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ACA Eligibility and Plan

Who is considered ACA-Eligible at Stanford?

The ACA employer mandate covers all Stanford employees who work full time by ACA standards. Full-time employees for ACA purposes are those who work, or are expected at hire to work, an average of 30 hours or more per week. They include not only Stanford’s benefits-eligible employees, but also Stanford’s temporary, casual, and student employees. Stanford’s temporary, casual, and student employees who meet the ACA’s full-time standard are referred to at Stanford as “ACA-eligible” employees.

ACA-Eligible Employee Medical Coverage - The ACA Plan

To comply with the ACA employer mandate, as of January 1, 2016, all full-time temporary, casual, and student employees identified as ACA-eligible are offered the ACA Plan. The ACA Plan is a high deductible health plan that provides affordable minimum essential medical coverage (MEC) of minimum value (MV) to full-time temporary, casual, and student employees and their eligible dependent children up to age 26.

View the ACA Plan Summary of Benefits & Coverage

Below are high level details on the ACA Plan:

ACA Plan Coverage (administered by Blue Shield) In Network Out of Network

Deductibles

$3,250 individual
$6,500 individual + children

$6,500 individual
$13,000 individual + children

Costs Covered

60% of costs covered after the deductible is paid

50% covered after the deductible is paid; deductible is also higher for out of network services.

Out-of-Pocket Maximums

$6,500 individual
$13,000 individual + children

$13,000 individual
$26,000 individual + children

Health Savings Account (HSA)

The ACA Plan provides the option of opening a health savings account (HSA) by contacting a financial institution of the employee's choice. An HSA helps employees pay for eligible health care expenses by setting aside their own tax-deductible funds.

ACA Plan Rates

ACA-eligible employees are individually notified of the ACA Plan’s current rates by Stanford’s Benefits administrator at the time they are determined to be eligible for the ACA Plan. 

2020 Medical Plan Costs 2020 Semi-Monthly Total Cost 2020 Semi-Monthly University Contribution 2020 Semi-Monthly EMPLOYEE Contribution
Employee Only $333.23 $282.73 $50.50
Employee & Child(ren) $599.81 $292.26 $307.55

ACA-Eligible Open Enrollment

Those who qualify for ACA-Eligible medical coverage will be notified about the opportunity to elect Stanford medical coverage. An annual Open Enrollment will be held in the fall for coverage beginning January 1 of the following year. During this time, employees may elect the ACA Plan for medical coverage.

Please note, as part of the ACA’s individual shared responsibility, all individuals must have qualifying health insurance coverage for the year, either through employer coverage or through the Health Insurance Marketplace, such as Covered California, the private health exchange for California residents. Before enrolling in the Stanford ACA Plan, employees may want to compare the ACA Plan coverage and costs with the medical plan options offered through Covered California.

Stanford will send eligible employees the IRS Form 1095-C each January, whether they elect Stanford coverage or not. This form details the coverage made available by Stanford in the prior year.

How to Enroll

Employees determined to be ACA-Eligible employees will receive notification of their ACA-Eligible opportunity either at hire, at first anniversary or at the annual Open Enrollment period. When the enrollment period begins, ACA Plan elections can be made online through My Benefits or by phone until the end of the enrollment period.