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ACA Basic High-Deductible Health Plan

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The ACA Basic High-Deductible Health Plan works the same as the Stanford Choice 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).


2024 Plan Details 

The ACA Basic High Deductible Health Plan works the same as the Stanford Choice High Deductible Health 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).

Network

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

Know where to go for care

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 at 888-922-3862 during Open Enrollment.

On the Aetna Tier 1 Guide, learn more about how you can reduce your costs when accessing these specific services: labs, imaging, and physical therapy.

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.

BASICSBENEFIT
Overview

You may visit any doctor or hospital, but you receive a higher level of benefits when you use Aetna Choice POS II providers. 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.Group #2232361 Plan ID #004 Employee Only         #005 Employee + Dependents

This plan is compatible with an individual Health Savings Account (HSA). You can set up an HSA with any financial institution that provides HSA services, or when you elect the ACA Basic HDHP during Open Enrollment, you can set up an account with Fidelity when you make your elections through My Benefits. Note that Stanford does not contribute to your HSA unlike those enrolled in the Stanford Choice High Deductible Health Plan.

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 meet the individual deductible.

Out-of-Pocket Maximum

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

PREVENTIVE CAREBENEFIT
Physical Exams for AdultsIn-network: 100%Out-of-network: not covered
Physical Exams for ChildrenIn-network: 100%Out-of-network: not covered
Pap SmearsIn-network: 100% if part of annual preventiveOut-of-network: not covered
MammogramsIn-network: 100% if part of annual preventiveOut-of-network: not covered
ImmunizationsIn-network: 100%Out-of-network: not covered; travel immunizations not covered
Prostate Specific Antigen Test - PSAIn-network: 100%Out-of-network: not covered
Well-Woman Visits In-network: 100%Out-of-network: not covered
MEDICAL SERVICESBENEFIT
Office Visit (PCP and Specialty Care)In-network: 60% after deductibleOut-of-network: 50% after deductible
Urgent CareIn-network: 60% after deductibleOut-of-network: 50% after deductible
Emergency RoomIn-network: 60% after deductible (waived if admitted)Out-of-network: 60% after deductible (waived if admitted)
PRESCRIPTION DRUGSBENEFIT
Pharmacy (Retail)In-network or out-of-network: 60% after deductible
Mail-Order Drug Program60% after deductibleMust use Aetna mail-order service
Birth Control PillsIncluded in prescription drug benefit
REPRODUCTIVE HEALTHBENEFIT
Abortion servicesAbortion services are available to enrolled members. After the deductible, 60% of the costs for in-network or 50% of the costs for 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.

Traveling Outside the U.S.

Benefits will be provided for covered 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.

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 Information and Resources for the ACA Basic High Deductible Health Plan

2024 Plan Documents

  • ACA Basic HDHP Summary of Benefits and Coverage - Coming soon!

An SBC is an overview of plan benefits, deductibles, copays, and coverage levels for a variety of commonly used medical treatments and services.

  • ACA Basic HDHP Summary Plan Description - Coming soon!

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.

Plan Forms & Resources

Coming soon!