2026 ACA Basic High-Deductible Health Plan
The ACA Basic High-Deductible Health Plan works the same as the Stanford Choice HDHP, but has higher out-of-pocket costs.
This plan option meets the minimum essential coverage requirements under the federal health care reform, Affordable Care Act (ACA).
Plan Details
You may visit any doctor or hospital. You receive a higher level of benefits when you use Aetna Choice POS II providers. You are responsible for ensuring all providers are in the network.
For 2026, you also have access to Crossover Health Clinics, which includes services for Preventive Services and Health Coaching at no cost.
All telehealth services are covered at 100% before the deductible is met.
When you see a Non-Network provider, you are responsible for the balance of your bill that is not covered by Aetna. The Out-of-Pocket Maximum does not apply to the balance of the bill not covered by Aetna.
This plan is compatible with an individual Health Savings Account (HSA), that you establish at a financial institution of your choice.
This document is a summary. Please refer to the plan Evidence of Coverage (coming soon), or the Summary of Benefits Coverage (SBC) for more details.
Plan Information
Plan Year:
Offered To:
Full-Time Employee * Contribution Per Pay Period:
Employee & Spouse/Registered Domestic Partner - $227.07
Employee & Child(ren) - $194.71
Employee & Family - $313.27
Part-Time Employee * Contribution Per Pay Period:
Employee & Spouse/Registered Domestic Partner - $567.68
Employee & Child(ren) - $486.78
Employee & Family - $783.18
Basics
Pre-Authorization Requirement:
Pre-authorization is required for the following services: Advanced Imaging (CT, MRI, MRA, and PET); all electively scheduled inpatient hospital admissions; all elective outpatient procedures (example – endoscopic procedures, arthroscopic procedures, epidural steroid injections, etc); other procedures and services as defined on the pre-certification requirement list.
PENALTY for not pre-authorizing: the services will be considered not covered by the plan, and the member is responsible for the full amount of the service.
*Exception: When members receive care in any inpatient facility or emergency room, or in observation bed status.
Care Management:
Our Aetna One Advisor program takes a comprehensive population health approach to care management. Our multidisciplinary team of nurses, behavioral health clinicians, health coaches, dietitians, pharmacists, and customer service representatives help members live better with illness, recover from acute conditions, and have a seamless healthcare experience.
Deductible:
$6,800 per individual coverage/$13,600 out-of-network.
The individual deductible will apply to each covered family member's claims. If met, the plan would begin sharing costs for the family member who met the individual deductible.
Office co-pay:
Non-Network: Plan pays 50% after deductible
Crossover Clinic: 60% after deductible.
Coinsurance:
60% after deductible for all other services, including prescriptions
Out-of-Pocket Maximum:
$13,600 per individual/$27,200 per family Out-of-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.)
Overall Lifetime Maximum Benefit:
Maternity
Maternity Hospital Stay:
Non-Network: 50% after deductible
Baby's First Exam:
Non-Network: 50% after deductible
Birthing Centers:
Non-Network: 50% after deductible
Midwives:
Non-Network: 50% after deductible
Doulas:
Prenatal and Postnatal Physician Office Visits:
Non-Network: 50% after deductible
Doctor Delivery Charge:
Reproductive Health:
Non-Network: 50% after deductible.
If services are not available within 100 miles of the member's home zip code, travel expenses (airfare, mileage, rental car, lodging, and meals) will be reimbursable after the deductible up to $10,000 per year.
Mental Health/Autism/Substance Abuse
Mental Health:
Pre-Certification is required by you or your provider.
Network: 60% after deductible
Non-Network: 50% of the allowed amount after deductible
Outpatient Therapy Visit [no visit limit]
Network: 60% after deductible.
Non-Network: 50% of the allowed amount after deductible
Crossover Health: 60% after deductible
Substance Abuse:
Pre-Certification is required by you or your provider.
Network: 60% after deductible
Non-Network: 50% of the allowed amount after deductible
Outpatient Therapy Visit [no visit limit]
Network: 60% after deductible.
Non-Network: 50% of the allowed amount after deductible
Autism:
Prescription Drugs
Pharmacy (Retail):
*Note: per federal regulation,s certain preventive drugs (if covered by your plan) pay at first dollar coverage - no deductible required
Fertility drugs: Covered under Medical at 50% after deductible; max benefit of $10,000 per lifetime
Cost Saver provides eligible members with automatic access to GoodRx's prescription pricing that allows them to pay lower prices, when available, on generic medications. This experience is seamless. All members have to do is present their member ID card when they pick up their prescriptions at their in-network pharmacy.
Crossover Health: Pre-pack pharmacy - no cost, included as part of the visit
Mail order drug program:
*Note: per federal regulation,s certain preventive drugs (if covered by your plan) pay at first dollar coverage - no deductible required
Must use CVS mail-order service
Birth Control Pills:
Preventive Care
Physical exams for adults:
Non-Network: Not covered
Physical exams for children:
Non-Network: Not covered
Pap smears:
Non-Network: Not covered
Mammograms:
Non-Network: Not covered
Immunizations:
Non-Network: not covered
Travel immunizations are covered both in-network and out of network at no charge.
*Immunizations may have an additional consultation fee, which the member will be responsible for, based upon where the member receives care.
Prostate Specific Antigen test - PSA:
Non-Network: Not covered
Well-woman visits:
Non-Network: Not covered
Other Services
Acupuncture:
Non-Network: 50% after deductible
Up to 20 combined Network and Non-Network visits per year
Allergy Tests:
Non-Network: 50% after deductible
Allergy Treatment:
Non-Network: 50% after deductible
Alternative Medicine:
Ambulance charges:
CT and PET Scans (Complex Imaging):
Network: 60% after deductible
Non-Network: 50% after deductible
Chiropractors:
Crossover Clinic: 60% after deductible
Non-Network: 50% after deductible
Up to 20 combined Network and Non-Network visits per year
Christian Science Practitioners:
Cosmetic Surgery:
Dental Treatment:
Emergency Room:
Non-Network: 60% after deductible
Lab/ancillary/professional charges paid at 60% after deductible for Network or Non-Network
Urgent Care:
Non-Network: 50% after deductible
Hearing Care:
Preventive Exam: 100% as part of preventive care
Non-Routine Exam: Network 60% after deductible
Non-Network: 50% after deductible
Hearing aids are covered at $3,000 per ear for 36 months
Home Health Care:
Non-Network: not covered
Hospice Care:
Non-Network: 50% after deductible (prior authorization required)
Hospital Stay:
Network: 60% after deductible
Non-Network: 50% after deductible
Infertility Treatment:
Artificial Insemination: Network: 50% of billed charges.
Ovulation Induction: Network: 50% of billed charges
Advanced Reproductive Technology (ART), which includes In Vitro Fertilization (IVF), Cryo-preserved embryo transfers: Covered at 50% after deductible for up to 3 cycles per lifetime. GIFT and ZIFT are not covered.
Cryopreservation of eggs, embryos, and sperm (actual service to freeze what is retrieved from the fertility preservation IVF cycle). This is limited to 3 retrievals and thawing and storage up to 3 years of eggs, embryos and sperm. This includes iatrogenic and elective fertility.
Fertility drugs: Covered at 50% after deductible; max benefit of $10,000 per lifetime. (Covers both oral and injectable fertility drugs at 50% after deductible.) Member would be responsible for any fertility drugs over the $10,000 fertility drugs lifetime maximum and that would be an additional out-of-pocket expense.
*Artificial insemination and ovulation induction are covered regardless of partner status and without a diagnosis of infertility.
Laboratory Charges:
Non-Network: 50% after deductible
Crossover Clinic: No additional cost to office visit
Magnetic Resonance Imaging (MRI) (Complex Imaging):
Network: 60% after deductible
Non-Network: 50% after deductible
Durable Medical Equipment:
Non-Network: 50% after deductible
Pre-authorization may apply
Occupational Therapy:
Non-Network: 50% after deductible
Organ Transplants:
Skilled Nursing:
Non-Network: 50% after deductible
Up to a 120-day annual maximum Network and Non-Network combined (pre-certification required).
Physical Therapy:
Non-Network: 50% after deductible
Crossover Clinic: 60% after deductible
*All physical therapy visits are subject to Aetna’s medical necessity review process at 26 visits.
Prosthetic & Orthotic Devices:
Speech Therapy:
Non-Network: 50% after deductible
Surgery : Facility Charges:
Non-Network 50% of billed charges after deductible
Surgery : Physician Services:
Non-Network: 50% after deductible
Transgender Services:
Mastopexy/Breast Augmentation, Voice and communication therapy, including B60 for therapy performed by other professionals (i.e. voice coach, bodily movement coach); Tracheal shave, Suction-assisted lipoplasty of the waist, Rhinoplasty, Facial bone reduction, Face lift, Blepharoplasty, Laryngoplasty/vocal cord (voice surgery), Liposuction (contour modeling of the waist), Lipofilling (b+D63reast, body, face), Gluteal augmentation, Permanent hair remova+B60l, Subcutaneous injection of filling material, Demabrasion, Chemical peel, Excision, excessive skin, and subcutaneous tissue; abdomen, inframubilical panniculectomy; Hair implants, Hair cranial prosthesis (wigs), Liposuction to reduce fat in hips, thighs, buttocks; Male chest reconstruction, Pectoral implants, Calf implants, Geniplasty and chin augmentation; Abdominoplasty, Facial bone reconstruction, Other electrolysis or hair laser removal, Laryngoplasty/vocal cord (voice surgery), Reversal treatment, in case a member decides to reverse procedures.
No Lifetime Limit.
Tubal Ligation:
Non-Network: 50% after deductible
Vasectomy:
Non-Network: 50% after deductible
Vision care:
Non-Network: Not covered
Limited to screen and refraction exams only.
X-rays (Basic Imaging):
Non-Network: 50% after deductible
Plan Documents
Summary of Benefits Coverage (SBC)
An SBC is an overview of plan benefits, deductibles, copays, and coverage levels for a variety of commonly used medical treatments and services. Summary of Benefits Coverage (SBC)
Additional Plan Resources and Services
Aetna offers a concierge program to help you maximize your benefits and guide you to the right resources. Clinical care specialists assist you in managing chronic medical conditions, answering questions, and finding the right doctors. Get started at Aetna’s website
If you are enrolled in Stanford Choice HDHP, Stanford Select Copay Health Plan, or ACA Basic HDHP, you can get primary care through Crossover Health's in-person or virtual clinics. This expanded access enables you to receive care more quickly and at a lower cost.
Crossover Health is not a replacement for your current medical plan. Rather, an enhancement to your existing plan. At Crossover, you’ll develop an ongoing relationship with an interdisciplinary care team that will address your health concerns and look at your health history, environment, and unique circumstances that affect your complete well-being.
The ACA Basic High-Deductible Health Plan uses the Aetna Choice Network and offers coverage for both in-network and out-of-network services.
Aetna formulary for all three plans: Aetna Standard Plan
Aetna will help you locate high-quality and cost-effective options for diagnostic services, lab draws, imaging, colonoscopies, and other services. Visit Aetna’s website to compare costs or contact Aetna A1A member services at 833-971-4583.
There may be situations at certain facilities where providers are submitting 2 claims for the same visit, one for the provider (in office) and one for the facility (outpatient hospital). The Evaluations done on the professional claim are being processed as specialist visits, and the surgical procedures on the facility claims are being treated with Outpatient Benefits. If this occurs you may contact the Aetna A1A member services team and they can review and potentially rework it so only one of the cost shares applies.
Benefits will be provided for covered services you receive anywhere in the world. We encourage you to see Aetna providers to help reduce your costs, but you still have the option to see any provider to get needed care.
You can access services through the Aetna Choice POS II network.
If you need to file a claim for emergency care received while overseas, contact Aetna at 855-888-9046 or 215-775-6445 to have an international claim form sent to you.