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Medical Plans

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Our medical plans provide coverage for preventative care, preexisting conditions, prescription drugs, as well as mental health services.

We understand that you may have questions regarding Aetna’s tiered services. We are working directly with Aetna to help you find the services you need. To assist you in finding Maximum Savings preferred providers and minimizing your costs, please refer to the Maximum Savings Guide webpage or contact Aetna’s Members Services at (833) 971-4583.

2024 Medical Plans

Stanford offers four medical plan options — three nationwide plans administered by Aetna and a Kaiser HMO. Below is a brief overview of the in-network annual deductible, out-of-pocket maximums, and costs for common services. (Looking for Retiree Medical Plans?)

View the 2024 employee contribution ratesLearn more about each plan in the 2024 Comparison Tool

 Kaiser HMO (California and Hawaii only)Stanford Select Copay Health PlanStanford Choice High Deductible Health PlanACA Basic HDHP*
In-network onlyIn-network onlyIn-network**In-network** 
Primary Care Physician RequiredYesYesNoNo
Annual Deductible    
IndividualNoneNone$1,750$3,250
Family  $3,500$6,500
Out-of-Pocket Maximums    
Individual$3,500$3,500$3,750$6,500
Family$7,000$7,000$7,500$13,000
Stanford Health Savings Account (HSA) Contribution    
Annual Contribution (if HSA is elected)NoneNone$1,152 for employee-only coverage/$2,352 for family coverageNone
Cost for Services
Preventive CarePlan pays 100%Plan pays 100%Plan pays 100% for in-network carePlan pays 100% for in-network care
Primary Office Visit $30 copay$30 copayPlan pays 80% after deductible for in-network servicesPlan pays 60% after deductible for in-network services
Specialist Visit$50 copay$60 copay  
Emergency Room$200 copay$200 copay  

* The ACA Basic HDHP meets the minimum essential coverage requirements under the federal health care reform, Affordable Care Act (ACA).

**Out-of-network benefits available 

Preventive Care

All Stanford health care plans provide in-network preventive care covered at 100%, including well-woman visits, child wellness exams, and other adult preventive services. All plans cover preexisting conditions, prescription drugs, as well as mental health, behavioral health, and substance abuse care.

Access preventive care — and follow up with lifestyle changes that make you healthier and in need of less care. Building a relationship with your primary care physician (PCP) is important to your health and well-being, as your PCP is often the first one to spot any potential risks and can help you avoid more serious illnesses.

Access to preventive care matters.

To support your preventive care, Stanford also provides a broad range of programs: 

  • BeWell provides evidence-based personalized support and services, along with wellness activities to keep you engaged, and incentives to reward your progress toward achieving optimal well-being. You can earn points toward incentives for receiving preventive care.
  • The Faculty Staff Help Center offers confidential counseling, workshops, discussion groups, department consultations, and facilitated conversations. Learn more about our other mental health resources for employees enrolled in one of Stanford’s health plans.
  • SupportLinc This is a confidential resource that helps out-of-state employees deal with life’s challenges and the demands that come with balancing home and work.
  • STAP-approved Healthy Living classes, apps, and coaching also support your well-being.

Networks

Aetna

The Stanford Select Copay Health Plan, Stanford Choice High Deductible Health Plan, and ACA Basic HDHP are administered by Aetna. With Aetna’s nationwide network, you have access to Stanford Health Care along with Sutter Health, including the Palo Alto Medical Foundation (PAMF) network, University of California San Francisco (UCSF), and other local provider groups.

Kaiser HMO

The Kaiser HMO requires you to use Kaiser Permanente’s network of facilities and providers. Out-of-network care is only covered in emergencies. 

Compare Medical Plans & Costs

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Active employees and official retirees can use this tool to compare medical benefits, as well as plan costs.

Compare Plans

 

Waiving Coverage

Man Writing on Paper with Pen on Table

If you don’t need Stanford coverage, you must actively waive coverage in My Benefits. You’ll receive a $25 credit (or a $12.50 credit if you work part-time) provided as taxable income in each paycheck.

Log into My Benefits

 

Medical Contribution Assistance Program

medical treatment bill, calculator and phonendoscope on blue background

If you qualify, Stanford will help you pay your contributions to your university-sponsored medical plan when you cover your family.

Apply for assistance

 

ACA Plan for Temps & Casuals

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If you are a casual/temp employee, you may still be eligible for minimum essential medical coverage for you and your dependent children to age 26.

ACA Plan

 

COBRA

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Continuing coverage may be available if you or one of your covered dependents loses health coverage. 

COBRA

COMPLIANCE

Transparency in Coverage - Machine Readable Files

The Transparency in Coverage rule released by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury requires group health plans, such as Stanford’s, and health insurers to make price information available to consumers.  We are required to post the following links for each of our medical plan vendors effective July 1, 2022.  The information available through these links is provided in good faith compliance with the Machine-Readable Files approach. These files display negotiated rates for covered items and services between the health plans and in-network providers for the plans. Some in-network provider arrangements do not prescribe rates for all covered items and services. In those cases, the provider’s reimbursement might be determined in several different ways, but this file would not contain that information. Pharmacy Machine readable files are not an enforced requirement and will not be available.

SHCA Aetna - Machine Readable Files

Blue Shield of California - Machine Readable Files

Kaiser - Machine Readable Files