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Stanford Choice High Deductible Health Plan

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The Stanford Choice High Deductible Health Plan, administered by Aetna, has a nationwide network and a deductible and is eligible for a health savings account (HSA) 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.

Network

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

Know where to go for care

Preferred Providers

Certain services, such as lab work, imaging, and physical therapy, will have lower coinsurance for preferred in-network providers or facilities (Maximum Savings/Tier 1) than for other in-network or out-of-network providers and facilities (Standard Savings/Tier 2).

Learn more about how you can reduce your costs when accessing these services on the Aetna Tier 1 Guide.

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.

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. You receive a higher level of benefits when you use Aetna providers through their Choice POS II network. 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. 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.

Group: #232361Plan ID: #002 Employee Only               #003 Employee + Dependents

Pre-Authorization Requirement

Pre-authorization required for all hospital stays and certain outpatient procedures.

PENALTY for not pre-authorizing: benefit reduced to 50% of Aetna Allowed Amount. Maximum reduction of $1,000. You pay the balance of all charges not covered by Aetna. Out-of-pocket maximum does not apply. Certain services may be denied in full for failure to pre-authorize.

Deductible

$1,750 per individual coverage (for employee, retiree or LTD Term only coverage) / $3,500 per family coverage

Combined in-network or out-of-network. Up to $3,200 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 in-network or out-of-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.)

PREVENTIVE CAREBENEFIT
Physical Exams for Adults

In-network: 100%

Out-of-network: not covered

Physical Exams for Children

In-network: 100%

Out-of-network: not covered

Pap Smears

In-network: 100% if part of annual preventive

Out-of-network: not covered

Immunizations

In-network: 100%

Out-of-network: not covered

Travel immunizations and vaccinations are covered at 100% both in- and out-of-network

Well-Woman Visits 

In-network: 100%

Out-of-network: Not covered

Reproductive HealthAbortion services are available to enrolled members. After the deductible, 80% of the costs for either in-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.
MEDICAL SERVICESBENEFIT
Testing (Diagnostic and Imaging)

Maximum Savings/Tier 1: 90% after deductible

Standard Savings/Tier 2: 70% after deductible

Out-of-network: 60% after deductible

Imaging (CT/PET Scans, MRIs)

Maximum Savings/Tier 1: 90% after deductible

Standard Savings/Tier 2: 70% after deductible

Out-of-network: 60% after deductible

Rehab – Physical Therapy

Maximum Savings/Tier 1: 90% after deductible

Standard Savings/Tier 2: 70% after deductible

Out-of-network: 60% after deductible

Office Visit (PCP and Specialty Care)In-network: 80% after deductible 
Out-of-network: 60% after deductible
Urgent CareIn-network: 80% after deductible
Out-of-network: 60% after deductible
Emergency RoomIn-network: 80% after deductible (waived if admitted)
Out-of-network: 80% after deductible (waived if admitted)
PRESCRIPTION DRUGSBENEFIT
Pharmacy (Retail)

In-network: 80% after deductible

Out-of-network: 80% after deductible

Mail-Order Drug Program

In-network: 80% after deductible

Out-of-network: Not covered

Must use Aetna mail-order service

Birth Control PillsIncluded in prescription drug benefit

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 Stanford Choice High Deductible Health Plan 

2024 Plan Documents

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

  • Stanford Choice High Deductible Health Plan Summary Plan Description

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!