2026 Stanford Select Copay Health Plan
The Stanford Select Copay Health Plan, administered by Aetna, has a nationwide network. Medical care must be received in-network, and most services are covered by a copay. Out-of-network care is only covered in emergencies.
Plan Details
The Stanford Select Copay Health Plan requires you to designate a primary care provider to coordinate all of your care. You may visit any Aetna network doctor or hospital.
For 2026, you also have access to Crossover Health Clinics, which includes services for preventive services and health coaching at no cost.
There is no benefit if you see a Non-Network provider, except for emergency care or when clinically appropriate and prior authorized by Aetna, and outpatient mental health office visits (see Mental Health section).
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 - $370.00
Employee & Child(ren) - $317.00
Employee & Family -$511.00
Part-Time Employee * Contribution Per Pay Period:
Employee & Spouse/Registered Domestic Partner - $1,345.74
Employee & Child(ren) - $1,153.54
Employee & Family -$1,858.56
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 helps members live better with illness, recover from acute conditions, and have a seamless healthcare experience.
Deductible:
Office co-pay:
Crossover Clinic: $25 copay primary
Coinsurance:
Out-of-Pocket Maximum:
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.) There is no benefit if you see a Non-Network provider, except for outpatient professional mental health and substance abuse care, emergency care, or when clinically appropriate and prior authorized.
Overall Lifetime Maximum Benefit:
Maternity
Maternity Hospital Stay:
Baby's First Exam:
Birthing Centers:
If the birthing center is part of the Aetna network
Midwives:
If the midwife is part of the Aetna network
Doulas:
Prenatal and Postnatal Physician Office Visits:
Non-Network: Not Covered
Doctor Delivery Charge:
Reproductive Health:
If hospitalized, the $200 Hospital Stay copayment will also apply.
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.
$200 copay per admission
Outpatient Therapy Visit
[no visit limit]
Network: $30 copay per visit
Crossover Health: $25 per visit
Non-Network: 80% of billed charges (up to $300 maximum allowed charges) for professional services only and only in the United States.
The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.
If the out-of-pocket maximum is reached, then the benefit will be covered at 100% (up to $300 maximum allowed charge per visit) for that calendar year. "
Substance Abuse:
Pre-Certification is required by you or your provider.
$200 copay per admission
Outpatient Therapy Visit
[no visit limit]
Network: $30 copay per visit
Non-Network: 80% of billed charges (up to $300 maximum allowed charges) for professional services only.
The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.
If the out-of-pocket maximum is reached, then the benefit will be covered at 100% (up to $300 maximum allowed charge per visit) for that calendar year. "
Autism:
Prescription Drugs
Pharmacy (Retail):
Specialty medication classification will have a 10% co-insurance payment applied up to a $200 max cost per prescription.
Non-Network pharmacy: Member pays copayment plus 25% of billed charges
Fertility drugs: Covered at 50% (deductible does not apply); 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:
Must use CVS mail-order service.
Birth Control Pills:
Preventive Care
Physical exams for adults:
Physical exams for children:
Pap smears:
Mammograms:
Immunizations:
Travel immunizations are covered within the network.
*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:
Well-woman visits:
Other Services
Acupuncture:
Up to 20 visits per year
In-network providers only
Allergy Tests:
Office copay may apply
Allergy Treatment:
Office copay may apply
Alternative Medicine:
Ambulance charges:
CT and PET Scans (Complex Imaging):
100% no deductible after a $100 copay
Chiropractors:
Crossover Clinic: $25 copay
Up to 20 visits per year
In-network providers only
Christian Science Practitioners:
Cosmetic Surgery:
Dental Treatment:
Emergency Room:
Urgent Care:
Hearing Care:
Non-Routine Exam $60 copay
Hearing aids are covered at $3,000 per ear for 36 months
Home Health Care:
Hospice Care:
Hospital Stay:
$200 copay per admission
Infertility Treatment:
Ovulation Induction: Network: 50% of billed charges
Advanced Reproductive Technology (ART), which includes In Vitro Fertilization (IVF), GIFT, ZIFT, Cryo-preserved embryo transfers: Covered at 50% of billed charges for up to 3 cycles per lifetime.
Cryopreservation of eggs, embryos, and sperm (actual service to freeze what is retrieved from the fertility preservation IVF cycle). This is limited to 3 cycles per lifetime (as stated above) and thawing and storage up to 3 years of eggs, embryos, and sperm. This includes iatrogenic and elective fertility.
Rx: Fertility drugs
Max benefit of $10,000 per lifetime. (Covers both oral and injectable drugs.) 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. FSH level - not required. Elective/Social Fertility.
Laboratory Charges:
Crossover Health: No additional cost to office visit
Magnetic Resonance Imaging (MRI) (Complex Imaging):
100% no deductible after $100 copay
Durable Medical Equipment:
Pre-authorization may apply
Occupational Therapy:
Organ Transplants:
Skilled Nursing:
Up to 100 days per calendar year
Pre-Certification required.
Physical Therapy:
Crossover Clinic: $25 copay
*All physical therapy visits are subject to Aetna’s medical necessity review process at 26 visits.
Prosthetic & Orthotic Devices:
Speech Therapy:
Surgery : Facility Charges:
$200 copay per admission
OUTPATIENT
$200 copay per surgery
Surgery : Physician Services:
Covered under hospital copay
OUTPATIENT
Office visit copay may apply
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 (breast, 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.
Travel and Lodging:
Tubal Ligation:
Vasectomy:
Vision care:
Age 22 and over - $60
Limited to screen and refraction exams only
X-rays (Basic Imaging):
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.
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 Stanford Select Copay Health Plan uses the Aetna Select Network, which includes Stanford Health Care (SHC), Sutter Health, including the Palo Alto Medical Foundation (PAMF) network, and University of California San Francisco (UCSF) providers.
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 copays applies.
Effective June 15, 2024 everyone enrolled in the Stanford Select Copay Health Plan has international benefit coverage through Aetna International. This benefit includes a $0 deductible and 100% coinsurance for all medically necessary services received outside the United States during a vacation or a short-term business trip.
The international component of the Copay plan includes 24/7 customer service to assist you at any time while you are travelling overseas. You can contact Aetna’s international customer service team telephonically or via the member portal:
- AetnaInternational.com
- +1-800-231-7729
The Aetna International member portal is linked to AetnaHealth so you will not need to create a separate User ID and Password. Log into AetnaHealth to access an electronic version of your international medical card which can be uploaded to your cell phone (Ios and Android).
You can receive medical services anywhere around the world. Aetna International has an expansive network of hospitals and providers where you can receive services on a cashless basis. This means that when you receive care from a participating facility or provider, the bill for the service is sent to Aetna directly rather than you, saving you the burden of submitting the claim for reimbursement. You will need to contact Aetna International within 3 days of any outpatient services so Aetna can establish this service for you. Aetna International will secure this arrangement the same day for any emergency services.
You will see the network of international providers with this link.
Aetna International has an easy process if you have to submit a claim for reimbursement:
- Log into the member portal.
- Go to AetnaInternational.com.
- Click on “My Claims” and select “New Claim.”
- Complete the online form.
- Upload a picture of your receipts.
- Click “Submit.”
You will receive your reimbursement via a paper check of electronically deposited into your bank account.
When you’re outside the United States and have questions about any health event, you can call Aetna International and speak with a member of their care management team. Their clinicians are available 24/7 and can help you with:
- Finding doctors/hospitals where you are
- Providing culturally appropriate care recommendations
- Coordinating and supervising emergency services including evacuation (if needed)
- Support in multiple languages
- Getting medical devices or prescription medications
Aetna provides “Emergency Care” coverage anywhere you may experience an emergency that is life-threatening in nature. Contact Aetna to locate an approved facility for non-emergency/non-life-threatening medical services. Pre-authorization may be required for certain services. You can log into your Aetna account and download a digital ID card at MyAetnaWebsite.com. This card will be different than your Stanford Select Copay Plan card used for domestic US benefits.
- Aetna Maternity Support flyer
- Aetna Cancer Support flyer
- Stanford's Mental & Behavioral Health resources
- Aetna Guide to Submitting International Claims for Reimbursement
- Aetna Guide to Care Outside the U.S.
- Aetna Copay Plan International Benefit Grid
- Aetna Preventive Health Services flyer
- Aetna Preventive Health Services Spanish flyer
- Aetna Skin Cancer Awareness flyer
- Aetna Skin Cancer Awareness Spanish flyer
- Aetna Cholesterol Awareness flyer
- Aetna Cholesterol Awareness Spanish flyer
- Aetna Teladoc Services flyer
- Aetna Plans Hearing Aid Benefit flyer
- How to Access Hearing Aid Benefits with Aetna flyer