptions section below for more information.
- Cigna is the claims administrator for the optional supplemental dental plan. See the dental section below for more information on this plan.
- VSP (Vision Service Plan) is the administrator for the optional supplemental vision plan. See the vision section below for more information on this plan.
Can I decline the SHP coverage?
No. All graduate students are automatically enrolled in the SHP program.
… But I’m already covered (by my significant other, etc.)! Why can’t I decline?
Very few students actually pay for tuition (and the SHP) out of pocket. For students with an Assistant in Instruction position or a University-sponsored fellowship (such as the first-year fellowships), the University pays this fee. For students with a Assistant in Research position, tuition usually comes from an advisor’s grant. In this case, there may be a financial incentive for an advisor to encourage his or her student to decline coverage against his or her best interests. To prevent that from ever becoming an issue, students are simply not allowed to opt out.
DCE students without outside funding may be financially impacted by the inability to opt out, but unfortunately there is not currently a policy to help these students.
When does SHP coverage begin? When does it end?
The annual period for SHP coverage is Sept 1 – Aug 31. If an incoming student arrives on campus any time after July 1 prior to their September start-date for an assistantship or other Graduate School-approved program, coverage can begin then, with a pro-rata fee assessed for the period of time between arrival and Sept 1. SHP coverage will continue, with fees automatically assessed, as long as a student is enrolled at Princeton (including in absentia and DCE status).
When coverage ends is a slightly more complicated topic. If you complete the degree that you originally intended to get when you began your program (usually a Ph.D., with the exception of a few Master’s programs) within the program length (usually 5 years) or within the DCE time period (an additional 2 years), then SHP coverage ends 90 days after the 1st of the month after the FPO. Degrees at Princeton can be approved five different times during the year: September (SHP extends to Dec 31), November (SHP extends to Jan 31), January (SHP extends to Apr 30), April (SHP extends to June 30), or May/June (SHP extends to Aug 31).
If, on the other hand, you leave Princeton prior to receiving degree you originally enrolled for, whether voluntarily or not, then the 90-day extension does not apply, even if you earn a terminal Master’s degree. In this case, your SHP coverage will terminate at the end of the month in which your student enrollment ends. If, within 30 days of this cutoff date, you or one of your dependents is undergoing treatment for an existing condition, then you can apply for a 90-day extension due to disability.
If you enter ETDCC (Enrollment Terminated, Degree Candidacy Continued) status, then your official student enrollment is terminated, and your SHP coverage terminates along with it.
SHP coverage will end prior to the dates listed above if:
- a student becomes insured as an employee under a separate policy
- a student withdraws or takes a leave of absence
or for a dependent if:
- the student he or she depends on is no longer eligible for the SHP
- the dependent becomes insured as an employee under a separate policy group
- he or she reaches the age of 19.
How much does the SHP cost, and how is it paid?
The SHP plan currently costs $1850 for the 2012-2013 academic year or $925 per semester. This amount is rolled into the comprehensive fee assessed to all graduate students, which is included as part of tuition.
I’ve received several cards associated with the SHP. Do I need to present these to receive medical care?
You should receive at least one card from Aetna Student Health for medical claims and one from Medco for prescription claims. If you sign up for the supplemental dental plan (see below), you should also receive a card from Cigna. The supplemental vision plan from VSP does not require a card. If you did not receive one or more of these ID cards, you should contact the vendors (Aetna, Medco, or Cigna) directly.
You will not have to present your Aetna Student Health card at McCosh Health Center, except when receiving lab work from Quest Diagnostics, but you will need it when you use off-campus services.
How do I contact the various vendors?
Where is University Health Services located?
UHS is currently located in the McCosh Health Center building (not to be confused with McCosh Hall). This building is located in the center of Princeton’s main campus, next to the Frist Campus Center. The main entrance is off Washington Rd. The only parking near the building is restricted to emergency vehicles, handicapped parking, and other authorized vehicles. Public Safety (609-258-3134) can drive you to the Health Center if you are unable to walk there. (See map, green)
What services are offered through UHS? Where? When?
McCosh offers a range of services, including outpatient primary medical care services, urgent care, women’s and men’s health, athletic medicine, nutrition services, immunization and allergy service, travel medicine service, inpatient services, lab, radiology, and physical therapy. A full description of these services can be found on UHS’s webpage.
UHS also includes an urgent care center for walk-in service, located on the first floor. Hours are the same as the outpatient clinic.
During the academic year, many services are available 24 hours a day. After hours, all service is conducted at Inpatient Services on the second floor of McCosh. In order to enter the building, use the intercom system at the front entrance of the building; a staff member will respond and unlock the door. Students will be seen by a registered nurse; if necessary, physicians and mental health professionals are on call 24/7. These services are intended for urgent problems that cannot wait until the morning.
Is all on-campus care free?
Most services offered through UHS at McCosh are offered without any direct cost to either students or Aetna. The exceptions to this rule are listed here, and are billed according to the SHP as follows:
- Diagnostic lab tests (including HIV tests): covered 100% by SHP (so in effect this is still free to graduate students). However, fertility/infertility testing and physical examinations are not covered by the SHP, and will be billed to students directly.
- X-rays: covered 100% by SHP (on campus only, x-rays performed off-campus are only covered at 80%)
- Contraceptives: Certain contraceptives are offered by UHS at a discounted price (see below), and can be applied toward the Medco prescription deductible.
- Immunizations: not covered by SHP
- Medical Transport Vehicle (MTV) rental: not covered by SHP. Contact Jan Runkle (609-259-3555) for rental costs and details.
- Orthopedic supplies: covered by SHP at 80%. If you receive an orthopedic supply from UHS, you will receive a walk-out statement for the service and the charge will be billed to your student account. You must submit a claim to Aetna Student Health to receive reimbursement.
What are my options for preventative care? Which of these services are available at UHS?
ANSWER: UHS is available 12 months of the year, Monday through Friday, for preventive care.
Annual physical/well visit
Any student can request an appointment for a physical (health assessment) at UHS, with occasional exceptions during high volume periods.
Woman’s well visit
Woman’s well visits are available at UHS, consistent with national guidelines which recommend:
1. Women under 21: No Pap is recommended. STI testing is available (if appropriate), breast exam and check heart, lungs, thyroid and abdomen, blood pressure check. An annual exam is required if a prescription for birth control is desired from UHS.
2. Women 21 to 30: A Pap is recommended every 2 years. An annual exam is required if a prescription for birth control is desired from UHS. STI testing is available (if appropriate), breast exam and heart, lung, thyroid and abdomen, blood pressure checks.
3. Women older than 30: Both Pap and HPV are recommended. If negative, then Pap every 3 years. If birth control pills are requested a yearly checkup is necessary.
Skin cancer full body check
UHS clinicians are available to conduct full body checks, and to assess skin lesions and moles of concern to students and their eligible dependents. If a suspicious lesion is encountered the patient is referred to a dermatologist.
Dental care is not provided by UHS at McCosh Health Center as there are many dentists located in the local community. A preventative dental cleaning is reimbursed by the SHP up to $125 per academic plan year. No referral is needed; students can go to any local or home dentist, and submit a claim to Aetna to be reimbursed up to $125. Some local providers offer discounts.
If you are enrolled in the voluntary dental plan, you are eligible for two cleanings per academic plan year, plus other services. For further information regarding the voluntary dental plan, go to our web site link at: https://www.princeton.edu/uhs/student-insurance/vision-dental/.
UHS clinicians can provide screening eye exams using a Snellen chart. For more extensive eye exams a student / eligible dependent would be referred to an ophthalmologist or optometrist.
Eye exams provided by practitioners external to UHS are not covered by the SHP. However, there is a Vision discount program available through Aetna (For information call 1.877.437.6511). Students on the SHP can search DocFind for an eye doctor in the EyeMed Select Network to receive discounts.
Alternatively students can enroll in the VSP. Students enrolled in the voluntary Vision plan (VSP) do receive an annual eye exam plus other eye care benefits according to the VSP plan. For more information about VSP, go to our web site link at: http://www.princeton.edu/uhs/student-insurance/vision-dental/.
For which of these services do I need a referral, and how much will they cost in the community?
Annual physical/well visit
Annual physicals are available at the health service for free (see above), so the plan does not cover physicals outside the health service. To determine the cost of the visit to a community provider, you need to contact their business office.
Woman’s well visit
Annual woman’s well visits are available at the health service for free (see above) so the plan does not cover these outside the health service. To determine the cost of the visit to a community provider, you need to contact their business office.
Skin cancer full body check
If you arrange for a skin cancer screening from a community provider, you will need to contact that provider to determine the cost of the screening. A referral from UHS is required for a suspicious lesion, or if you do not wish to obtain a referral, you will be responsible for the full cost of the visit.
To determine the cost of an eye exam from a local provider, contact the provider’s office. The plan will cover the cost of a visit to an ophthalmologist if you are referred by a UHS provider for a medical reason, i.e. for a headache. Otherwise, if you seek services without a referral, you will be responsible for the full cost of the visit.
Costs for services through Cigna can be found on our website. There is a schedule of benefits which can be accessed at:http://www.princeton.edu/uhs/student-insurance/vision-dental/. No referral is required.
Costs for services through VSP can be found on our website. There is a schedule of benefits which can be accessed at:http://www.princeton.edu/uhs/student-insurance/vision-dental/. No referral is required.
Are IUDs covered?
ANSWER: The SHP will not cover a visit for the IUD insertion outside of UHS since insertion is available at UHS at no charge. IUDs devices are covered through Medco/Express Scripts. To purchase an IUD, you may follow these instructions:
IUD/IUS’s are covered under prescription benefits through Medco. The plan works in the following way:
1. Prescriptions are subject to an annual $100 deductible. The deductible requirement begins each September 1 of the plan year to August 31st.
2. The deductible is the amount of eligible out-of-pocket expenses that must be paid first by the enrollee for the IUD/IUS device or other prescription expense before benefits become payable by the Medco Pharmacy Plan.
3. Once the deductible has been satisfied, published plan benefits go into effect. Please contact Medco at: 1.800.711.0917 for additional information.
4. The applicable copays for IUDs are $5 for a generic; $20 for brand name.
IUD insertions are performed by a UHS clinician or a consulting gynecologist at UHS, both of whom are fully and appropriately trained.
How do I know if my blood work is “routine”? Can UHS conduct “routine” blood work for free?
ANSWER: The following routine tests are provided at UHS at no charge to eligible students and dependents:
• CBC (Diff/Plt) Complete Blood Count •
• Chem Screen Panel & HDL – blood chemistry screen and cholesterol panel
• Culture, Gp. A Strep – throat culture
• HCG, Serum, Qual — pregnancy blood test
• Heterophile, Mono – a screen for mono
• Sed Rate by Mod West – screens for inflammation
• UA, Complete – urine analysis
Most tests other than those listed above are covered at 100% under the SHP. If you are on the SHP, you will need to provide Quest with your current Aetna Student Health medical identification card whenever you have lab tests performed at McCosh Health Center (The lab in McCosh Health Center is operated by Quest labs; you should provide the phlebotomist in the lab with your card and information). Please bring your SHP/ Aetna card with you when accessing lab services. Quest, in turn, will bill Aetna Student Health, which is the third party administrator for the Princeton University Student Health Plan. An explanation of benefits (EOB) will be sent to the address you have on file with Aetna. Aetna will process the claim and pay 100% of eligible charges. The deductible will not be applied to lab tests. Please note there are some exceptions; for example, immunization titers, fertility testing, and lab work for physical examinations are not covered by the plan.
Who communicates the results?
For tests other than the free “McCosh Profile” (listed above): Laboratory tests are performed when ordered by a licensed clinician. If the test is ordered by a UHS clinician the results are sent to the UHS clinician; the UHS clinician notifies the patient and the test results become part of the health record at UHS. If the test is ordered on the prescription of a clinician outside of UHS the results are sent to the outside clinician; the outside clinician notifies the patient and the test results become part of the health record at the outside clinician’s office. If desired, the patient can request that the outside clinician forward copies of the results to UHS for improved continuity of care.
Also, if a student fails to show up for a scheduled appointment, a no-show fee will be assessed to the person’s student account.
I need/want to see a doctor outside of UHS. Is this possible?
In order to be covered by the SHP, you must receive a referral from UHS before seeing an off-campus doctor. Referrals must be updated every 12 months to receive continuing care from an off-campus doctor. However, you do not need a referral if…
- you have a life threatening emergency illness or injury and require hospitalization or emergency room services.
- you choose to use your $125 preventative dental visit.
- the appointment is for a dependent under the age of 16.
- Princeton University is in a break period, (e.g., fall recess, spring recess, and summer).
- you are in absentia status and not within a reasonable proximity to the University (i.e., outside Mercer, Middlesex and Somerset Counties in NJ and Bucks County in PA).
I live in New York/Philadelphia/somewhere else not-quite-local, but am still regularly enrolled (not in absentia). Do I/my dependents really need to come to Princeton for all primary care?
Yes, unfortunately. The SHP is designed assuming that UHS will be your primary care provider. As such, the SHP will usually not cover services that can be received there (including women’s health) through any other providers. And you always need a UHS referral to see specialists for services not offered through UHS.
McCosh Health Center is closed (summer and academic breaks) and I need care. Where should I go?
For true emergencies, go straight to an emergency room. This is true at all times of the year, regardless of whether UHS is open. The closest hospital to Princeton’s main campus is the University Medical Center at Princeton (see map, yellow).
University Medical Center at Princeton
253 Witherspoon St
Princeton, NJ 08540
For non-emergency situations, you may also go to a hospital emergency room, but many students prefer to avoid this option due to the potential for high costs. As an alternative, you can instead use an urgent care center. These centers can perform most medical and minor surgical procedures for much less than an emergency room visit. See their websites for specifics on the services offered (see map, red).
Princeton Primary and Urgent Care Center
707 Alexander Road
Hrs: M-F 8AM-7PM; Sat 9AM – noon
Brunswick Urgent Care PA
3110 State Hwy #27
Kendall Park, NJ 08824
Hours: 9AM-10PM M-Sat; 9-5 Sun
All services received off-campus will be billed according to the SHP. At the Princeton Center, Aetna is accepted for primary care; urgent care is treated as “fee for service”, so you will have to pay upfront and then can be reimbursed when you file a claim with Aetna. The New Brunswick office accepts Aetna insurance directly. If you take public transportation to reach one of these facilities, you may be able to get reimbursement through UHS’s special needs fund; call 609-258-3555 for information on this.
I will be traveling out of the country for my research. How should I prepare? Will the SHP cover expenses incurred outside the U.S.?
UHS offers travel planning services, including immunizations, for students traveling to foreign countries. To begin this process, a student must first schedule a travel planning appointment at McCosh Health Center. This should be done at least 4-6 weeks prior to your trip; students traveling to multiple countries and/or continents should allow at least 10 weeks.
The SHP does cover medical expenses incurred outside the U.S.; however, it will not make direct payments to providers outside the U.S. Students must arrange for payments until their claims can be processed. Therefore, it is recommended that you carry claim forms with you so that claims can be processed as quickly as possible. These forms can be downloaded from UHS’s website or picked up from the waiting areas at McCosh on the first floor. For each claim, you will need to attach original medical bills to the form (including your name and ID number, date of service, itemization of services rendered, charge, and diagnosis). Also, if the service was rendered in a country using a different language and/or currency than the US, you will be required to provide translations and currency conversions.
Is well-child care for my children covered by the SHP?
Well-baby care is covered, up to 6 visits (i.e. up to and including 2nd-year visit) is covered with a small copay. Also, required immunizations for children 11 and under are covered. However, well-child care past the age of 2, i.e. yearly pediatric check-ups, is not covered.
I/my significant other is pregnant. Do I have to worry about enrolling the new baby in the SHP at the beginning of this academic year, or do I wait until the child is born?
Wait. The new baby will be automatically covered for the first 31 days following birth, with no fee charged (though the $200 deductible does apply to any charges). You must notify the Student Health Plan office within 48 hours of the birth. Within that 31-day period, you must then submit a Dependent enrollment Form for the new child, and you will be charged a pro-rated (from the 32nd day onward) fee as applicable (depending on how many children you already have enrolled).
Does the SHP cover any dental services?
Yes. The SHP offers $125 towards preventive dental care each year. This covers the services that you would expect for a typical yearly visit, including examination, cleaning, x-rays, and fluoride treatment. Unlike most off-campus services, this one does not require a referral or preauthorization; you can make an appointment with the dentist of your choice. You are not required to use an Aetna preferred provider, but if you would like to find a dentist in Aetna’s network, you can use the DocFind tool on their website (enter “Aetna PPO” for plan type). The $125 does not apply towards your yearly SHP deductible.
If I am enrolled in the optional dental plan, should I go to the dental center I selected or should I use my SHP coverage?
ANSWER: This decision is really up to you. If you are traveling or have a residence out of state, you would use the SHP benefits.
I’ve heard several complaints about the quality of service provided by the dental centers, and of course the geographic restriction as well.
ANSWER: NEW THIS FALL 2013: The university has changed the optional dental care provider from Healthplex to Cigna. Students who enroll now have more providers to choose from, several within walking distance of campus. For a list, see https://www.princeton.edu/uhs/pdfs/Cigna%20NJ-DHMO-Primary-Dentist-Listing%20Summer-2013.pdf.
Student complaints regarding dental coverage or any other coverage issue can be put in writing and sent to Janet Finnie, Associate Director, UHS, in the McCosh Health Center. These complaints will be reviewed by the Student Health Advisory Council (SHPAC) which meets twice a year. The SHPAC takes student concerns very seriously and works hard to continuously improve satisfaction with plan benefits, while also keeping an eye on increasing costs.
Some local offices provide discounted rates to Princeton graduate students (see map, purple):
Dr. Craig Tyl Dental Health Care
601 Ewing St, Suite B-15
Princeton, NJ 08540
Princeton Park Dental
Dr. Eric Abrams
Princeton Professional Park
601 Ewing St Suite B16
Princeton, NJ 08540
What qualifies as “catastrophic dental”? In other words, when is dental care treated as a medical/surgical situation?
Extraction of a partially- or fully-impacted wisdom tooth (not a fully erupted one) and treatment for injury to natural teeth both qualify as medical care under the SHP. To receive these benefits, you must first make an appointment at UHS. These procedures will be treated under the medical/surgical part of the SHP, with 80% of expenses covered after the deductible is satisfied. You may work with UHS to choose a dentist to perform the procedure, but will often be encouraged to use an Aetna preferred provider due to the savings they offer.
What is the optional dental plan?
If you would like additional dental services other than those listed above (namely, anything non-preventative), you can enroll in the optional dental plan, which is administered by Cigna. The enrollment costs an additional $72 (Student), $144 (Student + 1 Dependent), $242 (Student + 2 Dependents or more), which will be billed to your student account when you send in the enrollment form. The optional plan covers a one-year period, from Sept 1 – Aug 31; you must reenroll each year to continue this coverage. The enrollment period is limited to early May through August 9, 2013; you will receive an email from the Graduate School each year with exact dates of the enrollment period for the coming year.
The optional plan covers a wide variety of dental services. The price of each procedure varies.
Can I visit any dentist using the optional plan?
No. You must choose one of these offices from the Cigna list: https://www.princeton.edu/uhs/pdfs/Cigna%20NJ-DHMO-Primary-Dentist-Listing%20Summer-2013.pdf.
What is the Vital Savings program?
If you would like to see a dentist of your choice (within the Aetna Dental Access network) for dental procedures beyond the $125 covered in the SHP, you may enroll in a discount program offered through Aetna, known as Vital Savings on Dental. For $25, you receive a card that allows you to receive the contract price for a wide range of procedures. The contract price is a price that has been negotiated between Aetna and the various providers, and can be between 15-50% lower than the typical rate for a procedure. Because the rates vary by region, you must contact individual providers to learn about the exact costs of various procedures.
The Vital Savings program is simply a discount program, not insurance; all payments will be made by the student directly to their dental provider, and these services do not count towards the SHP deductible. Generally, under this program, procedures will be more expensive than under the supplemental plan, but this can be an alternative to dental insurance for students who don’t wish to use the supplemental plan or who missed the enrollment period and need to have an expensive procedure. Questions about Vital Savings should be directed to Aetna Student Health (1-877-437-6511).
Does the SHP cover any vision-related expenses?
Yes. The SHP automatically enrolls students in the Aetna Vision Discounts (formerly known as Vision One) program. This is not an insurance program, but rather a discount program. It provides discounts on eye exams, the purchase of contact lenses or glasses, and LASIK procedures. To find a provider, use Aetna’s DocFind utility (Provider category: pharmacy/vision discount/hearing, Provider type: Vision discount program). More details of this plan can be found in here. Payments for vision services do not count toward your yearly deductible.
Some local businesses also offer discounts for students (see map, purple):
Optical Gallery of Princeton
301 N. Harrison St.
Princeton Shopping Center
Au Courant Opticians
57 Palmer Square West
What is the optional vision plan?
A vision insurance program is offered through Vision Service Plan (VSP). This program offers low copays on eye exams and the purchase of glasses or contacts as well as discounts on LASIK through VSP-network providers. This is a separate network from the Aetna network; see theirwebsite to locate a provider.
Like the optional dental plan, there is an enrollment period each year (early May – Aug 15). You must reenroll each year to continue receiving the optional vision benefits. The supplemental plan costs $72 (Student Only), $112 (Student & Spouse), $114 (Student & Child(ren), $184 (Student, Spouse & Child(ren)) A complete list of services and their costs, as well as the enrollment form, can be found on UHS’s Optional Health Benefits site.
I have enrolled/am thinking of enrolling in the Vital Savings program; do I get any additional vision benefits through this program?
No. The Vital Savings on Vision program is the same program as the Aetna Vision Discounts program, simply under a different name. You do not have to pay the additional $25 to receive the vision discounts. (However, you may wish to pay this extra to receive dental discounts, which are not included in the SHP, see above).
My specialist performed a procedure that’s not covered by SHP and Aetna sent me an explanation of benefits “EOB” saying that I owe the provider money. What should I do?
ANSWER: You should first call Aetna directly at: 1.877.437.6511 to confirm benefits. If it is an actual exclusion, then you are responsible for paying the bill. If there seems to be a discrepancy in what the physician performed compared to what the bill states, the student should call the physician’s office to review the claim. If there was a coding mistake, the physician will need to resubmit a claim to Aetna with the correct coding.
To avoid this problem, you can contact Aetna in advance of having a procedure performed to ask if it is covered.
If you are responsible for a bill and cannot afford to pay it, you may contact Jan Runkle, Business Manager, at 258-3555. She will assist you in determining if there are any funds available to help you in making payment.
If there seems to be a dispute between Aetna and your provider, you may contact Aetna about the claim. You can also monitor claims via Aetna Navigator at www.aetnastudent health.com.
If I have non-medical questions about medication is it better to call UHS, Aetna, or Medco?
ANSWER: It depends. If you have a coverage question about your medication or regarding costs/deductibles, you call Medco/Express Scripts. They are a separate company from Aetna and while your prescription benefits are included with your medical benefits, the two companies do work independently of each other. Students receive an ID card and information from each of the vendors explaining their respective services and how to access each Customer Service area for assistance. You may also access the Vendor Contact list at:https://www.princeton.edu/uhs/pdfs/Vendor-Contact-Information-for-Studen…. If your question is about which medication might work better or a situation where you have been on this medication before and want to try another medication, then you are best served by speaking with your clinician at UHS.
Can I ask my out-of-network provider to fill out a claims request so that the provider gets reimbursed by Aetna or do I always need to be the one to be reimbursed?
ANSWER: Out of network providers don’t participate with Aetna and in most cases the provider will not fill out or send in claims to Aetna; however; you can always ask. There are the occasional out of network providers that will assist in this way. If the out of network provider is unwilling to directly submit a claim, which is common with some specialties, such as psychology and psychiatry, it then becomes the responsibility of the student to submit the claim to Aetna along with a receipt from the provider.
Why does it take so long to receive a reimbursement check (up to six weeks)?
ANSWER: Aetna processes approximately 80 percent of claims within 10 business days or less with an additional 3-4 days of mailing time. Claims sent electronically by the provider get processed within 10 business days or less as well; however, it varies depending on when the provider sends in the claims to be processed. Some providers are quicker in sending claims than others. International claims take longer and can take up to six weeks to be processed. Students can track their claims by registering online at: www.aetnastudenthealth.com and logging onto the Aetna Navigator- Claim Status.
Where can I get a list of local doctors that distinguishes between those that are in-network and out-of-network?
ANSWER: Student’s can register with Aetna online (see link above) and go to the DocFind prompt. DocFind provides a listing of all in-network (participating) physicians. If the clinician is not listed as in network, they are out of network. For information regarding local resources that are not in network you may consult with UHS for names of community providers. UHS does not maintain a list of which providers are in and out of network because physician contracts with Aetna can change frequently, and lists can become obsolete in a short period of time. We recommend contacting the provider office directly and asking if they are in or out of network when you call to make an appointment.
What prescription benefits are included in the SHP?
The SHP includes a prescription benefit through Medco, which offers a $5 copay for generic drugs, a $20 copay for brand name drugs, and a $70 copay for multi-source drugs, with a $100 deductible per student or $200 deductible per family per year (Sept 1-Aug 31). Many prescriptions can be filled with even lower copays when ordered through Medco’s mail order service; register for an account on Medco’s website to see if your prescriptions can be filled through this service.
I’ve heard that UHS used to offer several discounted brand name birth control options. What do they offer now?
The Deficit Reduction Act, passed by Congress in 2005, required pharmaceutical companies to offer Medicaid and similar services their lowest price on prescription drugs. Prior to this, most pharmaceutical companies offered deeply discounted prices to university clinics; however, the change in law would have required the pharmaceutical companies to match these deep discounts for Medicaid. The companies were unable to do this, and so the unintentional consequence of the law was that prices for universities were raised significantly. Lobbying efforts by the American College Health Association to exempt university clinics from this Act are ongoing.
Based on the new prices, Princeton is no longer able to offer the wide variety of birth control options at a low price as they did previously. UHS still offers two generic options: Aviane (the generic form of Alesse), and Cryselle (the generic form of Lo Ovral), both of which are estrogen/progestin birth control pills sold in 28-day packs. Both are offered at $6-$8 per pack at UHS. This amount can be applied towards your prescription deductible if you choose (most students simply don’t report these purchases to Medco because the total yearly cost will not reach the $100 deductible, but students taking other medications may choose to do so in order to reach their deductible more quickly). Note that if you have already reached your deductible for the year, it is cheaper to purchase Cryselle and Aviane through Medco or a local pharmacy with the generic copay of $5 for one pack at a retail pharmacy or $10 for 3 packs via mail order (both retail for around $25 per pack prior to the deductible being reached).
Does this mean I have to pay out of pocket for birth control if I don’t want to use one of the two generics offered through UHS?
No. The majority of birth control products, including other brands of the pill, the patch, and the ring, are covered by the prescription plan offered through Medco, with a $5 copay for generics and $20 copay for brand names after the deductible.
Is it less expensive to get home delivery of medication or to pick it up at a pharmacy? The price structure documented seems to suggest that it varies by quantity and price (and thereby medication).
ANSWER: Home delivery is utilized when the student is on a maintenance medication; meaning a medication that they are required to take month after month. An example would be a diabetic who needs insulin and diabetic supplies or someone needing allergy medication each month. Home delivery is less expensive in that you essentially get three months worth of prescriptions for the price of two months buying it at retail. Retail is utilized for the occasional prescription need such as an antibiotic for an infection that you may only need to take for one or two months.
The prescription price structure is set up to reflect three classifications of medications you may receive; generic, brand or multi-source. With retail you get a 30-day supply of medication.
For generic medications:
• Your co-payment is $5.00.
For brand-name medications:
• Your co-payment is $10.00.
For brand-name medications when a generic is available (multi-source):
• Your co-payment is $70.00.
With home delivery you get a 90-day supply. There is a price differential, with the home delivery being less expensive (see below for the 90-day supply prices).
For generic medications:
• Your co-payment is $10.00. (= $5.00 savings over retail cost of $15.00)
For brand-name medications:
• Your co-payment is $20.00. (=$10.00 savings over retail cost of $30.00)
For brand-name medications when a generic is available (multi-source):
• Your co-payment is $140.00. (=$70 savings over retail cost of $210.00)
There seems to be no distinction between in-network vs. out-of-network providers, especially with regard to mental health care. It seems students are responsible for 20% for psychologist visits regardless of whether they are in-network or out-of-network.
ANSWER: The Student Health Plan involves 20% coinsurance payable by the student regardless of the in or out of network status of the provider. In the case of mental health providers, as noted above, there are a very limited number of mental health providers who are willing to contract with Aetna, so students seeing these providers must submit their expenses to Aetna directly. This is one of the specialties where this happens often because most practices are small, one and two person manned offices, without administrative staff to coordinate insurance matters. Despite our efforts to encourage local providers to contract with Aetna, many mental health providers do not choose to do so.
In-network mental health providers can be located in the DocFind function on the Aetna website.
Students with financial need may contact Jan Runkle at 258-3555 to inquire about their options, which include a mental health loan.
Psychiatrist visits are sometimes considered mental health and sometimes medical health. Depending on the condition code patients may be charged 20% and/or a $10 copay (assuming the provider is in-network), so a student could save money by choosing an in-network provider.
ANSWER: Rule of thumb is that you usually save more with an in-network provider because of the negotiated discounts when a physician has a contract with Aetna.
Do visits involving a $10 copay to a psychiatrist count toward the 30 annual behavioral health visits (i.e., is the visit count associated with the provider code or the condition code)?
ANSWER: The $10 copay is for the office visit itself which can be a mental health visit or medical visit. Medically coded claims for mental health do not go toward the 30 outpatient visits or the 30 inpatient admission days.
The diagnosis code determines how many visits are attributed to the 30 outpatient mental health visits. Because most MH providers do not participate with Aetna, most times a $10 copay visit fee is not charged because this fee is part of the “in network” structure.
Due to medical problems I am thinking of taking a Leave of Absence. Will the SHP cover me during this time?
Yes, but only for 90 days after your leave of absence begins (note that this applies only for medical leaves of absence; if you take a leave of absence for any other reason coverage ends on your official leave date). Try to avoid LOA status for medical reasons if at all possible. Talk to your advisor, department, the deans of the Graduate School, etc.; you may be able to arrange for lower workloads while still maintaining the status of an enrolled student.
I’m about to graduate. Will I lose my health insurance immediately after my degree is granted?
In most cases, no. Students who graduate (hold their Final Public Oral) while still enrolled in the SHP can receive a 90-day extension to the SHP. See the question regarding start/end dates for the SHP above for more details. This should apply to all regularly enrolled and DCE students. However, be aware that this extension will not apply if you enter ETDCC status prior to defending.
How do I get health insurance if I am no longer eligible for the Student Health Plan (leave of absence, graduating)?
There are a few options available to continue to have health insurance if you are no longer eligible for the student health plan:
Princeton offers a conversion program from Celtic Insurance to provide health insurance for students when they are no longer eligible for the Student Health Plan. The conversion program that is sponsored by Princeton, contract #C0S002002 (as of August 2009), does not require medical underwriting (i.e., it will cover all pre-existing conditions), does not have limitations based on state of residence and does not have limitations based on length of policy coverage. Note that this plan is very expensive ($1080 per month as of August 2009) and should probably only be used by students who need continuing coverage and cannot purchase an individual plan.
More information about the Celtic conversion program is available on the UHS website. Look for the Conversion Application (PDF) form, which includes the Group number for the program (C0S002002) and the phone number to contact to sign up (800-365-2365). Celtic supposedly also sells an individual health insurance policy which is NOT the conversion program that Princeton provides to students. This individual health insurance policy requires medical underwriting and has various limitations based on state of residence. If you choose Celtic Insurance, make sure you enroll in the conversion program from Princeton and not an individual policy.
Note: You may have heard about COBRA plans, which allow employees to buy into their old health plans after leaving employment. Graduate students don’t qualify for COBRA since COBRA is for an individual who had an Employee plan which is regulated under the federal ERISA guidelines. Students aren’t employees, so no COBRA; the conversion plan sort of fills this gap (though in a much more expensive sort of way).
There are a number of other health insurance companies from whom you can choose to buy a long-term or short-term individual healh plan. TheState of New Jersey Individual Health Coverage website lists many of these options. They offer a variety of plans, with different levels of benefits.
Most insurers offer some type of “Basic and Essentials” or “EPO” plan. Be careful since while these are usually the cheapest plans, they offer very limited benefits, especially for catastrophic injuries or expensive hospital care. If you are trying to save money, are generally healthy, and are mostly worried about protecting yourself in case of a major injury or illness, you should consider a high-deductible plan with co-insurance options. Many insurance companies offer such plans for $300-500 per month, and usually allow you to see a Primary Care Physician that is in their network of providers with only a small co-payment. Some of these plans do cover pre-existing conditions if you have been covered continuously for 18 months and have not had a break in coverage of 31 days or more.
You can also search actual health plans and rates for any state at http://www.ehealthinsurance.com.
Note that some plans provide different benefits for in-network providers (doctors and facilities who have agreements with the insurance company) and out-of-network providers (all others). If you will be moving out of New Jersey, you should make sure that you can access in-network providers from where you will be living.
Emergency Care and Locations
If I need urgent care and can’t get to UHS, what are my options? Should I call UHS, Public Safety, or 911? How should my decision change if I am in Princeton but not on campus, if it is during the academic year but after UHS business hours, if it is during a university break period, etc.
ANSWER: Emergency care is always available to you at the nearest emergency department. Always carry your health insurance card in case you have to access emergency care. Ambulance expense is covered at 80% and is not subject to the $200 deductible.
Urgent matters on-campus should always go through Public Safety, regardless of hour, time of year, etc., as they have a direct link to the dispatch of emergency response personnel. To reach DPS when on campus for a true emergency call 609 258-3333 from a cell. For all other matters call 609 258-1000. Off campus call 911 for true emergencies.
If you feel that this is a less urgent matter that cannot wait until the next business day at UHS, you may utilize our After-Hours care in the Infirmary. The Infirmary is open 24/7 from early September to early June with the exception of the holiday break in mid-December. Please consult the UHS website for detailed information on our hours and services.
Further information about available resources:
The nearest Emergency Department, for use in case of emergency, is:
University Medical Center of Princeton at Plainsboro (UMCPP) – (Acute Care Hospital)
1 Plainsboro Rd. (On Route, North side)
Hours – 24/7
The following resources are available for use when someone has an urgent need, especially during summer and winter breaks after hours when the Infirmary is closed. These clinics are likely to be less costly than an Emergency Department.
Princeton Primary and Urgent Care
707 Alexander Rd.
Princeton, NJ 08540
Hours: M-F 8am to 7pm, Sat. – 9am to noon
St. Peter’s Urgent Care Center
1378 Route 206
Skillman, NJ 08558
Hours: M-F 8am to 8pm, Weekends & Holidays 10am to 6pm
CVS Minute Clinic
881 State Rd. (Route 206)
Princeton, NJ 08540
Hours: M-F 8:30am to 7:30pm, Sat – 9am to 5:30pm, Sun – 9am to 4:30pm
The following are local pediatric offices where physicians see patients by appointment:
Nassau Pediatrics Princeton Nassau Pediatrics
66 Mount Lucas Rd. 196 Princeton Hightstown Rd.
Princeton, NJ 08540 West Windsor, NJ 08550
Hours – By Appointment Only Hours – By Appointment Only
At the following pharmacies, one can fill prescriptions and purchase over the counter medications and health care supplies:
172 Nassau Street
Princeton, NJ 08542f
Pharmacy Hours: M-F 8am to 10pm, Sat 9am to 6pm, Sun 9 am to 5pm
UStore on University Place
Hours: M-F 9am to 7pm, Sat 9am to 5pm, Sun 11am to 2pm