Comparable Coverage Criteria

To Opt-Out of the Princeton University Student Health Plan (SHP), a student’s private insurance/health plan coverage must meet specific criteria while at Princeton University and throughout the United States.

To determine if you plan is eligible for Opt-Out, review the Comparable Coverage Criteria requirements(.pdf). 

Coverage dates

Your coverage must be valid for the plan year beginning August 1, 2023 through July 31, 2024 (or beginning July 1, 2023 if you are an FSI program participant).  

Plans Ineligible for Opt-Out

  • Medicaid, Medicare, Medi-Cal, and HMO plans
  • Any plan that requires referral from your Primary Care Physician (PCP) to receive specialist or hospital care
  • Any plan that does not meet the plan coverage requirements

If you have an ineligible plan, you are required to enroll in the Student Health Plan. Financial aid may be available. Please contact the Financial Aid Office at 609-258-3330 or [email protected].

2023-2024 Plan Coverage Requirements

Your plan is required to provide in-Network coverage in the Princeton, NJ area and coverage throughout the United States for the following essential health benefits as defined by the Affordable Care Act (ACA):

  • routine wellness and preventive medical care
  • non-emergency medical care
  • emergency medical care and hospitalization (inpatient and outpatient)
  • athletic injuries resulting from practice or play on a sports team
  • chronic disease management
  • prenatal and postnatal maternity care, newborn care, and pediatric care/services
  • laboratory services and radiology
  • rehabilitative and habilitative services and devices
  • prescription medications

Your plan will also be required to provide coverage for the following health benefits:

  • inpatient and outpatient coverage for mental health care and substance use disorders in the Princeton, NJ area and throughout the United States
  • covers pre-existing conditions, with no waiting periods or exclusions
  • covers medical evacuation and repatriation expenses
  • covers ambulance expenses
  • your plan is issued in the United States, and has a U.S.-based claims administrator with a U.S. telephone number and address for claims submission
  • your annual out-of-pocket maximum does not exceed $9,100/individual plan or $18,200/family plan (per Affordable Care Act, as of 2023)