Stanford Choice High-Deductible Health Plan

The Stanford Choice High-Deductible Health Plan, administered by Aetna, has a nationwide network and a deductible and is eligible for a health savings account (HSA) with a university contribution.

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 an HSA with a university contribution that can be used toward your out-of-pocket deductible costs.

For 2026, the out-of-area employee contribution for the Choice High-Deductible plan has been phased out, and all employees enrolled will have the same contributions. Stanford has increased its contribution to the Health Savings Account (HSA) in 2026 for those enrolled in the Choice HDHP who also elect an HSA.

Network

The Stanford Choice High-Deductible Health Plan uses the Aetna Choice POS II Network and offers coverage for both in-network and out-of-network services.

Know where to go for care

Aetna formulary for all three plans: Aetna Standard Plan

Preferred Providers

Certain services, such as lab work, imaging, and physical therapy, will have lower coinsurance for preferred in-network providers or facilities (Maximum Savings/Tier 1) than for other in-network or out-of-network providers and facilities (Standard Savings/Tier 2).

View the Aetna Maximum Savings Guide

Outpatient Services

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 member services at 833-971-4583.

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.

Plan Details

View 2026 Plan Details

2025 Plan Details

BASICS	BENEFIT
Overview	You may visit any doctor or hospital. You receive a higher level of benefits when you use Aetna providers through their Choice POS II network. 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. 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 HSA, that you establish at a financial institution of your choice. Group: #232361Plan ID: #002 Employee Only #003 Employee + Dependents
Pre-Authorization Requirement	Pre-authorization required for all hospital stays and certain outpatient procedures. PENALTY for not pre-authorizing: benefit reduced to 50% of Aetna Allowed Amount. Maximum reduction of $1,000. You pay the balance of all charges not covered by Aetna. Out-of-pocket maximum does not apply. Certain services may be denied in full for failure to pre-authorize.
Deductible	$1,750 per individual coverage (for employee, retiree or LTD Term only coverage) / $3,500 per family coverage Combined in-network or out-of-network. Up to $3,300 of an individual’s claims (you or one of your covered dependents) will apply toward the family deductible, and once that threshold is met the plan will begin sharing the costs for that individual. (Note: if you continue the Stanford Choice High Deductible employee plan via COBRA or retirement with Stanford and there is no change in dependents covered your accumulators will carry over for deductible, out-of-pocket maximum, etc.)
Out-of-Pocket Maximum	$3,750 per individual / $7,500 per family Combined in-network or 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.)

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 preventive Out-of-network: not covered
Immunizations	In-network: 100% (Includes Covid and Flu Shots) Out-of-network: not covered Travel immunizations and vaccinations are covered at 100% both in- and out-of-network
Well-Woman Visits	In-network: 100% Out-of-network: Not covered
Reproductive Health	Abortion services are available to enrolled members. After the deductible, 80% of the costs for either in-network or 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.
MEDICAL SERVICES	BENEFIT
Blood work and basic imaging (X-Rays and Ultrasounds)	Maximum Savings/Tier 1: 90% after deductible Standard Savings/Tier 2: 70% after deductible Out-of-network: 60% after deductible
Imaging (CT/PET Scans, MRIs)	Maximum Savings/Tier 1: 90% after deductible Standard Savings/Tier 2: 70% after deductible Out-of-network: 60% after deductible Example: MRI at Tier 1 Maximum Savings provider. Contracted rate $1200. Plan pays 90% at $1080. Member owes $10% at $120. MRI at Tier 2 Standard Savings provider. Contracted rate $5,000. Plan pays 70% at $3500. Member owes 30% at $1500.
Rehab – Physical Therapy	Maximum Savings/Tier 1: 90% after deductible Standard Savings/Tier 2: 70% after deductible Out-of-network: 60% after deductible
Office Visit (PCP and Specialty Care)	In-network: 80% after deductible Out-of-network: 60% after deductible
Urgent Care	In-network: 80% after deductible Out-of-network: 60% after deductible
Emergency Room	In-network: 80% after deductible (waived if admitted) Out-of-network: 80% after deductible (waived if admitted)

PRESCRIPTION DRUGS	BENEFIT
Pharmacy (Retail)	In-network: 80% after deductible Out-of-network: 80% after deductible
Mail-Order Drug Program	In-network: 80% after deductible Out-of-network: Not covered Must use Aetna mail-order service
Birth Control Pills	Included in prescription drug benefit
Hearing Aids	Access to nationwide network of providers: Log into your Aetna Member Portal (Aetna.com) using your username and password. Search for Audiology under Find Care. Contact an Audiologist to schedule your appointment. Members can also contact Hearing Care Solutions or Amplifon Hearing Heath Care. They will locate and schedule you an appointment with an In Network audiologist that is local to you. You can confirm the audiologist is in the network by logging into the Aetna member portal. They are able to help with members’ hearing aid needs. Hearing Care Solutions 866-344-7756 Website: www.hearingcaresolutions.com Amplifon Hearing Health Care 877-301-0840 Website: www.amplifonusa.com. Process: Exam: If the exam shows hearing loss, work with you to find the best hearing aid for you Fit: Ensure the hearing aids fit Available in different shapes/sizes Follow Up: If additional questions/run into any issues If you need help or assistance, please call the number on the back of your ID card. (1-833-971-4583)"

Traveling Outside the U.S.

Benefits will be provided for covered emergent and non-emergent 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. Members need to submit the claims to be reimbursed under the medical plan.

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 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)

Evidence of Coverage (EOC) / Summary Plan Description (SPD)

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.