July 21, 2021 Updated 12/15/2021 Due to the COVID public health emergency, insurance companies/health plans are being required by state and federal agencies to cover certain health care services related to COVID. Over the last year and a half, the duration of these coverages has been updated multiple times by these governmental agencies, making it difficult to project their end dates. At this time, we can only list a projected end date, while noting that these dates may change and be extended. Learn more about: COVID-related coverage changes Telehealth for outpatient mental health coverage Telehealth for a physician visit coverage COVID-related Coverage Changes Coverage/Benefit Date of Change / Anticipated Date of Change Referrals from University Health Services for off-campus medical care will again be required. 8/31/2021 COVID-19 testing, vaccines, hospitalizations and related expenses will return to the standard coverage for in-network and out of network services. 7/31/2021 All telehealth/telemedicine, which includes all medical and behavioral health care, will return to the standard coverage for in-network and out of network services, as described below. 7/6/2021 For those Out of Network Benefits currently covered at 80%, coverage will return to 70%. 7/6/2021 Plan members should be aware that the following coverage is available under the SHP already and will continue to be available. It is unrelated to COVID: Telehealth for Outpatient Mental Health Coverage All telehealth visits or office visit expenses for outpatient mental health are covered as follows: Type of Outpatient Mental Health Provider Copay/Coinsurance Deductible Princeton University Exclusive Provider Network participating provider $20 Copay, after which the EPN covers 100% of the negotiated rate Waived Aetna participating provider The technical term for this is “Preferred Care” or “In Network” $10 copay, after which Aetna pays 100% of the negotiated rate Waived Non-Participating/Non-Preferred / Out of Network provider Patient is usually responsible for full payment upfront and responsible for submitting a claim to Aetna to obtain reimbursement of 70% of the recognized charge Deductible Applies Telehealth for Physician Visit Coverage All telemedicine visits or office visit expenses for a physician visit expense are covered as follows: Type of Physician Provider Copay/Coinsurance Deductible Aetna participating provider Technical term: “Preferred Care” or “In Network” $10 Copay, after which Aetna covers 100% of the negotiated rate. Waived Non-Participating/Non-Preferred / Out of Network provider Patient is usually responsible for full payment upfront and responsible for submitting a claim to Aetna to obtain reimbursement of 70% of the recognized charge. Deductible Applies Contact for Questions If you have questions about these new changes or about coverage for other specific benefits and services, contact Aetna by calling 1-877-437-6511. You may also contact the SHP Office at: [email protected].
