Healthcare + Savings Plan
Guidelines, Policies & Forms
Compare Medical Plans & Costs
Active employees and official retirees can use this tool to compare medical benefits, as well as plan costs.
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In 2024, the Healthcare + Savings HDHP will be expanded and renamed to Stanford Choice High Deductible Health Plan. Also, the plan will be administered by Aetna, which means you’ll have access to Aetna’s nationwide network, including Stanford Health Care, Sutter Health and the PAMF network, and UCSF providers.
The Healthcare + Savings Plan has a nationwide network and a deductible and is eligible for a health savings account with a university contribution.
After you meet your deductible, the university shares the cost of all benefits, including prescription drugs. The university pays for a larger share if you use in-network providers and facilities. This is the only plan available through Stanford that works in conjunction with an HSA with a university contribution that can be used toward your out-of-pocket deductible costs.
View plan information and resources for the Healthcare + Savings Plan
Plan enhancement as of Aug. 1, 2022: Coverage for travel to access medical care, including covered abortion services, when there is no in-network provider within 100 miles of a member’s home.
| BASICS | BENEFIT |
|---|---|
| Overview | You may visit any doctor or hospital. You receive a higher level of benefits when you use Blue Shield PPO providers through their Blue Shield PPO network. 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. As not all providers charge the same amount for the same service, even if in-network, you may want to inquire about service costs before seeing a provider. This plan is compatible with an individual HSA, that you establish at a financial institution of your choice. Healthcare + Savings HDHP - Group ID: W0051428, Plan ID: PPOX0004 |
| Pre-Authorization Requirement | Pre-authorization required for all hospital stays and certain outpatient procedures. PENALTY for not pre-authorizing: benefit reduced to 50% of Blue Shield Allowed Amount. Maximum reduction of $1,000. You pay the balance of all charges not covered by Blue Shield. Out-of-Pocket Maximum does not apply. Certain may be denied in full for failure to pre-authorize. |
| Office copay | Network: 80% after deductible Non-Network: 60% after deductible |
| Deductible | $1,750 per individual coverage (For Employee, Retiree or LTD Term only coverage) / $3,500 per family coverage Combined Network or Non-Network. Up to $3,000 of an individual's claims (you or one of your covered dependents) will apply toward the family deductible, and once that threshold is met the plan will begin sharing the costs for that individual. |
| Out-of-Pocket Maximum | $3,750 per individual / $7,500 per family Combined Network or Non-Network. A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.) |
| PREVENTATIVE CARE | BENEFIT |
|---|---|
| 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 |
| Immunizations | Network: 100% Non-Network: Not covered. Travel immunizations and vaccinations are covered at 100% both in and out of network. |
| Well-woman visits | Network: 100% Non-Network: Not covered |
| Reproductive Health | Abortion services are available to enrolled members. After the deductible, 80 percent of the costs for either network or 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. |
| PRESCRIPTION DRUGS | BENEFIT |
|---|---|
| Pharmacy (Retail) | Network or Non-Network: 80% after deductible |
| Mail order drug program | 80% 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 services 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 855-599-2657 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.