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Blue Shield Healthcare + Savings Plan

The Blue Shield Healthcare + Savings Plan works the same as the Blue Shield PPO plan, but there are no fixed copays with this plan. 

Instead, after you meet your deductible the university shares the cost of all benefits, including prescription drugs. The university pays for a larger share if you use in-network providers and facilities. This is the only plan available through Stanford that works in conjunction with a Health Savings Account (HSA).

View detailed information about the Blue Shield Healthcare + Savings Plan

BASICS  

Overview

You may visit any doctor or hospital. You receive a higher level of benefits when you use Blue Shield PPO providers. You are responsible for ensuring all providers are in the network.

When you see a Non-Network provider you are responsible for the balance of your bill that is not covered by Blue Shield. The Out-of-Pocket Maximum does not apply to the balance of the bill not covered by Blue Shield.  As not all providers charge the same amount for the same service, even if in-network, you may want to inquire about service costs before seeing a provider.

This plan is compatible with an individual Health Savings Account (HSA), that you establish at a financial institution of your choice.

Group #PPOX0004

Pre-Authorization Requirement

Pre-authorization required for all hospital stays and certain outpatient procedures.

PENALTY for not pre-authorizing: benefit reduced to 50% of Blue Shield Allowed Amount. Maximum reduction of $1,000. You pay balance of all charges not covered by Blue Shield. Out-of-Pocket Maximum does not apply. Certain may be denied in full for failure to pre-authorize.

Office copay

Network: 80% after deductible

Non-Network: 60% after deductible

Deductible

$1,750 per individual coverage/$3,500 per family coverage

Combined Network or Non-Network. Up to $2,600 of an individual's claims will apply toward the family deductible, and once that threshold is met the plan will begin sharing the costs for that individual.

Out-of-Pocket Maximum

$3,750 per individual/$7,500 per family

Combined Network or Non-Network. A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.)

PREVENTATIVE CARE  

Physical exams for adults

Network: 100%

Non-Network: Not covered

Physical exams for children

Network: 100%

Non-Network: Not covered

Pap smears

Network: 100% if part of annual preventive

Non-Network: Not covered

Immunizations

Network: 100%

Non-Network: Not covered; travel immunizations not covered.

Well-woman visits 

Network: 100%

Non-Network: Not covered

 

PRESCRIPTION DRUGS  

Pharmacy (Retail)

Network or Non-Network: 80% after deductible

Mail order drug program

80% after deductible

Must use Blue Shield mail-order service

Birth Control Pills

Included in Prescription Drug benefit

Traveling Outside the U.S.

Benefits will be provided for covered services you receive anywhere in the world. Blue Shield has network providers outside of California and the United States. We encourage you to see Blue Shield providers to help reduce your costs, but you still have the option to see any provider to get needed care.

You can access service outside of California through the BlueCard Worldwide® Network.

If you need care while out of the country, call the toll-free BlueCard Program Access number at (800) 810-2583, or call collect at (804) 673-1177—24 hours a day, seven days a week.

Before traveling abroad, call Blue Shield Customer Service at 800-873-3605 to find out what you need to make your plan work for you when you travel. For more information, visit the Blue Shield website.

In an emergency, go directly to the nearest hospital. As soon as possible, you should call Blue Shield at (800)343-1691 or call collect at (804) 673-1177—24 hours a day, seven days a week.