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ACA Basic High-Deductible Health Plan

The ACA Basic High-Deductible Health Plan works the same as the Healthcare + Savings 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).

You may enroll in a Health Savings Account (HSA) to set aside money to cover eligible out-of-pocket expenses, but Stanford does not contribute to your HSA unlike those enrolled in the Healthcare + Savings plan.

View detailed information about the ACA Basic High-Deductible Health Plan

BASICS  

Overview

You may visit any doctor or hospital, but you receive a higher level of benefits when you use Blue Shield PPO providers.  You are responsible for ensuring all providers are in the network.

When you see a non-network provider, you are responsible for the balance of your bill that is not covered by Blue Shield.  The Out-of-Pocket Maximum does not apply to the balance of the bill not covered by Blue Shield.

This plan is compatible with an individual Health Savings Account (HSA)

Group # PPOX0007

Office copay

Network: 60% after deductible

Non-Network: 50% after deductible

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 me the individual deductible.

Out-of-Pocket Maximum

$6,500 per individual $13,000 per family for in-network services; $13,000 per individual and $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).

PREVENTATIVE CARE  

Physical exams for adults

Network: 100%

Non-Network: Not covered

Physical exams for children

Network: 100%

Non-Network: Not covered

Pap smears

Network: 100% if part of annual preventive

Non-Network: Not covered

Mammograms

Network: 100% if part of annual preventive

Non-Network: Not covered

Immunizations

Network: 100%

Non-Network: Not covered; travel immunizations not covered.

Prostate Specific Antigen test - PSA

Network: 100%

Non-Network: Not covered

Well-woman visits 

Network: 100%

Non-Network: Not covered

PRESCRIPTION DRUGS  

Pharmacy (Retail)

Network or

Non-Network: 60% after deductible

Mail order drug program

60% after deductible

Must use Blue Shield mail-order service

Birth Control Pills

Included in Prescription Drug benefit

Traveling Outside the U.S.

Benefits will be provided for covered services you receive anywhere in the world. Blue Shield has network providers outside of California and the United States. We encourage you to see Blue Shield providers to help reduce your costs, but you still have the option to see any provider to get needed care.

You can access service outside of California through the BlueCard Worldwide® Network.

If you need care while out of the country, call the toll-free BlueCard Program Access number at (800) 810-2583, or call collect at (804) 673-1177—24 hours a day, seven days a week.

Before traveling abroad, call Blue Shield Customer Service at 800-873-3605 to find out what you need to make your plan work for you when you travel. For more information, visit the Blue Shield website.

In an emergency, go directly to the nearest hospital. As soon as possible, you should call Blue Shield at (800)343-1691 or call collect at (804) 673-1177—24 hours a day, seven days a week.