2026 Stanford Choice High-Deductible Health Plan
2026 Stanford Choice High-Deductible Health Plan Plan Details
Control #: 232361, Plan #002 Employee Only, Plan #003 Employee plus Dependent(s)
You may visit any doctor or hospital. 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.
For 2026, you also have access to Crossover Health Clinics, which includes services for Preventive Services and Health Coaching at no cost.
All telehealth services are covered at 100% before the deductible is met.
When you see a Non-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.
This plan is compatible with an individual Health Savings Account (HSA), that you establish at a financial institution of your choice.
This document is a summary. Please refer to the plan Evidence of Coverage (coming soon) or the Summary of Benefits Coverage (SBC) for more details.
Plan Information
Plan Year:
Offered To:
Employees
Full-Time Employee * Contribution Per Pay Period:
Employee Only - $53.00
Employee & Spouse/Registered Domestic Partner - $317.00
Employee & Child(ren) - $272.00
Employee & Family - $438.00
Employee & Spouse/Registered Domestic Partner - $317.00
Employee & Child(ren) - $272.00
Employee & Family - $438.00
Part-Time Employee * Contribution Per Pay Period:
Employee Only - $462.45
Employee & Spouse/Registered Domestic Partner - $1,081.61
Employee & Child(ren) - $927.15
Employee & Family - $1,493.81
Employee & Spouse/Registered Domestic Partner - $1,081.61
Employee & Child(ren) - $927.15
Employee & Family - $1,493.81
Basics
Pre-Authorization Requirement:
Pre-authorization is required for all hospital stays and certain outpatient procedures.
Pre-authorization is required for the following services: Advanced Imaging (CT, MRI, MRA, and PET); all electively scheduled inpatient hospital admissions; all elective outpatient procedures (example – endoscopic procedures, arthroscopic procedures, epidural steroid injections, etc); other procedures and services as defined on the pre-certification requirement list.
PENALTY for not pre-authorizing: the services will be considered not covered by the plan, and the member is responsible for the full amount of the service.
*Exception: When members receive care in any inpatient facility or emergency room, or in observation bed status.
Pre-authorization is required for the following services: Advanced Imaging (CT, MRI, MRA, and PET); all electively scheduled inpatient hospital admissions; all elective outpatient procedures (example – endoscopic procedures, arthroscopic procedures, epidural steroid injections, etc); other procedures and services as defined on the pre-certification requirement list.
PENALTY for not pre-authorizing: the services will be considered not covered by the plan, and the member is responsible for the full amount of the service.
*Exception: When members receive care in any inpatient facility or emergency room, or in observation bed status.
Care Management:
Participation in care management is optional.
Our Aetna One Advisor program takes a comprehensive population health approach to care management. Our multidisciplinary team of nurses, behavioral health clinicians, health coaches, dietitians, pharmacists, and customer service representatives helps members live better with illness, recover from acute conditions, and have a seamless healthcare experience.
Our Aetna One Advisor program takes a comprehensive population health approach to care management. Our multidisciplinary team of nurses, behavioral health clinicians, health coaches, dietitians, pharmacists, and customer service representatives helps members live better with illness, recover from acute conditions, and have a seamless healthcare experience.
Deductible:
$1,750 per individual coverage/$3,500 per family coverage
Combined Network or Non-Network. Up to $3,400 of an individual's claims will apply toward the family deductible, and once that threshold is met, the plan will begin sharing the costs for that individual.
Combined Network or Non-Network. Up to $3,400 of an individual's claims will apply toward the family deductible, and once that threshold is met, the plan will begin sharing the costs for that individual.
Office co-pay:
Network: 80% after deductible
Non-Network: 60% after deductible
Crossover Clinic: 80% after deductible
Non-Network: 60% after deductible
Crossover Clinic: 80% after deductible
Coinsurance:
Network: 100% covered for preventive care; 80% after deductible for all other services, including prescriptions
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.)
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.)
Overall Lifetime Maximum Benefit:
No overall health care lifetime maximum, but there can be for benefits that are considered non-essential, like there is a lifetime max for fertility drugs. See below.
Maternity
Maternity Hospital Stay:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Baby's First Exam:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Birthing Centers:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Midwives:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Doulas:
Not covered
Prenatal and Postnatal Physician Office Visits:
Network: 100% no deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Doctor Delivery Charge:
Covered the same as all other inpatient surgery
Reproductive Health:
Network: 80% after deductible
Non-Network: 60% after deductible.
If services are not available within 100 miles of the member's home zip code, travel expenses (airfare, mileage, rental car, lodging, and meals) will be reimbursable after the deductible up to $10,000 per year.
Non-Network: 60% after deductible.
If services are not available within 100 miles of the member's home zip code, travel expenses (airfare, mileage, rental car, lodging, and meals) will be reimbursable after the deductible up to $10,000 per year.
Mental Health/Autism/Substance Abuse
Mental Health:
INPATIENT CARE
Pre-Certification is required by you or your provider.
Network: 80% after deductible
Non-Network: 60% of billed charges
Outpatient Therapy Visit
[no visit limit]
Network: 80% after deductible.
Crossover Health: 80% after deductible
Non-Network: 80% of billed charges after deductible (up to $300 maximum allowed charges) for professional services only and only in the United States.
The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.
Pre-Certification is required by you or your provider.
Network: 80% after deductible
Non-Network: 60% of billed charges
Outpatient Therapy Visit
[no visit limit]
Network: 80% after deductible.
Crossover Health: 80% after deductible
Non-Network: 80% of billed charges after deductible (up to $300 maximum allowed charges) for professional services only and only in the United States.
The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.
Substance Abuse:
INPATIENT CARE
Pre-Certification is required by you or your provider.
Network: 80% after deductible
Non-Network: 60% of the allowed amount after deductible
Outpatient Therapy Visit
[no visit limit]
Network: 80% after deductible.
Non-Network: 80% of billed charges after deductible (up to $300 maximum allowed charges) for professional services only.
The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.
Pre-Certification is required by you or your provider.
Network: 80% after deductible
Non-Network: 60% of the allowed amount after deductible
Outpatient Therapy Visit
[no visit limit]
Network: 80% after deductible.
Non-Network: 80% of billed charges after deductible (up to $300 maximum allowed charges) for professional services only.
The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.
Autism:
Behavioral health treatment (BHT) consists of professional services and treatment programs, including applied behavior analysis (ABA) and evidence-based behavior intervention programs that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorders or autism.
Prior authorization for BHT or ABA services is required. Plan mental health cost sharing applies.
Prior authorization for BHT or ABA services is required. Plan mental health cost sharing applies.
Prescription Drugs
Pharmacy (Retail):
Network or Non-Network: Covered at 80% after deductible. (30-day supply of maintenance drugs available at Retail Pharmacy)
*Note: per federal regulations, certain preventive drugs (if covered by your plan) pay at first dollar coverage - no deductible required.
Fertility drugs: Covered at 50% after deductible; max benefit of $10,000 per lifetime
Cost Saver provides eligible members with automatic access to GoodRx's prescription pricing that allows them to pay lower prices, when available, on generic medications. This experience is seamless. All members have to do is present their member ID card when they pick up their prescriptions at their in-network pharmacy.
Crossover Health: Pre-pack pharmacy - no cost, included as part of the visit
*Note: per federal regulations, certain preventive drugs (if covered by your plan) pay at first dollar coverage - no deductible required.
Fertility drugs: Covered at 50% after deductible; max benefit of $10,000 per lifetime
Cost Saver provides eligible members with automatic access to GoodRx's prescription pricing that allows them to pay lower prices, when available, on generic medications. This experience is seamless. All members have to do is present their member ID card when they pick up their prescriptions at their in-network pharmacy.
Crossover Health: Pre-pack pharmacy - no cost, included as part of the visit
Mail order drug program:
80% after deductible up to a 90-day supply at CVS mail order or CVS retail pharmacies; Specialty drugs are not available via mail order.
*Note: per federal regulations, certain preventive drugs (if covered by your plan) pay at first dollar coverage - no deductible required.
Must use CVS mail-order service.
*Note: per federal regulations, certain preventive drugs (if covered by your plan) pay at first dollar coverage - no deductible required.
Must use CVS mail-order service.
Birth Control Pills:
Included in Prescription Drug benefit
Preventive Care
Physical exams for adults:
Network: 100%
Non-Network: Not covered
Non-Network: Not covered
Physical exams for children:
Network: 100%
Non-Network: Not covered
Non-Network: Not covered
Pap smears:
Network: 100% if part of annual preventive
Non-Network: Not covered
Non-Network: Not covered
Mammograms:
Network: 100% if part of annual preventive
Non-Network: Not covered
Non-Network: Not covered
Immunizations:
Network: 100% (Includes Covid and Flu Shots)
Non-Network: not covered
Travel immunizations are covered both in-network and out of network at no charge
*Immunizations may have an additional consultation fee, which the member will be responsible for, based on where the member receives care.
Non-Network: not covered
Travel immunizations are covered both in-network and out of network at no charge
*Immunizations may have an additional consultation fee, which the member will be responsible for, based on where the member receives care.
Prostate Specific Antigen test - PSA:
Network: 100%
Non-Network: Not covered
Non-Network: Not covered
Well-woman visits:
Network: 100%
Non-Network: Not covered
Non-Network: Not covered
Other Services
Acupuncture:
Network: 80% after deductible
Non-Network: 60% after deductible
Up to 20 combined Network and Non-Network visits per year
Non-Network: 60% after deductible
Up to 20 combined Network and Non-Network visits per year
Allergy Tests:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Allergy Treatment:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Alternative Medicine:
Not covered
Ambulance charges:
Network or Non-Network: 80% after deductible (if medically approved)
CT and PET Scans (Complex Imaging):
**Pre-authorization required
Network: 80% after deductible
Non-Network: 60% after deductible
Network: 80% after deductible
Non-Network: 60% after deductible
Chiropractors:
Network: 80% after deductible
Crossover Clinic: 80% after deductible
Non-Network: 60% after deductible
Up to 20 combined Network and Non-Network visits per year
Crossover Clinic: 80% after deductible
Non-Network: 60% after deductible
Up to 20 combined Network and Non-Network visits per year
Christian Science Practitioners:
Not covered
Cosmetic Surgery:
Not covered
Dental Treatment:
Coverage limited to certain conditions only. Contact Aetna for more information.
Emergency Room:
Network: 80% after deductible
Non-Network: 80% after deductible
Lab/ancillary/professional charges paid at 80% after deductible for Network or Non-Network
Non-Network: 80% after deductible
Lab/ancillary/professional charges paid at 80% after deductible for Network or Non-Network
Urgent Care:
Network 80% after deductible or Non-Network: 60% after deductible
Hearing Care:
Network:
Preventive Exam: 100% as part of preventive care
Non-Routine Exam: Network 80% after deductible
Non-Network: 60% after deductible
Hearing aids are covered at $3,000 per ear for 36 months
Preventive Exam: 100% as part of preventive care
Non-Routine Exam: Network 80% after deductible
Non-Network: 60% after deductible
Hearing aids are covered at $3,000 per ear for 36 months
Home Health Care:
Network: 80% after deductible - 100 days per calendar year. Prior authorization required.
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Hospice Care:
Network: 80% after deductible
Non-Network: 60% after deductible (prior authorization required)
Non-Network: 60% after deductible (prior authorization required)
Hospital Stay:
Pre-Certification required by you or your provider.
Network: 80% after deductible
Non-Network: 60% after deductible
Network: 80% after deductible
Non-Network: 60% after deductible
Infertility Treatment:
Standard Base Benefit: Covers the diagnosis and treatment of the underlying cause. Cost share is based upon the type of service and place of service rendered (covered for in and out of network).
Artificial Insemination: Network: 50% of billed charges
Ovulation Induction: Network: 50% of billed charges
Advanced Reproductive Technology (ART), which includes In Vitro Fertilization (IVF), Cryo-preserved embryo transfers: Covered at 50% after deductible for up to 3 cycles per lifetime. GIFT and ZIFT are not covered.
Cryopreservation of eggs, embryos, and sperm (actual service to freeze what is retrieved from the fertility preservation IVF cycle). This is limited to 3 retrievals and thawing and storage up to 3 years of eggs, embryos, and sperm. This includes iatrogenic and elective fertility.
Fertility drugs: Covered at 50% after deductible; max benefit of $10,000 per lifetime. (Covers both oral and injectable fertility drugs at 50% after deductible.) Member would be responsible for any fertility drugs over the $10,000 fertility drugs lifetime maximum and that would be an additional out-of-pocket expense.
*Artificial insemination and ovulation induction are covered regardless of partner status and without a diagnosis of infertility.
Artificial Insemination: Network: 50% of billed charges
Ovulation Induction: Network: 50% of billed charges
Advanced Reproductive Technology (ART), which includes In Vitro Fertilization (IVF), Cryo-preserved embryo transfers: Covered at 50% after deductible for up to 3 cycles per lifetime. GIFT and ZIFT are not covered.
Cryopreservation of eggs, embryos, and sperm (actual service to freeze what is retrieved from the fertility preservation IVF cycle). This is limited to 3 retrievals and thawing and storage up to 3 years of eggs, embryos, and sperm. This includes iatrogenic and elective fertility.
Fertility drugs: Covered at 50% after deductible; max benefit of $10,000 per lifetime. (Covers both oral and injectable fertility drugs at 50% after deductible.) Member would be responsible for any fertility drugs over the $10,000 fertility drugs lifetime maximum and that would be an additional out-of-pocket expense.
*Artificial insemination and ovulation induction are covered regardless of partner status and without a diagnosis of infertility.
Laboratory Charges:
Network: 80% after deductible.
Non-Network: 60% after deductible
Crossover Health: No additional cost to office visit
Non-Network: 60% after deductible
Crossover Health: No additional cost to office visit
Magnetic Resonance Imaging (MRI) (Complex Imaging):
**Pre-authorization required.
Network: 80% after deductible
Non-Network: 60% after deductible
Network: 80% after deductible
Non-Network: 60% after deductible
Durable Medical Equipment:
Network: 80% after deductible
Non-Network: 60% after deductible
Pre-authorization may apply.
Non-Network: 60% after deductible
Pre-authorization may apply.
Occupational Therapy:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Organ Transplants:
Contact Aetna for information on transplant coverage benefits.
Skilled Nursing:
Network: 80% after deductible
Non-Network: 60% after deductible
Up to a 120-day annual maximum Network and Non-Network combined (pre-certification required).
Non-Network: 60% after deductible
Up to a 120-day annual maximum Network and Non-Network combined (pre-certification required).
Physical Therapy:
Network: 80% after deductible
Non-Network: 60% after deductible
Crossover Clinic: 80% after deductible
*All physical therapy visits are subject to Aetna’s medical necessity review process at 26 visits.
Non-Network: 60% after deductible
Crossover Clinic: 80% after deductible
*All physical therapy visits are subject to Aetna’s medical necessity review process at 26 visits.
Prosthetic & Orthotic Devices:
Contact the plan for details.
Speech Therapy:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Surgery : Facility Charges:
Network: 80% after deductible
Non-Network 60% of billed charges after deductible
Non-Network 60% of billed charges after deductible
Surgery : Physician Services:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Transgender Services:
Transgender Procedures are subject to the applicable prior approval based upon the procedure, which may include, but are not limited to: clinical diagnosis, office/progress notes from provider(s), referral letter(s), and other applicable information:
Mastopexy/Breast Augmentation, Voice and communication therapy, including B60 for therapy performed by other professionals (i.e. voice coach, bodily movement coach); Tracheal shave, Suction-assisted lipoplasty of the waist, Rhinoplasty, Facial bone reduction, Face lift, Blepharoplasty, Laryngoplasty/vocal cord (voice surgery), Liposuction (contour modeling of the waist), Lipofilling (breast, body, face), Gluteal augmentation, Permanent hair remova+B60l, Subcutaneous injection of filling material, Demabrasion, Chemical peel, Excision, excessive skin, and subcutaneous tissue; abdomen, inframubilical panniculectomy; Hair implants, Hair cranial prosthesis (wigs), Liposuction to reduce fat in hips, thighs, buttocks; Male chest reconstruction, Pectoral implants, Calf implants, Geniplasty and chin augmentation; Abdominoplasty, Facial bone reconstruction, Other electrolysis or hair laser removal, Laryngoplasty/vocal cord (voice surgery), Reversal treatment, in case a member decides to reverse procedures.
No Lifetime Limit.
Mastopexy/Breast Augmentation, Voice and communication therapy, including B60 for therapy performed by other professionals (i.e. voice coach, bodily movement coach); Tracheal shave, Suction-assisted lipoplasty of the waist, Rhinoplasty, Facial bone reduction, Face lift, Blepharoplasty, Laryngoplasty/vocal cord (voice surgery), Liposuction (contour modeling of the waist), Lipofilling (breast, body, face), Gluteal augmentation, Permanent hair remova+B60l, Subcutaneous injection of filling material, Demabrasion, Chemical peel, Excision, excessive skin, and subcutaneous tissue; abdomen, inframubilical panniculectomy; Hair implants, Hair cranial prosthesis (wigs), Liposuction to reduce fat in hips, thighs, buttocks; Male chest reconstruction, Pectoral implants, Calf implants, Geniplasty and chin augmentation; Abdominoplasty, Facial bone reconstruction, Other electrolysis or hair laser removal, Laryngoplasty/vocal cord (voice surgery), Reversal treatment, in case a member decides to reverse procedures.
No Lifetime Limit.
Travel and Lodging:
Contact the plan for details.
Tubal Ligation:
Network: 100% no deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Vasectomy:
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Vision care:
Network: 100%
Non-Network: Not covered
Limited to screen and refraction exams only
Non-Network: Not covered
Limited to screen and refraction exams only
X-rays (Basic Imaging):
Network: 80% after deductible.
Non-Network: 60% after deductible
Non-Network: 60% after deductible