Making Decisions About Your Medical Plan

Before you choose your medical plan, take time to evaluate your needs, coverage options, and plan costs to ensure that you select the best plan for you.

Consider your health care needs.

Your health care needs change throughout the years — and so should your benefits. The first step to making the best decision is to consider your health care needs for the upcoming year. This includes any planned procedures or specific health conditions you or your covered dependents have.

Understand your coverage options.

When deciding which medical plan is right for you, it is important to understand the main features and benefits of Stanford’s four medical plan options.

Plans with a Copay

Kaiser HMO | Stanford Select Copay Health Plan

Plans with a Deductible

Stanford Choice High Deductible Health Plan | ACA Basic HDHP

Preventive care covered at no cost
Must choose a primary care physician (PCP) to oversee care and handle specialist referrals
In-network benefits only; no out-of-network coverage, unless in an emergency
Kaiser HMO is available in California and Hawaii
Flexible spending account (FSA)-eligible

Preventive care covered at no cost
You pay the full cost for non-preventive medical care until you meet the deductible
No PCP is needed
No referral for specialists is needed
In-network and out-of-network benefits available, but you’ll save money staying in-network
Health savings account (HSA)-eligible*

*If enrolled in an HDHP, you may only participate in the health care FSA if you do not contribute to an HSA. Review the Medical Plan Overview below for more information.

Evaluate the costs.

Your total costs include your employee contributions — what you pay for medical coverage — as well as what you pay out-of-pocket for services.

A plan with lower monthly contributions and higher out-of-pocket costs might be the better choice if you are in good health and rarely see doctors. A plan that has higher monthly contributions but pays a higher portion of your medical costs may be better if you see specialists frequently or have been diagnosed with a chronic condition.

Keep in mind that if you enroll in the Stanford Choice High Deductible Health Plan and elect an HSA, Stanford will contribute $1,152 for employee-only coverage or $2,352 for family coverage. You can use this money to help you cover out-of-pocket medical costs.

If you are considering changing medical plans, please review the Changing Medical Plans checklist.

Overview of Stanford Medical Plan Options

	Kaiser HMO	Stanford Select Copay Health Plan	Stanford Choice High Deductible Health Plan	Out of Area Stanford Choice High Deductible Health Plan	ACA Basic HDHP*
Access to Care
Network	Kaiser Permanente	Aetna Select Network, includes SHC, Sutter Health and the PAMF netwrok, and UCSF providers	Aetna Choice Network, includes SHC, Sutter Health and the PAMF network, and UCSF providers	Aetna Choice Network, includes SHC, Sutter Health and the PAMF network, and UCSF providers	Aetna Choice Network, includes SHC, Sutter Health and the PAMF network, and UCSF providers
Out-of-Network Coverage	Only in emergencies	Plan pays 60% after you meet the deductible	Plan pays 60% after you meet the deductible	Plan pays 50% after you meet the deductible
Costs
Semi-Monthly Contributions Employee Only Employee & Spouse Employee & Child(ren) Employee & Family	$0 $184.94 $158.53 $255.40	$62.70 $400.58 $347.92 $520.35	$27.00 $250.91 $217.92 $325.92	$17.38 $208.79 $179.97 $279.99	$26.20 $189.35 $162.31 $261.47
Stanford HSA Contribution (Annual)	None	None	$1,152 for employee-only coverage/$2,352 for family coverage	$1,152 for employee-only coverage/$2,352 for family coverage	None
Service Costs (in-network care)	Copay-based plan; no deductible	Copay-based plan; no deductible	You must meet the deductible ($1,750 individual/$3,500 family) and then the plan covers 80% of in-network services	You must meet the deductible ($1,750 individual/$3,500 family) and then the plan covers 80% of in-network services	You must meet the deductible ($3,250 individual/$6,500 family) and then the plan covers 60% of in-network services

* The ACA Basic HDHP meets the minimum essential coverage requirements under the federal health care reform, Affordable Care Act (ACA)

If you do not actively choose a medical plan, you will be automatically enrolled in the following coverage:

If you are currently enrolled in…	You will automatically be enrolled in this plan for 2024.
SHCA	Stanford Select Copay Health Plan
Healthcare + Savings HDHP	Stanford Choice High Deductible Health Plan
ACA Basic HDHP	ACA Basic HDHP
Kaiser HMO	Kaiser HMO
Trio	Stanford Select Copay Health Plan
Waived coverage	Waived coverage

Save on Health Care Costs

Stanford offers ways to help you offset your health care expenses:

Health Care Flexible Spending Account (FSA): If you enroll in either the Kaiser HMO or Stanford Select Copay Health Plan (formerly SHCA), you can set aside tax-free funds in an FSA to pay for health care expenses. The IRS contribution limit for health care FSAs will increase in 2024 to $3,050.
Health Savings Account (HSA): If you enroll in an HDHP and you also elect an HSA, you can set aside tax-free money through convenient payroll deductions for health care expenses now and in the future. Additionally, if you enroll in the Stanford Choice High Deductible Health Plan (formerly Healthcare + Savings HDHP), Stanford will contribute $1,152 for employee-only coverage or $2,352 for family coverage to your HSA to help you cover out-of-pocket medical costs. 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.
Preventive care: To stay on the healthy track, take advantage of preventive care, such as annual exams or checkups. Preventive care is free under all of the plans as long as you stay in-network. Learn more about how to save time and money by knowing where to go for care.
BeWell : By participating in the BeWell program and completing wellness activities, including preventive health care activities, you can earn up to $560 in financial incentives that can be used however you see fit, including paying for health care expenses.
Medical Contribution Assistance Program (MCAP): You may qualify for a medical contribution subsidy based on your family income level.
Employee Emergency Assistance Fund (EEAF): You can receive financial support for unanticipated expenses that cause you financial hardship.

Use These Decision Tools to Choose Your Medical Plan

Get support as you weigh your options and decide which plan works best for you. These tools can help:

Nayya, our online decision tool, helps you choose your health care plans by asking you questions and giving you personalized recommendations based on the information you provide. Your information is confidential, and you can decide how much personal information to input. Access the tool via My Benefits portal during Open Enrollment.
Use the Cardinal at Work Comparison Tool to compare the cost of coverage and out-of-pocket costs under the medical and dental plans offered by Stanford.
Contact the University HR Service Team at 877-905-2985, Monday – Friday, 8 a.m. – 5 p.m. PT, to get your questions answered from members of the Stanford Benefits team.