ACA Basic High-Deductible Health Plan
Guidelines, Policies & Forms
Compare Medical Plans & Costs
Active employees and official retirees can use this tool to compare medical benefits, as well as plan costs.
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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).
2024 Plan Details
The ACA Basic High Deductible Health Plan works the same as the Stanford Choice High Deductible Health Plan 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).
Network
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
Outpatient Services
Aetna will help you locate high-quality and cost-effective options for diagnostic services, lab draws, imaging, colonoscopies, and other services. Learn how you can reduce your costs when accessing these specific services: labs, imaging, and physical therapy.
View the Aetna Maximum Savings Guide
Advocacy Services and Clinical Care Management
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.
| BASICS | BENEFIT |
|---|---|
| Overview | You may visit any doctor or hospital, but 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. When you see an out-of-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.Group #2232361 Plan ID #004 Employee Only #005 Employee + Dependents This plan is compatible with an individual Health Savings Account (HSA). You can set up an HSA with any financial institution that provides HSA services, or when you elect the ACA Basic HDHP during Open Enrollment, you can set up an account with Fidelity when you make your elections through My Benefits. Note that Stanford does not contribute to your HSA unlike those enrolled in the Stanford Choice High Deductible Health Plan. |
| Deductible | $3,250 per individual $6,500 per family for in-network services; $6,500 per individual $13,000 per family for out-of-network services. The individual deductible will apply to each covered family member’s claims. If met, the plan would begin sharing costs for the family member that meet the individual deductible. |
| Out-of-Pocket Maximum | $6,500 per individual $13,000 per family for in-network services; $13,000 per individual $26,000 per family for out-of-network services. A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This plan will cover eligible prescriptions and medical expenses at 100% once the out-of-pocket maximum is met). |
| PREVENTIVE CARE | BENEFIT |
| Physical Exams for Adults | In-network: 100%Out-of-network: not covered |
| Physical Exams for Children | In-network: 100%Out-of-network: not covered |
| Pap Smears | In-network: 100% if part of annual preventiveOut-of-network: not covered |
| Mammograms | In-network: 100% if part of annual preventiveOut-of-network: not covered |
| Immunizations | In-network: 100% (Includes Covid and Flu Shots) Out-of-network: not covered Travel immunizations are covered both in-network and out of network at no charge |
| Prostate Specific Antigen Test - PSA | In-network: 100%Out-of-network: not covered |
| Well-Woman Visits | In-network: 100%Out-of-network: not covered |
| MEDICAL SERVICES | BENEFIT |
| Office Visit (PCP and Specialty Care) | In-network: 60% after deductibleOut-of-network: 50% after deductible |
| Urgent Care | In-network: 60% after deductibleOut-of-network: 50% after deductible |
| Emergency Room | In-network: 60% after deductible (waived if admitted)Out-of-network: 60% after deductible (waived if admitted) |
| PRESCRIPTION DRUGS | BENEFIT |
|---|---|
| Pharmacy (Retail) | In-network or out-of-network: 60% after deductible |
| Mail-Order Drug Program | 60% after deductibleMust use Aetna mail-order service |
| Birth Control Pills | Included in prescription drug benefit |
| REPRODUCTIVE HEALTH | BENEFIT |
|---|---|
| Abortion services | Abortion services are available to enrolled members. After the deductible, 60% of the costs for in-network or 50% of the costs for out-of-network provider/facility use are covered by the plan. If abortion services are not available within 100 miles of their home ZIP code, members can be reimbursed for the costs of travel (airfare, mileage, rental car, lodging, and meals) up to $10,000 annually. |
Traveling Outside the U.S.
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.
Learn more about traveling outside the U.S.
Plan Information and Resources for the ACA Basic High Deductible Health Plan
2024 Plan Documents
An SBC is an overview of plan benefits, deductibles, copays, and coverage levels for a variety of commonly used medical treatments and services.
An SPD or EOC is the official, detailed plan document for each plan outlining information about eligibility; costs and cost sharing; included and excluded services; claims process; procedures for filing grievances, complaints and appeals.