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Comparison Tool

2020 Plans & Contribution Rates



Medical Plans

Compare medical plans available for each of these roles:

Dental Plans

Compare dental plans available for each of these roles:

Vision Plan

Compare vision plans available for each of these roles:

Full Plan Costs

Compare the premium costs for each of these roles:

Active Employees

Retirees

SELECT THE PLAN(S) TO COMPARE:
SELECT THE PLAN(S) TO COMPARE:
SELECT THE PLAN(S) TO COMPARE:
Active employees may select one of two offered dental plans.
Stanford offers one dental plan for all eligible retirees.

Delta Dental Enhanced PPO Plan #3366 - 2020

Basics
Full-Time Employee * Contribution Per Pay Period: 

Employee Only: $11.08
Employee & Spouse/Partner: $23.20
Employee & Children: $19.92
Employee & Family: $32.08

Part-Time Employee * Contribution Per Pay Period: 

Employee Only: $19.81
Employee & Spouse/Partner: $41.61
Employee & Children: $35.65
Employee & Family: $57.43

Overview: 

Delta Dental PPO is the dentist network for this plan. This plan pays in-network benefits when your care is either provided or authorized by your Delta Dental PPO network dentist.  Basic procedures by a Premier or non Delta Dental dentist will be covered at a lower percentage.

If your network dentist does not provide or authorize your care, the charges are considered out-of-network.

You are encouraged to obtain a predetermination of benefits from Delta for services greater than $300, or for crowns or bridges.

Deductible: 

Network: $0 per individual/$0 per family
Non-network: $50 per individual/$150 family

Coinsurance: 

Network: Delta Dental PPO providers

  • Preventive and diagnostic:  100% of the negotiated rate
  • Basic procedures:  80% of the negotiated rate
  • Major restorative procedures:  50% of the negotiated rate

Non-Network: Delta Dental Premier or non Delta Dental providers

  • Preventive and diagnostic:  100% of usual & customary charges
  • Basic procedures:  60% of usual & customary charges
  • Major restorative procedures:  50% of usual & customary charges
Annual maximum: 

Network: $3,000 per individual
Non-Network:  $1,500 per individual

Lifetime maximum: 

Orthodontia only: $1,500

Preventive Type of Care
Cleanings: 

Preventive and Diagnostic service:
PPO or Premier Network Provider: 100%
Non-Network: 80% (deductible waived)

Plan allows up to three cleanings/year.  The third cleaning applies to certain conditions including diabetics, pregnancy, those requiring periodontal maintenance and those in an active orthodontic treatment plan.

Fluoride treatments: 

Preventive and Diagnostic service:
PPO or Premier Network Provider: 100%
Non-Network: 80% (deductible waived)

Routine exams: 

Preventive and Diagnostic service:
PPO and Premier Network Provider: 100%
Non-Network: 80% (deductible waived)

Sealants: 

Basic procedures service:
PPO Network Provider: 80%
Premier or Non-Network: 60% after deductible

X-rays: 

Preventive and Diagnostic service:
PPO or Premier Network Provider: 100%
Non-Network: 80% (deductible waived)

Orthodontic Services
Orthodontia: 

Network: 50% of Delta's approved fee
Non-Network: 50% of Delta's approved fee
Combined Orthodontia lifetime maximum benefit of $1,500.  Payment is split over two plan years at $750 per year and you must be enrolled in the Enhanced plan both years.

Retainers: 

(Covered under the Orthodontia benefit)
PPO Network Provider: 50% of Delta's approved fee
Premier or Non-Network: 50% of Delta's approved fee

Other Services (A-E)
Anesthesia: 

Basic procedures service:
PPO Network Providers: 80%
Premier or Non-Network: 60% after deductible

Bridges: 

Major Restorative procedures service:
PPO Network Providers: 50%
Premier or Non-Network: 50% after deductible

Crown: 

Major Restorative procedures service:
PPO Network Providers: 50%
Premier or Non-Network: 50% after deductible

Dentures: 

Major Restorative procedures service:
PPO Network Providers: 50%
Premier or Non-Network: 50% after deductible

Extractions: 

Basic procedures service:
PPO Network Providers: 80%
Premier or Non-Network: 60% after deductible

Other Services (F-O)
Fillings: 

Basic procedures service:
PPO Network Provider: 80%
Premier or Non-Network: 60% after deductible

Gingivectomy: 

Basic procedures service:
PPO Network Provider: 80%
Premier or Non-Network: 60% after deductible

Gold restorations: 

(Inlays & Onlays only)
Major Restorative procedures service:
PPO Network Provider: 50%
Premier or Non-Network: 50% after deductible

Implants: 

Major Restorative procedures service:
PPO Network Provider: 50%
Premier or Non-Network: 50% after deductible

Inlays: 

Major Restorative procedures service:
PPO Network Provider: 50%
Premier or Non-Network: 50% after deductible

Onlays: 

Major Restorative procedures service:
PPO Network Provider: 50%
Premier or Non-Network: 50% after deductible

Oral surgery: 

Basic procedures service:
PPO Network Providers: 80%
Premier or Non-Network: 60% after deductible

Other Services (P-Z)
Periodontal surgery: 

Basic procedures service:
PPO Network Provider: 80%
Premier or Non-Network: 60% after deductible

Prescription drugs: 

Not covered

Root canals: 

Basic procedures service:
PPO Network Provider: 80% 
Premier or Non-Network: 60% after deductible

Space maintainers: 

Preventive and Diagnostic service:
PPO or Premier Network Provider: 100%
Non-Network: 80% (deductible waived)

Splinting: 

Not covered

TMJ (Temporomandibular joint syndrome): 

Not covered

Delta Dental Basic PPO Plan #3365 - 2020

Basics
Full-Time Employee * Contribution Per Pay Period: 

Employee Only: $0.00
Employee & Spouse/Registered Domestic Partner: $0.00
Employee & Children: $0.00
Employee & Family: $0.00

Part-Time Employee * Contribution Per Pay Period: 

Employee Only: $8.97
Employee & Spouse/Registered Domestic Partner: $18.84
Employee & Children: $16.14
Employee & Family: $26.00

Overview: 

Delta Dental PPO is the dentist network for this plan. This plan pays in-network benefits when your care is either provided or authorized by your Delta Dental PPO network dentist.  Basic procedures by a Premier or non Delta Dental dentist will be covered at a lower percentage.

If your network dentist does not provide or authorize your care, the charges are considered out-of-network.

You are encouraged to obtain a predetermination of benefits from Delta for services greater than $300, or for crowns or bridges.

Deductible: 

$50 per individual
$150 per family

Coinsurance: 
  • Preventive and diagnostic:  100% of usual & customary charges
  • Basic procedures:  80% of usual & customary charges
  • Major restorative procedures:  50% of usual & customary charges

You are responsible for amounts not covered by the dental plan.

Annual maximum: 

$1,000 per individual

Lifetime maximum: 

Orthodontia is not covered

Preventive Type of Care
Cleanings: 

Preventive and diagnostic service:
100% (deductible waived)

Balance billing by a Non-Network dentist may apply. You are responsible for these charges.

Plan allows up to three cleanings/year.  The third cleaning applies to certain conditions including diabetics, pregnancy, and those requiring periodontal maintenance.

Fluoride treatments: 

Preventive and diagnostic service:
100% (deductible waived)

Balance billing by your dentist may apply. You are responsible for these charges.

Routine exams: 

Preventive and diagnostic service:
100% (deductible waived)

Balance billing by your dentist may apply. You are responsible for these charges.

Sealants: 

Basic procedures service:
80% after deductible

X-rays: 

Preventive and diagnostic service:
100% (deductible waived)

Balance billing by your dentist may apply. You are responsible for these charges.

Orthodontic Services
Orthodontia: 

Not covered

Retainers: 

Not covered

Other Services (A-E)
Anesthesia: 

Basic procedures service:
80% after deductible

Bridges: 

Major Restorative procedures service:
50% after deductible

Crown: 

Major Restorative procedures service:
50% after deductible

Dentures: 

Major Restorative procedures service:
50% after deductible

Extractions: 

Basic procedures service:
80% after deductible

Other Services (F-O)
Fillings: 

Basic procedures service:
80% after deductible

Gingivectomy: 

Basic procedures service:
80% after deductible

Gold restorations: 

(Inlays & Onlays only)
Major Restorative procedures service:
50% after deductible

Implants: 

Not covered

Inlays: 

Major Restorative procedures service:
50% after deductible

Onlays: 

Major Restorative procedures service:
50% after deductible

Oral surgery: 

Basic procedures service:
80% after deductible

Other Services (P-Z)
Periodontal surgery: 

Basic procedures service:
80% after deductible

Prescription drugs: 

Not covered

Root canals: 

Basic procedures service:
80% after deductible

Space maintainers: 

Preventive and diagnostic service:
100% (deductible waived) 

Balance billing by your dentist may apply. You are responsible for these charges.

Splinting: 

Not covered

TMJ (Temporomandibular joint syndrome): 

Not covered

Delta Dental PPO Plan #1149 - 2020

Basics
Overview: 

This plan pays in-network benefits when your care is either provided or authorized by your Delta Dental PPO network dentist.

If your network dentist does not provide or authorize your care, the charges are considered out-of-network.

You are encouraged to obtain a predetermination of benefits from Delta for services greater than $300, or for crowns or bridges.

Deductible: 

Network: $0 per individual/$0 per family
Non-network: $50 per individual/$150 family

Coinsurance: 

Network:  

  • Preventive and diagnostic: 100% of the negotiated rate  
  • Basic procedures: 80% of the negotiated rate  
  • Major restorative procedures: 50% of the negotiated rate  

Non-Network:  

  • All services: 50% of usual & customary charges
Annual maximum: 

Network & Non-Network Combined: $1,000 per individual

Lifetime maximum: 

No lifetime maximum

Preventive Type of Care
Cleanings: 

Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)
Plan allows up to 2 cleanings a year.

Fluoride treatments: 

Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)

Routine exams: 

Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)

Sealants: 

Basic procedures service:
Network: 80%
Non-Network: 50% after deductible

X-rays: 

Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)

Orthodontic Services
Orthodontia: 

Not covered

Retainers: 

Not covered

Other Services (A-E)
Anesthesia: 

Basic procedures service:
Network: 80%
Non-Network: 50% after deductible

Bridges: 

Major Restorative procedures service:
Network: 50% 
Non-Network: 50% after deductible

Crown: 

Major Restorative procedures service:
Network: 50% 
Non-Network: 50% after deductible

Dentures: 

Major Restorative procedures service:
Network: 50% 
Non-Network: 50% after deductible

Extractions: 

Basic procedures service:
Network: 80% 
Non-Network: 50% after deductible

Other Services (F-O)
Fillings: 

Basic procedures service:
Network: 80% 
Non-Network: 50% after deductible

Gingivectomy: 

Basic procedures service:
Network: 80% 
Non-Network: 50% after deductible

Gold restorations: 

(Inlays & Onlays only)
Major Restorative procedures service:
Network: 50% 
Non-Network: 50% after deductible

Implants: 

Major Restorative procedures service:
Network: 50%
Non-Network: 50% after deductible

Inlays: 

Major Restorative procedures service:
Network: 50% 
Non-Network: 50% after deductible

Onlays: 

Major Restorative procedures service:
Network: 50%
Non-Network: 50% after deductible

Oral surgery: 

Basic procedures service:
Network: 80% 
Non-Network: 50% after deductible

Other Services (P-Z)
Periodontal surgery: 

Basic procedures service:
Network: 80% 
Non-Network: 50% after deductible

Prescription drugs: 

Not covered

Root canals: 

Basic procedures service:
Network: 80% 
Non-Network: 50% after deductible

Space maintainers: 

Preventive and Diagnostic service:
Network: 100% 
Non-Network: 50% (deductible waived)

Splinting: 

Not covered

TMJ (Temporomandibular joint syndrome): 

Not covered

Kaiser Permanente Senior Advantage Group #7145 (Northern CA) Group #230178 (Southern CA) - 2020

Ratings
National Committee For Quality Assurance (NCQA)
Up to four stars are given for each of the following criteria:
Overall Accredition Status: 
Accredited
Access & Services: 
3
Qualified Providers: 
4
Staying Healthy: 
2
Getting Better: 
1
Living With Illness: 
4
Basics

This plan pays benefits when you get care from your Kaiser Permanente doctor and when your doctor refers you to a hospital or specialist in the network. Most covered expenses are paid at 100%.

You will pay a co-pay for certain services.

You do not get benefits from this plan or from Medicare if you receive non-emergency care outside the network. When you enroll in this plan, you assign your Medicare benefits to the plan.

Description: 
Kaiser Permanente Senior Advantage Group
Deductible: 

No deductible

Office co-pay: 

$25 co-pay primary

Coinsurance: 

100% after applicable co-pays

Out-of-Pocket Maximum: 

$1,500 per individual
$3,000 family

Overall Lifetime Maximum: 

No maximum

Maternity
Maternity Hospital Stay: 

100%

Baby's First Exam: 

100%

Birthing Centers: 

100%

Midwives: 

100% in hospital; if out-patient office visit: $25 co-pay

If midwife is available at Kaiser Permanente

Prenatal Visits: 

100%

Doctor Delivery Charge: 

100%

Pregnancy Termination: 

$25 co-pay

Mental Health/Substance Abuse
Mental Health: 

Kaiser Permanente must approve mental health care.
INPATIENT CARE
100%

OUTPATIENT CARE
[no visit limit]
$25 co-pay per visit, individual
$12 co-pay per visit, group

Autism: 

NA

Substance Abuse: 

INPATIENT DETOXIFICATION
$100%

OUTPATIENT CARE
[no visit limit]
$25 co-pay per visit, individual
$5 co-pay per visit, group

Other Services (A-D)
Acupuncture: 

$15 co-pay

Up to 40 combined chiropractic and acupuncture visits per year

American Specialty Health (ASH) Plans Participating  Acupuncturists

Allergy Tests: 

$25 co-pay

Allergy Treatment: 

$3 co-pay for injections

Alternative Medicine: 

Not covered

Ambulance charges: 

$50 co-pay

CAT Scans: 

100%

Chiropractors: 

$15 co-pay

Up to 40 combined chiropractic and acupuncture visits per year

American Specialty Health (ASH) Plans Participating Chiropractors

Christian Science Practitioners: 

Not covered

Cosmetic Surgery: 

Not covered

Dental Treatment: 

Not covered

Other Services (E-N)
Emergency Room: 

$65 co-pay (waived if admitted)

Urgent Care: 

$25 co-pay

Hearing Care: 

100% for routine exam during annual physical. Audiologist hearing exam $30 copay, Specialist visit to treat hearing problem $50 copay.

$1000 ALLOW/DEVICE; 1 DEVICE/EAR; 2 DEVICE(S) PER 36 MONTHS

Home Health Care: 

100%

Hospice Care: 

100%

Hospital Stay: 

100%

Infertility Treatment: 

$25 co-pay

Fertility Drugs: Covered under drug benefits; In Vitro, GIFT, and ZIFT: Not covered.

Laboratory Charges: 

100%

Magnetic resonance imaging - MRI: 

100%

Durable Medical Equipment: 

100%

Other Services (O-Z)
Occupational Therapy: 

$25 co-pay

Organ Transplants: 

Contact Kaiser Permanente for information on transplant coverage benefits

Skilled Nursing: 

100%
Up to 100 days per benefit period. More than 100 days not covered.
Benefit period renews after patient is out of facility for 60 consecutive days.

Physical Therapy: 

$25 co-pay

Surgery : Physician Services: 

INPATIENT
100%

OUTPATIENT 
100% after Facility Charge co-pay

Surgery : Facility Charges: 

INPATIENT
100%

OUTPATIENT
$25 co-pay per procedure

Speech Therapy: 

NA

Tubal Ligation: 

NA

Vasectomy: 

$25 co-pay per procedure

X-rays: 

100%

Prescription Drugs
Pharmacy (Retail): 

KAISER PERMANENTE PHARMACY
Generic: $10 for up to a 30-day supply, $20 for a 31- to 60-day supply, or $30 for a 61- to 100-day supply

Brand: $30 for up to a 30-day supply, $60 for a 31- to 60-day supply, or $90 for a 61- to 100-day supply

Mail order drug program: 

KAISER PERMANENTE MAIL ORDER PHARMACY
Generic:  $10 for up to a 30-day supply, $20 for a 31- to 100-day supply.

Brand:  $30 for up to a 30-day supply, $60 for a 31- to 100-day supply

Birth Control Pills: 

Included in Prescription Drug benefit

Preventive Care
Physical exams for adults: 

100%

Physical exams for children: 

100%

Pap smears: 

100%

Mammograms: 

100%

Immunizations: 

100% 
When office visit not required

Prostate Specific Antigen test - PSA: 

100%

Well-woman visits: 

100%

Vision care: 

100%

$150 eyewear allowance every 24 months

Contact Kaiser for other vision benefit information

Blue Shield Retiree PPO Group #PPOX0005 - 2020

Ratings
National Committee For Quality Assurance (NCQA)
Up to four stars are given for each of the following criteria:
Overall Accredition Status: 
Not reported by NCQA
Access & Services: 
0
Qualified Providers: 
0
Staying Healthy: 
0
Getting Better: 
0
Living With Illness: 
0
Basics

This plan provides coverage from any licensed physician anywhere in the world, and pays Medicare Part A and Part B deductibles and co-insurance for all Medicare-approved services. This plan covers some services not covered by Medicare.

You will have lower costs if you use a provider who accepts Medicare assignment and is a Blue Shield PPO network provider.

Description: 
Blue Shield Retiree PPO Group
Deductible: 

Medicare-Approved: Deductibles Waived
Non-Medicare Approved: $100 per individual/$300 family

Office co-pay: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Coinsurance: 

100% for Medicare Approved services; 100% for Preventive Services; 80% after deductible for Non-Medicare Approved or other services

Out-of-Pocket Maximum: 

Medicare-Approved or Non-Medicare Approved: $1,000 per individual

Overall Lifetime Maximum: 

No maximum

Maternity
Maternity Hospital Stay: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Baby's First Exam: 

Not covered

Birthing Centers: 

Medicare Approved: 100%
Non-Medicare Approved: 80% after deductible

Midwives: 

Medicare Approved: Not covered
Non-Medicare Approved: 80% after deductible

Prenatal Visits: 

Medicare Approved: 100%
Non-Medicare Approved: 80% after deductible

Doctor Delivery Charge: 

Covered the same as all other inpatient surgery

Pregnancy Termination: 

Medicare Approved: 100% Non-Medicare Approved: 80% after deductible

Mental Health/Substance Abuse
Mental Health: 

INPATIENT CARE
Pre-Certification is required by you or your provider.
Medicare Approved: 100%
Non-Medicare Approved: 60% after deductible

OUTPATIENT CARE
[no visit limit]
Medicare Approved: 100%
Non-Medicare Approved: 80% after deductible

Autism: 

NA

Substance Abuse: 

INPATIENT DETOXIFICATION
Pre-Certification is required by you or your provider.
Medicare Approved: 100%
Non-Medicare Approved: 60% after deductible

OUTPATIENT CARE
[no visit limit]
Medicare Approved: 100%
Non-Medicare Approved: 80% after deductible

Other Services (A-D)
Acupuncture: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Up to 20 visits per year Medicare-Approved and Non-Medicare Approved combined.

Allergy Tests: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Allergy Treatment: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Alternative Medicine: 

Not covered

Ambulance charges: 

Medicare-Approved: 100% after $50 co-pay
Non-Medicare Approved: 80% of the allowed amount after $50 co-pay

CAT Scans: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Chiropractors: 

Up to $1,500 max benefit per calendar year
Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Christian Science Practitioners: 

Not covered

Cosmetic Surgery: 

Not covered

Dental Treatment: 

Coverage limited to certain conditions only. Contact Blue Shield for more information.

Other Services (E-N)
Emergency Room: 

Including emergency room professional and lab/ancillary charges
Medicare-Approved: 100% after $100 facility co-pay per visit (co-pay waived if admitted)
Non-Medicare Approved:  80% after $100 facility co-pay per visit (co-pay waived if admitted)

Urgent Care: 

Medicare-Approved: 100%; Non-Medicare Approved: 80% after deductible

Hearing Care: 

Medicare-Approved: 100% for annual exams
Non-Medicare Approved: 100% for annual exams
Hearing aids not covered

Home Health Care: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Hospice Care: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Hospital Stay: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Infertility Treatment: 

Not covered.

Laboratory Charges: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Magnetic resonance imaging - MRI: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Durable Medical Equipment: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Other Services (O-Z)
Occupational Therapy: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Organ Transplants: 

Contact Blue Shield for information on transplant coverage benefits

Skilled Nursing: 

Medicare-Approved: 100% up to 120 calendar days/year Non-Medicare Approved: 80% after deductible up to 120 calendar days/year

Physical Therapy: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Surgery : Physician Services: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Surgery : Facility Charges: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

Speech Therapy: 

NA

Tubal Ligation: 

NA

Vasectomy: 

Medicare-Approved: 100%
Non-Medicare Approved: 80% after deductible

X-rays: 

Medicare-Approved:
100% Non-Medicare Approved: 80% after deductible

Prescription Drugs
Pharmacy (Retail): 

Blue Shield Network pharmacy: $10 generic; $30 brand name; $75 non-formulary-up to a 30-day supply.

Non-Network Pharmacy: 80%, no deductible

Mail order drug program: 

Must use Blue Shield Mail Order Service. $20 generic; $60 brand name; $150 non-formulary -- up to a 90-day supply

Birth Control Pills: 

Included in Prescription Drug benefit

Preventive Care
Physical exams for adults: 

100%
Annual exam

Physical exams for children: 

Not covered

Pap smears: 

Medicare-Approved: 100%
Non-Medicare Approved: 100%

Mammograms: 

Medicare-Approved: 100%
Non-Medicare Approved: 100%

Immunizations: 

Medicare-Approved: 100%
Non-Medicare Approved: 100%
Travel immunizations not covered

Prostate Specific Antigen test - PSA: 

Medicare-Approved: 100%
Non-Medicare Approved: 100%

Well-woman visits: 

Medicare-Approved: 100%
Non-Medicare Approved: 100%

Vision care: 

100% no deductible
Limited to screen and refraction exams only; eyewear not covered