Stanford Choice High Deductible Health Plan
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.
Aetna formulary for all three plans: Aetna Standard Plan
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).
View the Aetna Maximum Savings 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 member services at 833-971-4583.
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.
| BASICS | BENEFIT |
|---|---|
| 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 CARE | BENEFIT |
| 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 Health | Abortion 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 SERVICES | BENEFIT |
| 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 Care | In-network: 80% after deductible Out-of-network: 60% after deductible |
| Emergency Room | In-network: 80% after deductible (waived if admitted) Out-of-network: 80% after deductible (waived if admitted) |
| PRESCRIPTION DRUGS | BENEFIT |
|---|---|
| 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 Pills | Included 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.
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.