Open Enrollment Frequently Asked Questions

In 2023, Stanford will continue to offer the same medical, dental, and vision plans available this year. We are making enhancements to our medical plans, such as expanding coverage for transgender services under certain plans, adding to our women’s health services, and offering new reproductive services. We are also enhancing our dental plans, and the vision frame allowance is increasing. 

Employee contributions for the Healthcare + Savings HDHP will decrease. The ACA Basic HDHP and Out of Area Healthcare + Savings HDHP will remain the same, and employee-only coverage through Kaiser and the Basic dental plan for all coverage levels will continue to be free. Based on national health care trends and other factors, employee contributions for Kaiser, Trio, and SHCA are increasing for 2023. Contributions for the Enhanced dental plan are increasing slightly.

Yes, Stanford is hosting virtual Open Enrollment information sessions and in-person Open Enrollment fairs for employees to learn more about their benefits. Details of these events can be found on Cardinal at Work.

Choosing a medical plan is an important decision. The election you make during Open Enrollment will be effective January 1 – December 31, 2023. You will not be able to make changes, unless you have a qualifying life event, such as marriage or the birth or adoption of a child. 

To help you make the right choice, we are providing valuable tools during Open Enrollment:

• Cardinal at Work provides an overview of your benefits and describes the changes to your benefits for 2023. 
• The new Nayya online decision tool helps you choose the best plans based on who you cover, how much you expect to use the plan, and your budget. Nayya is available starting October 24. To get started with Nayya, visit the Open Enrollment microsite. 
• The Cardinal at Work Comparison Tool shows the features of each plan in relation to cost, access to care, and tax savings opportunities. 
• During Open Enrollment, call the experts at Included Health and get free, unbiased support as well as answers to your specific questions about the plans. Included Health’s team of highly trained experts are ready to assist you with your plan decisions from October 24 through November 11. By specializing in helping people understand and navigate the complex health care system, Included Health can help you research specific doctors and hospitals you can access in the network during Open Enrollment. Call the University HR Services Team at 877-905-2985 and press 8 to connect with Included Health. 
• Attend an Open Enrollment information session from the Stanford Benefits team where we will provide some tips on how to choose the right medical plan. 
• Attend one of the Open Enrollment benefit fairs where you can speak directly with representatives from the different health, dental, and vision plans Stanford offers. 

Open Enrollment is your opportunity to review your current coverage and enroll in or make changes to your benefits for 2023. You may also add or remove dependents from coverage. Once Open Enrollment ends on November 11, you will not be able to change your elections until the next Open Enrollment period, unless you have a qualifying life event.

If you don’t make any changes during Open Enrollment, your current coverage will automatically continue in 2023 at the updated rates, except for the health savings account (HSA), flexible spending accounts (FSA), and Medical Contribution Assistance Program (MCAP), which require an election or application for the next year. If you currently waive benefits, you will continue to waive benefits unless you make an active election during Open Enrollment.

You may elect the following benefits during Open Enrollment:

• Medical
• Dental
• Vision
• Flexible spending accounts (FSA)
• Health savings account (HSA)
• Supplemental life and AD&D insurance
• Critical illness insurance
• Pre-paid legal services

Visit cardinalatwork.stanford.edu/OE23 to learn more about plan updates, rates, support tools, and more. When you are ready to enroll in benefits, log in to My Benefits to make your elections.

You will see a confirmation page appear after you complete and save your event. Please make a note of your confirmation number and print a copy for your records.

Employees on a leave of absence during Open Enrollment who want to make changes to their elections for 2023 can do so through My Benefits or by calling the University HR Service Team. Some benefit options will not be available to elect during a leave of absence, such as a dependent day care FSA, and you would make that election upon returning from leave to active status.

It is important to review and update your dependents when enrolling in your benefits for 2023. This is your only opportunity to add or remove dependents from your health care plans unless you have a qualifying life event during the year, such as a birth, marriage, or the loss/gain of coverage. 

Eligible dependents include your same- or opposite-sex spouse or registered domestic partner and your child(ren) under age 26. If you choose to cover an eligible dependent, you will be required to submit proper documentation, such as a marriage certificate, domestic partner affidavit, and/or birth certificates for any covered children. 

If you need assistance enrolling for your 2023 benefits, call the University HR Service Team at 877-905-2985 (Monday through Friday, 8 a.m. – 5 p.m. PT). They can also help you with questions about your employee or retiree benefits. Call them if …

• you are a new hire and need plan services before you receive your plan ID card—your doctor’s office or pharmacy may call to verify coverage. 
• you need help enrolling for benefits during an enrollment window.
• you have a question about a payroll deduction related to your benefits.
• you are unsure if a dependent is covered under your plan.
• you plan to retire in the next three to six months. 

If you have questions about specific plans or providers you can access under the different plans, reach out to Included Health by calling the University HR Service Team at 877-905-2985 (press 8).

The benefits you choose during Open Enrollment become effective on Jan. 1, 2023. If you elect supplemental life insurance, your coverage will begin as soon as your evidence of insurability (EOI) has been completed and approved.

Your new premiums will be deducted from your Jan. 7, 2023 paycheck.

Contact the plan administrator for specific information about your benefits covered under the plan, including:

• To find out if your doctor or dentist is in your medical or dental plan’s network
• If you have a claim dispute or question
• To verify what procedures are covered under your plan and obtain prior authorization
• You can’t find your member ID for your health plan
• To verify if a prescription drug is on your plan’s covered list 
• To find urgent care centers 
• If you are seeing a mental health professional or chiropractor for the first time and you want to verify costs/coverage
• Questions about your FSA balance or eligible expenses

Contact Plan Providers for benefit-specific questions.

We encourage you to take time during Open Enrollment to review your current plan elections, estimate your total cost for coverage and out-of-pocket costs in 2023, and enroll in a plan that best meets your needs. 

To help you do this, we are providing decision-support tools that help you compare your options and choose the one that that is right for you. Follow these steps to make your plan choices for 2023:

1. Use the new Nayya decision tool starting on Oct. 24. All you have to do is answer a few questions about your budget, who you cover, and how often you receive medical care and prescription drugs. 
2. Compare the suggested plan from Nayya with the other offerings on the Cardinal at Work Comparison Tool. 
3.  During Open Enrollment, call the experts at Included Health for free, unbiased support as well as answers to your specific questions about the plans. Included Health’s highly trained experts are ready to assist you with your plan decisions from October 24 through November 11. To connect with Included Health, call the University HR Service Team at 877-905-2985 and press 8. You can also reach out to the University HR Service Team for support at 877-905-2985, Monday - Friday from 8 a.m. – 5 p.m. PT.

Review the Changing Your Plans Checklist to help you think through your options. 

Yes, you can look up directories of providers on each carrier’s website or contact Included Health to find a provider who is accepting new patients before you choose a plan.

If you continue your current medical coverage, you will not receive a new ID card. If you enroll in a new medical plan, a new ID card will be sent to your home address in January. Please verify that your personal information is correct during Open Enrollment. You may also access a digital ID card on your health plan portal starting January 1, 2023.

Stanford offers five medical plans. The employee contribution and the level of service provided by each plan vary.

1. Kaiser HMO

Kaiser Permanente is a Health Maintenance Organization (HMO) that provides patient services, hospitalizations, supplies, and prescription drugs through its own network of doctors, hospitals and other Kaiser-affiliated health care facilities. Out-of-network care is not covered, except in emergencies.

2. Trio

Trio is a comprehensive medical plan that covers only in-network providers and facilities within certain California counties, requiring you to select a primary care doctor (PCP) who is responsible for the overall coordination of your care. Trio utilizes a smaller select Blue Shield network. Out-of-network care is not covered, except in emergencies.

3. Healthcare + Savings HDHP

Healthcare + Savings HDHP is a high deductible health plan that uses the nationwide Blue Shield PPO network. You are responsible for paying the full cost of medical care until you meet your annual deductible ($1,750 individual/$3,500 family) before Stanford shares in your health care costs. This plan is paired with a tax-advantaged HSA, and Stanford contributes funds each pay period to your HSA.

Employees outside of California may enroll in the Out of Area Healthcare + Savings HDHP, which has the same plan features at a lower employee contribution. 

4. Stanford Health Care Alliance (SHCA)

SHCA utilizes Stanford Health Care physicians and affiliated providers in multiple specialties to provide care. Services are covered by a co-pay or co-insurance. A primary care provider (PCP) is required to oversee your care. Out-of-network care is not covered, except in emergencies.

5. ACA Basic HDHP

The ACA Basic HDHP works the same as the Healthcare + Savings 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). You may contribute to an HSA; however, Stanford does not contribute HSA funds.

The SHCA, Healthcare + Savings HDHP, and ACA Basic HDHP allow you to receive care from Stanford Health Care physicians and facilities.

The Healthcare + Savings Plan and ACA Basic HDP allow you to receive care from Palo Alto Medical Foundation doctors, but SHCA, Kaiser, and Trio plans do not include access to PAMF physicians.      

If you enroll in the Kaiser HMO, you will be required to receive all care from Kaiser Permanente facilities and physicians. You will select a primary care physician (PCP) to oversee your care and provide referrals to specialists if necessary. Prescription drugs are also dispensed through Kaiser’s pharmacy. Kaiser offers robust health and wellness tools on their kp.org website and mobile app.

If you are enrolled in Kaiser, Trio, or SHCA and you do not elect a PCP, the plan will assign a PCP to you. You may call your medical carrier and change your PCP designation at any time.

If you are enrolled in Kaiser, Trio, or SHCA, you need a referral from your PCP to see a specialist. If you are enrolled in the Healthcare + Savings HDHP or ACA Basic HDHP, you do not need a referral.

The Healthcare + Savings HDHP has a nationwide network of providers and facilities and can support health care needs of dependents living outside of California. Trio also has a “away from home” program if you live within Trio’s CA coverage area and your child is in a state and county supported by this program.

No, your Kaiser plan designation will change automatically from Northern California to Southern California when your address is updated in StanfordYou as long as your new address is part of Kaiser’s service area. Kaiser in Southern California will assign a new ID number as the Northern and Southern systems are not integrated.

Health plan eligibility is driven by home ZIP code and the plan’s service area. If you are enrolled in Kaiser, SHCA, or Trio and move out of their service area, you will have 31 days from when your address changes to make new plan elections. If you do not, you will be enrolled in default coverage (Healthcare + Savings HDHP) automatically.

In-network preventive care is fully covered and is not subject to the deductible. Out-of-network preventive care is not covered.

No. You would have to wait for the next Open Enrollment period to make changes to your benefits unless you had a qualifying life event.

Yes. Co-pays for urgent care are significantly lower than emergency room co-pays.

Co-pays are a fixed cost paid for each service—for example, $30 when you go to the doctor. Co-insurance is a percentage of the cost for health care services, typically after you meet your annual deductible.

Cardinal at Work provides a link to Summaries of Benefits and Coverage (SBC) which outline each plan’s benefits. You can click on the plan you are interested in to access the SBC. During Open Enrollment, you can also call Included Health to ask specific questions about the plans.

Participating in BeWell is a great way to earn incentives while staying healthy. Visit the BeWell website for program details.

Your employee contributions for 2023 can be found in your Open Enrollment Guidebook and on Cardinal at Work.

As we emerge from the pandemic, Stanford and other employer plans across the nation are experiencing higher demand for medical services—and this demand is impacting the cost of health care. 

Additionally, other factors such as inflation, an older population, and disease prevalence have contributed to the rising cost of health care. The deferral of routine care during the pandemic, which, in some cases, caused minor health issues to develop into more serious conditions or resulted in the delay of planned procedures, such as knee or hip surgeries, has also impacted health care costs.

Each health plan’s increase is related to that specific plan, and SHCA’s members accessed care more frequently and experienced an influx of more acute medical conditions requiring higher-cost care than the members in other plans last year. Stanford Health Care also faced increases in the cost of delivering health care, including the rising prices of equipment, test procedures, and patient care services.

While we do not know what will happen in the future, Stanford and SHCA continue to work together to develop solutions that will help mitigate cost increases in the future.

Some actions you can take to help defray costs include: 

• Spend time each day taking good care of yourself and access the BeWell programs and fitness programs provided free by Stanford to help you stay well. By focusing on your physical, emotional, and financial well-being, you reduce the risk of developing chronic health conditions that are costly to treat. 
• During Open Enrollment, consider your plan options and how much you expect to use the health plan each year. 
  • Consider a low-cost option, such as Kaiser or the Healthcare + Savings HDHP if:
    • You only need to cover yourself
    • You don’t take expensive medications regularly
    • You don’t see the doctor other than for your annual physical or for a minor illness once in awhile
  • The Healthcare + Savings HDHP may also be the right choice for you if: 
    • You are interested in saving for future health care expenses and minimizing your taxes
    • You can cover your annual deductible before you can build the balance in your HSA
    • You want to access any doctor or hospital in the U.S. (including Stanford Health Care) 
    • You want to take advantage of Stanford’s contribution of $960 employee-only coverage or $1,968 for all other tiers. These funds will help you pay for out-of-pocket health care expenses. 
  • If you live in the Kaiser service area in California or Hawaii and are comfortable receiving all your health care within the Kaiser medical system, that might be the right choice, and it is free for employee-only coverage.
  • If you live within the Trio Plan service area in California and are comfortable accessing a smaller Blue Shield network to receive all your care, the Trio plan may be the best fit. 
• Concierge support for high deductible health plan (HDHP) members: Those who enroll in the Healthcare + Savings HDHP or ACA Basic HDHP will have access to a concierge service through Included Health that helps you navigate your health insurance, resolve claims, get a second opinion, find great doctors, and more. Your Included Health personal care team will provide free, unbiased support 24/7 to help you make good health care decisions throughout the year. Learn more. 
• Preventive care: To stay on the healthy track, be sure to take advantage of preventive care, such as annual exams or “well baby” checkups. Preventive care is free under all of the plans as long as you stay in network. 
• Elect a health care FSA during Open Enrollment: The health care FSA lets you set aside money for out-of-pocket health care expenses, such as deductibles, co-pays, prescriptions, eyeglasses, etc., before taxes are calculated on your salary, and you are reimbursed tax-free. Keep in mind that you cannot have both a health care FSA and an HSA.
• Pre-authorization: Inpatient hospitalization and many outpatient procedures can be costly. For all procedures scheduled in advance, please work with your provider and medical plan carrier to obtain pre-authorization approval and understand in advance how much of the cost you will be responsible to pay. Except for emergencies, most inpatient and outpatient procedures are not covered by your health plan without prior authorization, and you would be responsible for the entire cost of the services received.

You may enroll in the Out of Area Healthcare + Savings Plan HDHP or the ACA Basic HDHP to take advantage of the Health Savings Account (HSA) and low employee contributions. Also, for 2023, we are adding an Employee Assistance Program (EAP) for employees outside of California that offers 24/7 telephonic support and in-person counseling at no cost to you.

Stanford continues to evaluate the options. Currently, our remote population is spread out, which makes it difficult to find a plan where there is a concentration of employees. We are also looking at national programs and how to consider how those plans would work differently from the Healthcare + Savings HDHP or ACA Basic HDHP. Finding a nationwide managed care plan, like Kaiser, is not easy. We understand that employees want cost predictability with plans that offer co-pays, but there hasn’t yet been a plan that fits.

While your ID card may say “California,” your plan offers nationwide coverage through Blue Shield’s provider partnerships. You can search Blue Shield’s online directory to find network providers and facilities near you. Simply tell your provider that you have coverage through Blue Shield and provide your member ID number.

No. Because it is a nationwide plan, you are not losing access to services by moving. You can change plans if you experience certain qualifying life events or during Open Enrollment.

While both plans offer tax savings, you can only enroll in an HSA if you elect the Healthcare + Savings HDHP or ACA Basic HDHP. Your HSA funds are always yours to keep, and your unused balance can be invested, growing interest tax-free. The FSA only allows you to roll over up to $570 of unused funds to the next year, and any unused dollars over the allowed amount are forfeited. The FSA does not offer an investment option, and the account is owned by Stanford. Keep in mind that you cannot contribute to both an HSA and an FSA.

The 2023 health care FSA limit is $2,850. The maximum contribution for the dependent day care FSA is $5,000, or $2,500 if you and your spouse both work and file your taxes separately. To learn more, visit the Flexible Spending Account page.

For 2023, FSA expenses must be incurred from January 1, 2023, through December 31, 2023. If you currently have funds remaining in the health care FSA for 2022, $570 will roll over into 2023. Any funds remaining in the dependent day care FSA will be forfeited. To learn more, visit the Flexible Spending Account page.

With the Healthcare + Savings HDHP, you pay less in paycheck contributions, but you have a higher deductible for non-preventive medical care and prescription drugs. The Healthcare + Savings HDHP requires you to pay the full cost of your annual deductible before Stanford shares in your health care costs. You can use your HSA to pay for qualified health care expenses or reimburse yourself for out-of-pocket costs. Once you meet your deductible, the plan will cover 80% of the cost of in-network medical services, and you will pay 20%. If you meet the annual out-of-pocket maximum, the plan will pay the full cost of in-network medical services for the rest of the plan year including prescription drugs. In-network preventive care is covered 100% and not subject to the deductible. Out-of-network preventive care is not covered.

The Healthcare + Savings HDHP and ACA Basic HDHP give you the option of contributing to a tax-advantaged savings account — the health savings account (HSA) — which you can use to pay your deductible, co-insurance, or other eligible expenses now or in the future. Together, the HDHP and the HSA are designed to help you spend your health care dollars on medical services and not on coverage you may not need, and to save for future health care needs.

The balance can be rolled over in your account from year to year and belongs to you, even if you switch to another plan or leave the University. You cannot participate in an HSA unless you are enrolled in either the Healthcare + Savings HDHP or ACA Basic HDHP.

You are exempt from paying federal taxes on the HSA, but you may be subject to state taxes depending on where you live. 

If you live in California or New Jersey, your HSA contributions are subject to state income tax. Your withdrawals for eligible health care expenses and earnings on your account are non-taxable. 

If you live in New Hampshire or Tennessee, your investment earnings are subject to state taxes, but your contributions and withdrawals are tax-free.

To be eligible to contribute to an HSA, you must be enrolled in an HDHP. You cannot be:

• Covered by any other health plan, including a health care FSA
• Claimed as a dependent on another person’s tax return (excluding your spouse’s)
• Enrolled in a Medicare plan option
• In receipt of VA benefits within the past three months
• Without a valid Social Security number

In 2023, the IRS allows you to contribute $3,850 if you have employee-only coverage and $7,750 if you have family coverage. If you are enrolled in the Healthcare + Savings HDHP, Stanford will contribute $960 into your HSA if you choose employee-only coverage and $1,968 for all other tiers. Both Stanford’s contribution and your personal contribution combined cannot exceed the IRS maximum. If you are age 55 or older, you may contribute an additional $1,000 as a catch-up contribution.

Yes. You may request your entire 2023 contribution in a lump sum from the first paycheck in 2023; however, Stanford’s contribution will continue to be paid out each paycheck. Contact the University HR Service Team to request a one-time lump sum payroll deduction.

During Open Enrollment, you must elect the Healthcare + Savings HDHP and make a separate election for the HSA, even if it’s $0. If you do not make an election, you will not receive Stanford’s contribution.

While the upfront cost of meeting the deductible of the Healthcare + Savings HDHP may seem daunting, Stanford offers ways to help offset your expenses:

• We are decreasing the premium cost for the Healthcare + Savings HDHP, making this plan more affordable. 
• Stanford makes a generous contribution to your HSA, which covers over half your deductible. For 2023, Stanford will contribute $960 into your HSA if you choose employee-only coverage and $1,968 for all other tiers. Stanford’s contribution is deposited into your account each pay period in the amount of $40 for employee-only coverage and $82 for all other tiers. 
• You can set aside tax-free money in an HSA through convenient payroll deductions for health care expenses now and in the future. In 2023, the IRS allows you to contribute $3,850 employee-only coverage and $7,750 family coverage. If you are age 55 or older, you may contribute an additional $1,000 each year.
• Unused funds roll over from one year to the next, and you can invest your HSA balance to earn interest tax-free. This allows you to plan ahead for future health care expenses in retirement. You can even use HSA funds to pay for your Medicare monthly premiums.
• If you have a large medical expense before you have a chance to fund your HSA, Stanford offers an Employee Emergency Assistance Fund (EEAF) that can help fill the gap. Additionally, the optional critical illness insurance provides cash payments for certain high-cost, unexpected illnesses. 
• The Healthcare + Savings HDHP gives you access to expanded services through Included Health throughout the year to help you find the right doctors, compare costs for procedures, locate the lowest-cost facilities and providers, schedule appointments, and resolve claims. This will help you access top-quality doctors and facilities near you while saving money.

No, any unused HSA funds can be rolled over year after year, with no limits. This is a significant advantage when compared to traditional FSAs. The money put into the HSA always belongs to you, even if you switch medical plans or leave Stanford.

Yes, HSA funds may be used to pay for qualified health care expenses (including medical, dental, prescription and vision expenses). Withdrawals for non-medical expenses would be subject to taxes and penalties from the IRS.

Once you are enrolled in Medicare Part A or B, the IRS does not allow you or Stanford to make contributions to an HSA. If you have an existing HSA balance, you may continue to use it to pay for eligible health care expenses, including Medicare premiums.

No, the Internal Revenue Service (IRS) does not allow you to participate in both the HSA and the health care FSA.