1. No category

Table of Contents
Benefit Basics and Things to Know3
Introduction
Eligibility and Enrollment
ClearBenefits Online Enrollment Instructions
When Coverage Begins
When Coverage Ends
Updating Personal Information During the Year
Making Changes During the Year
Special Enrollment Rules
Frequently Asked Questions
Special Information for Postdocs on J-1 Visas
3
3
4
5
5
5
6
7
8
8
Medical9
Postdoc Medical Plans
Prenatal Education and Incentive Program
NurseHelp 24/7
Wellvolution
Disease Management
Case Management
The Postdoc Benefits Office is available
by phone at (650) 724-9490 and by
email at [email protected].
Online resources are available at
https://benefits.stanford.edu/postdocs.
9
12
12
13
13
13
Dental14
Vision16
Life and Accident18
Disability19
Travel Assistance Programs21
Postdoc Assistance Program22
Stanford Help Center and Tax-Deferred Account Retirement Plan23
Monthly Contribution Rates24
Postdoc Premium Payment Information
25
Frequently Asked Questions26
Legal Notices29
HIPAA Privacy Notice
Women’s Health and Cancer Rights Act
Important Notice About Prescription Drug Coverage
and Medicare
Premium Assistance Under Medicaid and the Children’s
Health Insurance Program (CHIP) Genetic Information Nondiscrimination Act
HIPAA Special Enrollment Rights
Summary of Benefits and Coverage
Health Insurance Marketplace Notice
29
29
29
31
32
33
33
34
Contacts35
2
Benefit Basics and Things to Know
Introduction
This guide provides an overview of the Stanford
University Postdoctoral Scholar Benefits Program.
Use this guide and the online resources available at
https://benefits.stanford.edu/postdocs to help you
make benefit decisions and review the coverage for
each plan.
Eligibility and Enrollment
You are eligible to participate in the Stanford
University Postdoctoral Scholar Benefits Program
if you are a Postdoc who has been appointed 30 or
more hours per week.
Certain plans also permit you to cover your eligible
dependents. The health care plans allow you to
cover your:
n
Spouse (unless legally separated) or registered
domestic partner of the same sex, as well as
opposite-sex partners when one partner is age
62 or older and is qualified for Social Security
benefits.*
Married and unmarried dependent children who
are under 26 years, regardless of student status.
For the medical, dental and vision plans, you
may choose from one of the following enrollment
categories:
n
Postdoc Only
n
Postdoc + Spouse/Registered Domestic Partner
n
Postdoc + Child(ren)
n
Postdoc + Family (includes Spouse/Registered
Domestic Partner and Children)
If you enroll a dependent, the Postdoc Benefits
Office requires proof of dependent eligibility for
the dependents you cover. A document listing
acceptable forms of proof is available on the
Postdoc Benefits Website.
You also have the option to waive Postdoc medical,
dental and vision benefits.
Mandatory Medical Insurance
Requirement
In addition to your natural child, the term “child”
also includes stepchild, legally adopted child, a
child who has been placed with you in anticipation
of adoption, a child for whom you are the legal
guardian, and a child of your registered domestic
partner. The child also must be your tax dependent
if he or she is a child of your registered domestic
partner.
Stanford University requires all Postdocs,
regardless of visa status, to be insured by a
comprehensive medical plan that is compliant
with the Patient Protection and Affordable Care
Act and meets the new federal standards. If you
waive medical insurance offered to you through
the Postdoctoral Scholar Benefits Program, you
must provide proof that you have a qualifying
medical insurance policy (e.g., through your
spouse or an individual policy) to the Postdoc
Benefits Office. Waivers will only be permitted
in very limited instances. For information
about what qualifies as an acceptable medical
insurance policy, please contact the Postdoc
Benefits Office.
Stanford University also provides health coverage
to certain children if the University is directed to
do so by a qualified medical child support order
(QMCSO) issued by a court or state agency of
competent jurisdiction.
Department of State regulations require all J-1
visa holders to ensure their J-2 dependents
carry health insurance that meets the minimum
criteria. Special information for J-visa holders
can be found on page 8 of this guide.
n
*Currently, registered domestic partners are not included
in the IRS code as tax dependents. Thus, the IRS requires
us to report the value of the medical coverage paid on
behalf of a registered domestic partner (less any post-tax
contributions) as taxable income to you.
Under this law, courts may require a Postdoc,
in certain events such as a divorce, to provide
medical, dental and vision coverage to a child
who might not otherwise be covered. Contact the
Postdoc Benefits Office to obtain a copy of the
QMCSO procedure.
You may select different enrollment categories for
your medical, dental and vision plans. For example,
you may enroll your entire family for medical
coverage, but only yourself for dental; or you, your
spouse and child for medical and you and your
spouse for dental.
https://benefits.stanford.edu/postdocs
3
Benefit Basics and Things to Know
ClearBenefits Online Enrollment Instructions
ClearBenefits is the Postdoc online enrollment
website. You can log in to this website from any
computer with Internet access.
Once you are appointed as a Postdoctoral Scholar,
you will be provided with instructions on how to
go online and enroll for your benefits. You have
31 days from your appointment start date to make
your elections. During the annual Open Enrollment
period, you must complete your elections within the
designated Open Enrollment timeframe.
First time user instructions (for newly appointed
Postdocs and Postdocs logging in to the system
during the annual Open Enrollment period):
1. G
o to https://stanford.clearbenefits.com. You
will need your Stanford Postdoc ID number to
log in to ClearBenefits. Your Stanford Postdoc
ID number can be found in the upper left hand
corner of your Stanford University Postdoctoral
Scholar ID card.
Postdoctoral
Scholar
User ID: S
UP+ID# without the leading zeros, for
example: SUP7654321
Password: Your password will match your User ID
For example: User ID: SUP7654321
Password: SUP7654321
Once you are in the system, you will be prompted
to change your password. Your password length is
limited to 12 characters.
2. Y
ou will be asked to electronically sign a legal
acknowledgment.
4
3. Upon your first time logging in to the
ClearBenefits system, you will need to complete
your New Account Setup to verify/update your
personal and dependent information. Please
complete the required fields.
4. After completing your New Account Setup, you
may begin making your benefit elections.
Remember, you have 31 days from your
appointment start date to make your elections.
During the annual Open Enrollment period, you
must complete your elections within the designated
Open Enrollment timeframe.
If you need to make a mid-year change to your
benefits or beneficiaries
If you need to make mid-year changes to your
benefits, or if you want to update your life
insurance beneficiaries, those changes must be
made within the ClearBenefits online enrollment
website. It is your resource throughout the year.
You must experience a qualifying event (such
as marriage, the birth of a child, or divorce) in
order to make a change to your benefit elections
mid-year. Once logged in to ClearBenefits, select
“My Life Events” and the system will walk you
through the process. See the Making Changes
During the Year section of this guide for more
information on mid-year benefit changes.
If you are enrolling in any benefit plans for which
you are required to make monthly premium
contributions, refer to the Postdoc Premium
Payment Information section of this guide for
instructions on how to set up automatic direct
debit from your personal bank account through the
ClearBenefits website.
For more detailed instructions on
how to enroll or make changes online, or to
request a password reset, contact the Postdoc
Benefits Office.
Benefit Basics and Things to Know
When Coverage Begins
Heath care (medical, dental, vision) enrollment is
completed via ClearBenefits, the online enrollment
website. You have 31 days from your appointment
start date to make your elections.
If you make your elections within this 31-day
eligibility period, coverage for the following plans/
programs will be effective retroactive to your
appointment start date:
n
Medical
n
Dental
n
Vision
n
Life
n
Accident
n
Long term disability
n
Basic and extended travel assistance
n
Postdoc Assistance Program
When Coverage Ends
When your Postdoc assignment terminates, your:
n
n
Under certain circumstances, you may be able to
continue medical, dental or vision coverage for
yourself and your dependents through COBRA.
Refer to the Postdoc Benefits Website for additional
information.
Updating Personal Information During the
Year
The ClearBenefits and Stanford You systems do
not interface with one another and require that
any address changes be made to each system
individually.
n
Automatic Enrollment
If you do not take action within your 31-day
enrollment period, you will be automatically
enrolled for the following benefits (Postdoc Only
enrollment category):
Stanford HealthCare Alliance (SHCA) medical
plan*
n
Standard Insurance Company life, accident and
long term disability plans
n
Postdoc life, accident, disability, and basic and
extended travel assistance program coverage
ends on your termination date.
If you are disabled when coverage ends, your
termination of coverage will not affect benefits for
which you are eligible under the disability plans.
Short term disability coverage may or may not be
effective retroactive to your appointment start date
depending on the source of your funding (e.g.,
stipend, salary or other).
n
Postdoc medical, dental, vision and Postdoc
Assistance Program benefits end on the last day
of the month in which you stop participating in
the Postdoc program.
UnitedHealthcare Global (previously
FrontierMEDEX) basic travel assistance
program
You will not be automatically enrolled for dental
and vision coverage. Your effective date of
coverage will be the same as outlined in the
When Coverage Begins section of this guide.
*If you do not reside in SHCA’s network area, you
will be enrolled for the Blue Shield of California
PPO medical plan.
ClearBenefits Enrollment
n
ClearBenefits (online enrollment website): You
are responsible for ensuring that ClearBenefits
has your current address (https://stanford.
clearbenefits.com). You will need your Stanford
Postdoc ID number and password to access the
system. Refer to the Postdoc Benefits Website
for instructions on updating your ClearBenefits
profile. Remember that health insurance
communications from all insurers and the
Postdoc Benefits Office will be mailed to your
address recorded in the ClearBenefits system.
Stanford You (Stanford database): You are
also responsible for ensuring that Stanford
You (https://stanfordyou.stanford.edu) has your
current address. You will need your SUNet ID and
password to change your address. Once you are
in the system, click on “Maintain your directory
and AlertSU emergency contact information” to
change your address. Remember that tax forms
are among the most important forms mailed
to your address of record in the Stanford You
system.
Stanford You Database
https://benefits.stanford.edu/postdocs
https://stanford.clearbenefits.com
https://stanfordyou.stanford.edu
https://benefits.stanford.edu/postdocs
5
Benefit Basics and Things to Know
Making Changes During the Year
Generally, after you’ve made your medical,
dental and vision elections, you may change
those elections only during the next annual Open
Enrollment period for a January 1 effective date.
However, if you experience a qualifying event
during the year and notify the Postdoc Benefits
Office within 31 days of the event, you may change
certain benefit plan elections without having to wait
until the next annual Open Enrollment period.
You have 31 days from the date of your
qualifying event to make changes to your
benefits. If you miss your 31-day window,
you must wait until the next annual Open
Enrollment period to make your change.
If you are enrolling in any benefit plans for
which you are required to make monthly
premium contributions, refer to the Postdoc
Premium Payment Information section of
this guide for instructions on how to set up
automatic direct debit from your personal bank
account through the ClearBenefits website.
Your qualifying event must result in an
involuntary loss or gain of eligibility by you,
your spouse or registered domestic partner, or a
dependent. Additionally, your new election must
be as a result of the event and must correspond
with that involuntary loss or gain of coverage.
Examples of Qualifying Events
Event
Description
A change in legal marital status
This includes: marriage, divorce, death of spouse, legal separation,
or annulment. You may also add or drop your new spouse or
registered domestic partner’s children at this time.
A change in number of dependents
This includes: birth, adoption, placement for adoption, or loss of
a dependent. You may also add or drop your spouse or registered
domestic partner at this time.
A change in employment status
This includes any change in the Postdoc appointment status that
affects your eligibility for coverage under a plan (such as a change
between full-time to part-time status).
Your dependent satisfies or ceases to satisfy the requirements for
dependent status
This could be a registered domestic partner or a partner’s child
reaching an age limitation.
A judgment, decree or order resulting from a divorce, legal
separation, annulment or change in legal custody (including a
qualified medical child support order) that requires you to provide
health coverage for your child under the plan
In this instance, you could add coverage for the child named in the
legal action or you could drop coverage if the order requires your
former spouse or the child’s legal guardian to provide coverage.
Entitlement to Medicare or Medicaid
You may drop coverage for individuals who become enrolled in
Medicare or Medicaid or you may commence or add coverage for
individuals who lose eligibility for Medicare or Medicaid.
When there has been a significant change in the health coverage or
cost that is attributable to your spouse or dependent’s employment
Contact the Postdoc Benefits Office for more information.
Your dependent’s employer offers a new health plan or your
dependent becomes eligible for a group health plan
If coverage is elected under the dependent’s employer plan, you may
make a corresponding election change in your Postdoc benefit plans.
Your dependent’s employer has a different annual Open Enrollment
period and a change is made to his or her employer-provided
coverage
You may change your election, provided it corresponds with the
annual Open Enrollment period change that is made by your
dependent.
All mid-year benefit changes can be processed using the ClearBenefits enrollment website (see page 4 for login instructions). Once logged
in to ClearBenefits, select “My Life Events” and the system will walk you through the process. You must submit supporting documentation
of your qualifying event to the Postdoc Benefits Office in order for your mid-year change to be approved. You have 31 days from the date of
your qualifying event to make changes to your benefits.
If you waive medical insurance, you must provide proof that you have a qualifying medical insurance policy (e.g., through your spouse or
an individual policy) to the Postdoc Benefits Office. Waivers will only be permitted in very limited instances. See the Mandatory Medical
Insurance Requirement section of this guide for more information.
6
Benefit Basics and Things to Know
The coverage start date for a qualifying event
is retroactive to the date of the event. You will
be required to provide proof of the event to the
Postdoc Benefits Office. If you miss your 31day deadline, you will have to wait until the next
annual Open Enrollment period to make changes.
Elections made during Open Enrollment take effect
on January 1st following the Open Enrollment
period.
Special Enrollment Rules
If you originally waived coverage because you
had other qualifying health coverage, you may be
eligible to change your elections mid-year under
the following circumstances:
n
he other coverage was COBRA and it is now
T
exhausted.*
n T
he
other coverage was not COBRA and either the
coverage terminated due to an involuntary loss of
eligibility or employer contributions towards such
coverage terminated.*
n
n
he other coverage was Medicaid or state Child
T
Health Insurance Program (CHIP) and coverage
terminated due to loss of eligibility.**
ou become eligible for state premium assistance
Y
under a Medicaid or CHIP plan. (This is an
optional state program under Medicaid or CHIP
that pays your share of the premium for group
health plan coverage.)**
*You must process this change using the “My Life Events”
feature of the ClearBenefits website within 31 days of the date
you are eligible to change your coverage under this provision.
**You must notify the Postdoc Benefits Office within 60 days
of the date you are eligible to change your coverage under this
provision.
Refer to the next page for answers to frequently
asked questions about mid-year benefit changes.
Your coverage and premiums in the Postdoc
plans will be retroactive to the first day of loss of
Medicaid or state coverage or any “other” medical
coverage.
If your dependents also had other health coverage
and have experienced an involuntary loss of that
coverage in the above situations, they may be
added to your coverage. However, you will not
be able to add yourself or your dependents to this
coverage if the other coverage was terminated “for
cause” (including failure to timely pay the required
premiums).
Additionally, you may enroll yourself and your
spouse (with or without the new dependent) in
the Postdoc health care plan following marriage,
adoption, placement for adoption or birth. You
must be enrolled in order to cover your dependents.
Unless noted otherwise, you must process midyear changes online using the ClearBenefits
enrollment website (see page 4 for login
instructions). Once logged in to ClearBenefits,
select “My Life Events” and the system will
walk you through the process. You must submit
supporting documentation within 31 days of your
qualifying event to the Postdoc Benefits Office in
order for your mid-year change to be approved.
https://benefits.stanford.edu/postdocs
7
Benefit Basics and Things to Know
Frequently Asked Questions
If my dependent moves out of the country, can I drop
them from my coverage mid-year?
Yes. Moving out of the United States is considered
a qualifying life event, however, if you drop
coverage for a dependent mid-year, you will not
be able to add them back on to your plans until the
next Open Enrollment. Note that changes made
during the Open Enrollment period do not come
into effect until the following January 1.
If your dependent becomes eligible and enrolls
in another health plan, you would be able to drop
that dependent from your coverage as long as you
notify and provide proof to the Postdoc Benefits
Office that your dependent is covered under
another health plan.
Can I drop my coverage mid-year if I can no longer
afford to pay the required monthly contributions
applicable to my Postdoc benefit plan enrollments?
No. As you know, when you become eligible to
enroll in or change your benefits, the Postdoc
Benefits Office provides you with your benefit plan
options and the premium amounts that become
your responsibility each month (should you elect
to enroll in the plans). By enrolling for coverage
under the Postdoc plans, you are essentially
consenting to pay your premium amounts each
month. Changes to your enrollments can only be
made during the annual Open Enrollment period,
unless you experience a qualifying event.
Can I drop my coverage mid-year if I go on a personal
leave of absense?
No. Postdocs on an approved personal leave of
absence must continue participation in their benefit
programs. If you have questions or concerns about
your specific situation, please contact the Postdoc
Benefits Office.
Special Information for Postdocs on J-1
Visas
Stanford requires all Postdocs, regardless of visa
status, to be insured by a comprehensive medical
plan that is compliant with the Patient Protection
and Affordable Care Act and meets the new federal
standards.
This standard is higher than current Department
of State (DOS) requirements for J-1 visa holders.
As a J-1 visa holder with J-2 dependents, it is
your responsibility to ensure your dependents are
covered and meet the (DOS) standards.
8
The Bechtel International Center is obligated, by
federal law, to cancel the J-1 visa of any Exchange
Visitor who willfully neglects to obtain medical
insurance for their family members.
The following requirements have been established
by the DOS for the type and amounts of coverage
you must carry if you have J-2 dependents:
n
n
n
Medical benefits of at least $50,000 per accident
or illness.
Repatriation of remains in the amount of $7,500.
Expenses associated with the medical evacuation
of the exchange visitor to his or her home country
in the amount of $10,000.
nA
deductible not to exceed $500 per accident or
illness.
n
At least 75% of medical expenses must be
covered by the insurance plan.
nMay
require a waiting period for preexisting
conditions which is reasonable as determined
by current industry standards, which does not
exceed six months.
n
The policy must be backed by the full faith and
credit of your home country government or the
company providing the insurance must meet
minimum rating requirements established by
DOS (an A. M. Best rating of “A-” or above, an
Insurance Solvency International, Ltd. (ISI) rating
of “A-i” or above, a Standard & Poor’s Claimspaying Ability rating of “A-” or above, or a Weiss
Research, Inc. rating of “B+” or above).
The Postdoc medical plans meet all of the above
requirements except for Repatriation and Medical
Evacuation. Repatriation and Medical Evacuation
coverage is available for an additional monthly
charge through the Postdoctoral Scholar Benefits
Program by electing the Extended Travel Assistance
Program through UnitedHealthcare Global
(previously FrontierMEDEX). See page 21 for
information about this plan.
Department of State (DOS)
http://exchanges.state.gov/jexchanges/j-1_
visas/eligibility.html
Bechtel International Center
http://icenter.stanford.edu/quick_reference/
healthinsurance.html#J1regs
Medical
Postdoc Medical Plans
At Stanford, we understand that Postdocs have
differing medical coverage needs. The available
medical plans are designed to help protect you
and your covered dependents against financial
loss by paying for a substantial portion of eligible
expenses incurred for medically necessary care and
treatment. The medical plans offered to Postdocs
are administered by Blue Shield of California.
To receive the highest level of benefits under each
of the plans, use in-network providers and ensure
that you fully understand what is expected of you.
Stanford HealthCare Alliance (SHCA)
SHCA is a select network health insurance offering
for the Stanford Community. SHCA brings
improvements in access to services and to the
quality of care provided to members while helping
to manage the escalating costs of care.
SHCA gives you access to a true health partner,
your SHCA primary care physician (PCP), who will
coordinate your care throughout the SHCA network.
You must select a PCP at time of enrollment for
you and any enrolled dependents, or one will be
assigned based on your home zip code. When you
see an SHCA provider, there are no deductibles
or claims to file. If you go to a doctor outside of
the SHCA network, and are not referred by your
PCP, you pay the full cost for the care you receive,
except in the case of an emergency. Contact SHCA
Member Care Services for information on approved
out-of-network emergency services.
Need Urgent or Emergency Care?
Urgent Care: SHCA partners with a wide range of
urgent care centers across the state, country, and
world, including Stanford Hospital & Clinics which
offers urgent care services at Hoover Pavilion. SHCA
members must visit an in-network urgent care clinic
when within the SHCA service area. For out-ofnetwork urgent care needs, SHCA members must call
Member Care Services at (855) 345-SHCA (7422) for
assistance with locating an out-of-network urgent care
clinic.
New for 2015: SHCA Online PCP

New
Save yourself a trip to the doctor’s office by
selecting an online PCP through ClickWell Care.
You’ll obtain the same high quality care online
from an SHCA primary care doctor who can:
n
Diagnose your illness,
n
Prescribe or renew medications, and
n
Order lab tests or scans.
Your online PCP can even help you select a
convenient clinic for an in-person appointment.
Take advantage of this great resource and
extended service hours:
Monday – Friday, 7:00 am – 9:00 pm
Saturday – Sunday, 9:00 am – 5:00 pm
To join, use Provider Code 1598070898 when
selecting your PCP in the ClearBenefits
enrollment website. If you find that receiving
care online doesn’t work for you, SHCA member
care specialists can help you switch to a
traditional doctor at any time.
Wondering if online primary care is right for you?
Call a member care specialist at (855) 345-SHCA
(7422) or complete the health assessment using
your MyHealth account at https://enrollmyhealth.
stanfordhealthcare.org.
SHCA member care specialists are available
to provide you with personalized assistance
in navigating your health care journey within
SHCA. Member care specialists will answer your
questions, help you schedule appointments, assist
you in finding physicians, and answer all claims
and billing issues.
For more information regarding the SHCA,
call (855) 345-SHCA (7422) or visit
http://stanfordhealthcarealliance.org.
Emergency Care: Call 911 or go to the nearest medical
facility. The SHCA plan covers emergency care no
matter where you are – even overseas.
For non-urgent or non-emergency care, you can
contact your PCP, NurseHelp 24/7 at (877) 304-0504 or
SHCA Member Care Services at (855) 345-SHCA (7422).
https://benefits.stanford.edu/postdocs
9
Medical
Preferred Provider Organization (PPO)
With PPO plans, you may select any physicians
and hospitals within the plan’s network, as well
as outside of the network. Selecting the PPO plan
will give you the freedom to continue seeing your
current doctor, if your doctor isn’t part of the Blue
Shield of California PPO network.
Keep in mind that if your physician is not part of the
plan’s PPO network, you will have to pay more for
each visit, submit a claim for reimbursement and/or
pay for the entire visit. When the annual deductible
has been met, you pay a determined coinsurance
or copayment before the plan begins to pay for
covered services. If your current doctor is not in
the Blue Shield network, Blue Shield will work with
you to transition your care to a Blue Shield network
provider.
For more information regarding the PPO, call
(800) 873-3605 or visit www.blueshieldca.com/
stanfordpostdoc.
BlueCard Program (Available to SHCA and PPO
Members)
Traveling or working outside California, maybe
even overseas? The BlueCard Program
provides you and your family access to covered
services, including urgent and emergency care,
while you’re away. Providers in more than 200
countries belong to the BlueCard Worldwide
Network, and 85% of U.S. providers belong
to BlueCard’s national network. You should
have access to care wherever you go. For
more information on BlueCard providers, call
BlueCard Access at (800) 810-2583 (toll free) or
(804) 673-1177 (collect), or visit
www.bluecardworldwide.com. (SHCA
members: For out-of-network urgent care
needs, call Member Care Services at (855) 345SHCA (7422). In emergency situations, call 911
or go to the nearest medical facility. The SHCA
plan covers emergency care no matter where
you are – even overseas.)
Get answers to your frequently asked medical
plan questions starting on page 26 of this guide.
10
Summary of Benefits and Coverage
The Patient Protection and Affordable Care Act
(also known as the Health Care Reform law)
requires that you receive a Summary of Benefits
and Coverage (SBC). The SBC is designed to
help you understand and evaluate your health
plan choices. To obtain copies of the SBC for
each of the Leland Stanford Junior Universitysponsored medical plans, please visit the
Postdoc Benefits Website at https://benefits.
stanford.edu/postdocs. Paper copies are also
available, free of charge, from the Postdoc
Benefits Office by calling (650) 724-9490.
Medical
The medical coverage is designed to help protect you and your covered dependents against financial loss. The chart
below summarizes the key features of the medical plan options available to you and your covered dependents.
SHCA
Annual Deductible
Individual
Family
Annual Out-of-Pocket Maximum
Individual
Family
Hospital Services
Inpatient hospitalization (requires prior
auth.)
Outpatient
Physician Services
Physician office visit
Specialist office visit
Hospital & skilled nursing
Surgeon, assistant surgeon,
anesthesiologist
Short term physical, occupational, speech
therapy & chiropractic care
Preventive Care
Routine physical exams
Mammograms, pap tests
& prostate cancer screenings
Diagnostic x-ray & lab
Well-baby & well-child care
Vision/hearing exams
Covered immunizations
Other Care & Services
Emergency room services
Urgent care (not at hospital)
Skilled nursing facility
(100 preauthorized days/yr)
Hospice care
Home health care
Pregnancy & Maternity Care
Office visits
In-Network
You Pay
$500
$1,500
Out-of-Network
You Pay
$1,000
$3,000
$3,000
$6,000
$3,500
$7,000
$7,500
$15,000
$100 per admission
20%
$100 per surgery
20%
40% of $600/day; plus all charges
in excess of $600/day
40% of $350/day; plus all charges
in excess of $350/day
$20 copay
$35 copay
No copay
No copay
$20 copay
$35 copay
20%
20%
$20 copay (physician);
$35 copay (specialist)
20%
40%
No copay
No copay
Not covered
No copay
No copay
40% (no deductible)
No copay
No copay
No copay
No copay
No copay
No copay
No copay
No copay
40%
40%
40%
40%
$50 copay
(waived if admitted)
$20 copay (physician);
$35 copay (specialist)
No copay
$50 copay
(waived if admitted) +20%
$20 copay (physician);
$35 copay (specialist)
20%
$50 copay
(waived if admitted) +20%
$20 copay (physician);
$35 copay (specialist)
40%
No copay
No copay
20%
20%
20% (requires prior auth.)
20% (requires prior auth.)
$20 copay (initial visit);
thereafter no copay
No copay
$20 copay (initial visit);
thereafter no copay
20%
40%
Normal delivery & cesarean section
Mental/Nervous & Substance Abuse
Inpatient facility and residential treatment
$100 per admission
center (requires prior auth.)
Inpatient professional
No copay
Outpatient professional
$20 copay
Prescription – Retail (30-days); Mail Order (90-days)
Retail formulary generic
$10 copay
Retail formulary brand
$30 copay
Retail non-formulary brand
$75 copay
Retail contraceptive drugs and devices
No copay
Mail order formulary generic
Mail order formulary brand
Mail order non-formulary brand
Mail order contraceptive drugs and devices
Blue Shield PPO
In-Network
You Pay
None
None
$20 copay
$60 copay
$150 copay
No copay
No copay
20%
$20 copay
$10 copay
$30 copay
$75 copay
No copay
$20 copay
$60 copay
$150 copay
No copay
40%
40% of $600/day; plus all charges
in excess of $600/day
40%
40%
$10 copay + 25% of billed charges
$30 copay + 25% of billed charges
$75 copay + 25% of billed charges
Applicable retail drug tier copay
applies
Not covered
Not covered
Not covered
Not covered
This summary is provided for general information only. The benefit schedule in the above chart reflects the amount paid by plan members.
In addition to deductible and coinsurance amounts, you are responsible for out-of-network provider charges that are higher than the plan’s
allowable fee. Since exclusions, dollar/frequency limitations apply and prior authorization applies in many cases, you should refer to the specific
plan documents (available on the Postdoc Benefits Website) for detailed information. Services that reflect a percentage coinsurance are subject
to the deductible.
https://benefits.stanford.edu/postdocs
11
Medical
Medical Benefits Key Terms
Here are some short explanations of common
terms, which can help you better understand the
terms mentioned in this guide.
n
n
n
n
n
n
n
n
n
12
Coinsurance: The percentage of the allowable
amount or billed charges that the member must
pay for covered services, after meeting any
applicable plan deductible.
Copayment: The fixed amount the member
must pay for covered services after meeting any
applicable plan deductible.
Deductible: The initial amount the member must
pay in a calendar year for particular covered
services before Blue Shield pays.
In-network provider: A provider who is part of
the SHCA or the Blue Shield PPO network, also
called a preferred provider. SHCA members
must visit in-network providers for services to
be covered, except in the case of an emergency.
PPO members pay less when they see in-network
providers.
Out-of-network provider: A provider who is not
in the SHCA or the Blue Shield PPO network, also
called a non-network or non-preferred provider.
SHCA members must visit in-network providers
for services to be covered, except in the case of
an emergency. PPO members pay more when
they see out-of-network providers.
Out-of-pocket maximum: A dollar limit on the
total amount that a member has to pay for many
covered services in a calendar year, including the
copayments, coinsurance and deductible.
Prenatal Education and Incentive Program
Expectant mothers enrolled in the SHCA or the
Blue Shield of California PPO plan are eligible to
participate in Blue Shield’s Prenatal Education
and Incentive Program. In addition to receiving
educational materials, access to a 24/7 support
hotline, and personalized coaching and support
from a dedicated maternity nurse, expectant
mothers can also earn incentive rewards of up to
$100 at the conclusion of their pregnancy if at least
two out of the three required assessments have
been completed (Note: you must still be an active
participant in the Postdoc medical plan in order to
receive the incentive). To enroll, call Blue Shield of
California at (888) 886-4596.
Important: Please notify the Disability Leave
Coordinator at [email protected] as soon
as you are aware of your pregnancy to receive
additional information about Postdoc maternity
leave. Health information (including pregnancy)
is protected information and is not shared outside
the Postdoc Benefits Office. Further questions
regarding the Prenatal Education and Incentive
Program and Postdoc maternity leave should be
directed to the Postdoc Benefits Office.
NurseHelp 24/7
Call NurseHelp 24/7 toll-free to talk with a registered
nurse anytime you have health-related questions.
Experienced nurses can help you figure out what’s
ailing you, evaluate treatment options, determine
whether to see a doctor and more.
n
Physician: Generally, a doctor that is categorized
as a General Practitioner, Family Practitioner,
Pediatrician, Internist or OB/GYN.
Primary care physician (PCP): A physician who
provides both the first contact for a person
with an undiagnosed health concern as well as
continuing care of varied medical conditions, not
limited by cause, organ system, or diagnosis.
Specialist: Generally, a doctor that is NOT
categorized as a General Practitioner, Family
Practitioner, Pediatrician, Internist or OB/
GYN. Examples of a specialist would include a
Dermatologist or Cardiologist.
n
n
Ouch, you stub your big toe and it swells. You call
NurseHelp 24/7 and the nurse gives you in-home
treatment options. So you’re back on your feet in
no time, without a trip to the doctor.
It’s 2 a.m. and you’re wide awake with an upset
stomach. You call NurseHelp 24/7 for tips on
how to feel better, and soon you’re sleeping like a
baby.
Your son wakes up with a bad earache. You
call NurseHelp 24/7 and describe his symptoms,
and the nurse says he should see a physician
immediately. You rush to the doctor and are able
to prevent lasting damage to your son’s hearing.
Get immediate answers and reliable information
about: minor illnesses and injuries, chronic
conditions, medical tests and medications, and
preventive care. You can use this convenient service
whenever you need it. Just call (877) 304-0504 to
talk to a nurse anytime, day or night.
Medical
WellvolutionSM
Disease management programs provide support for:
Understanding your health is the first step to
developing a lifetime of positive habits. The Blue
Shield interactive Wellvolution program can help
you understand your current health status, set goals
to improve or change behaviors, and get you on
the right track for success. Start by completing a
confidential Well-Being Assessment that helps tailor
a wellness program just for you. You’ll learn how to
adopt and maintain a healthy lifestyle from a variety
of programs that put you in control. Monitor and
track your progress using easy-to-use tools. Plus,
you can keep on top of all the latest health news and
research – all on one website.
Get support in these areas:
n
Stress reduction
n
Weight management
n
Smoking cessation
n
Exercise
n
Emotional wellness
n
Nutrition
Heart failure
n
Asthma
n
Diabetes
n
Coronary artery disease
n
Chronic obstructive pulmonary disease
When enrolled in the disease management and
case management programs, you also have access
to the online Care Center 24/7. The Care Center
gives you interactive online tools, displays uploaded
biometric data from home monitoring and stores
your self-reported health history – enabling better
self-management and communication with your
nurse care manager.
Case Management
Case managers help ensure that members have
access to the right care at the right time. Case
managers provide education, care coordination and
personal support to members when they need it
most. Programs include:
To take action, go to www.blueshieldca.com/
stanfordpostdoc, select the Programs and Resources
tab and choose Wellvolution.
Disease Management
n
If you have a certain chronic condition, the Blue
Shield disease management programs are designed
to help improve your quality of life by showing
you how to take an active role in managing your
condition. You can receive interactive online
support, educational materials and access to a
nurse any time you have questions. Members with
higher levels of risk receive additional telephone
outreach from a nurse, while others receive
more direct interaction with care managers and
management tools such as symptom monitoring
kits. The program uses a team of nurses,
pharmacists, nutritionist/dieticians and mental
health professionals to help monitor your progress
and your health.
High-Risk Case Management Program
Customized patient support helps members who
have highly complex conditions with challenging
emotional, social and end-of-life issues; members
with catastrophic illnesses and injuries; and
newborns with major medical conditions.
Neonatal Intensive Care Unit Case Management
Program
Promotes appropriate medical management
for newborns with complex medical conditions,
extremely low birth weight or requiring major
surgery.
Chronic Complex Case Management Program
Case managers are there to support members with
advanced chronic diseases such as cancer
or renal disease.
High-Risk Maternity Case Management Program
Personalized coaching and management to help
reduce the number of premature and complicated
births, improve quality of care and promote optimal
birth outcomes.
https://benefits.stanford.edu/postdocs
13
Dental
Delta Dental PPO Plan
The dental plan is designed to assist you and your
covered dependents by paying a portion of eligible
expenses incurred for a wide range of dental services.
Eligibility Rules
If you and your spouse/registered domestic partner
work at Stanford and are considered eligible to enroll
for the Delta Dental plan through the University:
n
n
Your child(ren) may only have coverage under one
parent, and
You may not cover your spouse/registered domestic
partner as your dependent (i.e., they must enroll for
the plan separately).
The chart below summarizes the key features of the
plan. Additional information on the plan is available at
www.deltadentalins.com or by calling (800) 765-6003.
Delta Dental PPO
Maximum Benefits
Annual Maximum Benefit (per person)
Annual Deductible
Individual
Family
Diagnostic and Preventive Services
Oral exams and routine cleaning (2 per year)
Full mouth x-rays (1 set every 5 years)
Bitewing x-rays (2 per year to age 18; 1 per year 18 and older)
Panoramic x-ray
Fluoride application (2 per year to age 19)
Space maintainers (limited to non-orthodontic treatment)
Emergency care to relieve pain
Histopathologic exams
Basic Restorative Services
Periodontal maintenance (2 per year)
Fillings and root canal therapy
Osseous and oral surgery
Periodontal scaling and root planning
Sealants (limited to first molars through age 8; second molars
to age 16 every 2 years)
Anesthetics
Repairs to crowns and inlays
Simple extractions and surgical extractions of impacted teeth
Major Restorative Services
Dentures (construction, repair and adjustments)
Implants, crowns and bridges
In-Network
Out-of-Network
PPO Provider
Premier Provider
$1,500
$1,250
Non-Network
Provider
$1,000
None
None
$50
$150
$75
$225
Plan Pays
Plan Pays
100% (no deductible)
90%
(no deductible)
80%
60%
50%
40%
Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists, and program allowance for
non-Delta Dental dentists. This summary is provided for general information only. Since exclusions and dollar/frequency limitations apply,
you should refer to the specific plan documents (available on the Postdoc Benefits Website) for detailed information. If your dental treatment
is extensive or costs more than $300, you should ask your dentist to request a predetermination estimate from Delta Dental.
14
Dental
Cost Difference Example
On your dentist’s recommendation, you decide to have major services performed (e.g., crown). The full cost of
this procedure is $1,200, but the eligible charge for this procedure under the Delta Dental PPO plan is $400.
As you can see in the table below, using in-network providers will cost you much less than using out-of-network
providers.
In-Network
Annual deductible (individual)
Full amount of bill
Out-of-Network
PPO Provider
None
$1,200
Premier Provider
$50
$1,200
$400
$500
Negotiated amount
Non-Network Provider
$75
$1,200
No fee agreement
with Delta Dental
40%: $160 (no fee agreement
with Delta Dental)
The plan pays percentage of the
50%: $200
50%: $250
negotiated amount
In-network dentist contractually
required to waive fees in excess
$800
$700
—
of negotiated amount
You pay out-of-pocket
$200
$300
$1,115
The charges shown in the above table are for illustrative purposes only and are not intended to provide you with the amounts paid
by you or the applicable plan.
When you enroll in the dental plan, Delta Dental
PPO offers several additional value-added benefits
as briefly described below.
Website Access
The Delta Dental website provides you with the
online tools to:
n
Find a network dentist and receive driving
directions
n
Verify eligibility and view benefit information
n
Print an ID card and download claim forms
n
n
n
n
Find the average cost of a dental procedure in
your area
Access dental tips and other oral health
information
Contact Member Services and subscribe to online
services
Get answers to frequently asked questions
Is Your Dentist a
Delta Dental PPO dentist?
It’s important that you verify your current dentist’s
participation in the Delta Dental PPO network.
Simply asking if a dentist “accepts Delta Dental”
does not guarantee he or she is a PPO dentist.
n
Ask specifically if your dentist is a contracted
n
You should verify your dentist’s participation
Extra Benefits for Expectant Mothers
When a covered person is pregnant, the dental plan
pays for additional services to help improve the oral
health of the covered person during the pregnancy.
The additional services include one oral exam
and either one additional routine cleaning or one
additional periodontal scaling and root planning per
quadrant. Written confirmation of pregnancy must
be provided by the covered person or her dentist
when the claim is submitted.
Interested in Receiving Additional Dental Resources?
Delta Dental’s SmileWaySM wellness program offers
information, activities and tools to help you create
added value to your dental plan. You can access the
SmileWay wellness website at
www.deltadentalins.com. In addition, you can
register for the free dental health e-newsletter,
Dental Wire, which provides valuable information
about dental health topics and how to maximize
your benefits.
How to Obtain Dental Services
Go to www.deltadentalins.com to locate a Delta
Dental PPO Network dentist or call Delta Dental
Member Services at (800) 765-6003. Dentists
participating in the Delta Dental PPO Network
offer the maximum savings.
Delta Dental PPO dentist.
before each dental appointment.
https://benefits.stanford.edu/postdocs
15
Vision
Vision Service Plan (VSP)
The vision care benefits are provided by Vision
Service Plan (VSP). Whether or not you see a VSP
provider, vision coverage is designed to assist you
and your covered dependents by paying a portion
of eligible expenses incurred for a variety of vision
services. The chart below summarizes key features
of the plan. Additional information is available at
www.vsp.com or by calling (800) 877-7195.
Vision Service Plan
Signature Plan
VSP In-Network Provider
Annual Copays
Exam
Prescription Glasses
Contact Lens Exam
Any Licensed Vision Care Provider
$10
$25
Copay not to exceed $60*
N/A
Examination
Plan Pays Every 12 Months
Covered in full
Up to $45
Lenses
Single Vision Lenses
Lined Bifocal
Lined Trifocal
Lenticular
Polycarbonate (dependent children)
Plan Pays Every 12 Months
Covered in full
Up to $45
Covered in full
Up to $65
Covered in full
Up to $85
Covered in full
Up to $125
Covered in full
N/A
Frame
Plan Pays Every 24 Months
Covered up to $130 allowance
Up to $47
Contacts (in lieu of glasses)**
Elective
Necessary
Plan Pays Every 12 Months
Covered up to $130 allowance
Up to $105
Covered in full
Up to $210
*Your copay will vary depending on the fit of the contact lenses. **If you choose contact lenses, you will be eligible for a frame 12
months from the date of service.
This summary is provided for general information only. Except for the Annual Copays, the benefit schedule in the above chart
reflects the amount paid by the plan. Since exclusions and dollar/frequency limitations apply, you should refer to the specific plan
documents (available on the Postdoc Benefits Website) for detailed information.
Other Program Features
Laser Vision Correction Discounts
Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.
After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor.
Glasses and Sunglasses
n
n
Average 35 – 40% savings on all non-covered lens option.
30% off additional glasses and sunglasses, including lens options, from the same VSP doctor on the same day as your exam. Or
get 20% off from any VSP doctor within 12 months of your last exam.
Contacts
Receive extra savings with exclusive contact lens rebates. Simply click the “Special Offers” tab on www.vsp.com to access the
rebates and special offers available to VSP members.
Diabetic Eyecare Program
This program provides coverage for additional medical eyecare services specifically targeted toward members with Type 1 diabetes.
Members still receive routine eyecare from their VSP doctor and this benefit allows them to get the follow-up medical care from the
same VSP doctor after a $20 copay.
16
Vision
Using an In-Network Versus an Out-of-Network Provider
In-Network
The plan gives you a choice
when it comes to receiving eye
care. You may receive services
from either in-network or outof-network providers. Although
you are not required to use VSP
network providers, your out-ofpocket costs will be lower when
network providers are used. This
table compares some of the key
differences between receiving
care from an in-network versus
an out-of-network provider.
Out-of-Network
Provider
Must use a VSP network provider
Use any licensed eye care provider
outside the VSP network
Benefit
Authorization
Your network provider obtains
authorization from VSP when you
make your appointment and identify
yourself as a VSP member
You must contact VSP to obtain
authorization before you visit your
non-network provider
Benefits
The plan pays a higher benefit level,
which means less out-of-pocket cost
for you
The plan pays a lower benefit level,
which means more out-of-pocket cost
for you
Claims
Your provider files claims on your
behalf
You must file your own claims with
VSP
Additional
Discounts and
Savings
Available, which means your share of
the cost for additional purchases will Not available
be less (e.g., Lasik surgery, etc.)
When searching for an in-network provider on the VSP website, select “VSP Signature” for your provider network.
VSP Resources
You can connect to www.vsp.com to print an ID
card, use VSP’s interactive doctor directory to find
the doctor that’s right for you and instantly view
personalized benefit information. You will also
have access to the latest eye health and wellness
information. Also, be sure to check out VSP’s
newsletter at http://vspenvisionnewsletter.com to
learn about special offers and rebates, tips and trends,
and answers to frequently asked eye health questions.
VSP Website
www.vsp.com
First time visitors: You will need to
establish a user ID and password.
Then, information is available 24/7.
Practice good vision health. Obtain an eye
exam every year and help stop vision loss
before it starts. According to VSP providers:
4
Diabetic retinopathy can be prevented
with regular eye exams 90% of the time.
4
Glaucoma will take you by surprise and
there aren’t always symptoms.
4
Macular degeneration can cause damage
that you may not notice until it’s too late.
https://benefits.stanford.edu/postdocs
17
Life and Accident
Life and Accident
The life and accident plans through Standard
Insurance Company provide you with the following
basic coverage:
n
Basic Life Insurance – $20,000 for the Postdoc
n
Basic Accident Insurance – $20,000 for the Postdoc
You are automatically enrolled in the basic life and
accident coverage on your appointment start date.
When you become covered under the plan, you
need to provide your beneficiary designations
via the ClearBenefits enrollment website. Also
keep in mind that changes in your family status
(such as marriage, divorce or new children) do
not automatically alter or revoke your previous
designations. Therefore, it is important that
you review your beneficiary designations from
time to time.
Life Insurance
This benefit is payable to your beneficiary in the
event of your death from any cause. A repatriation
benefit covers the expense incurred, up to $2,000, to
transport your body to a mortuary near your primary
place of residence.
Accident Insurance
This benefit is payable in the event your death is
a result of an accident. There are several special
benefit provisions under this plan, which are
described below.
Special Benefit Provisions
Accelerated Death
Benefit
Air Bag
Career
Adjustment
Child Care
Higher Education
Loss of Use
If you are terminally ill with a life expectancy of less than 12
months, you may receive up to 75% of your life insurance amount.
Provides a benefit if the loss occurs while wearing a seat belt in an
automobile accident where the car is equipped with an air bag and
the air bag deploys.
Reimbursement for tuition expenses incurred by your spouse within
36 months after your death, exclusive of room and board charges.
Reimbursement for total child care expenses for all children under
age 13, incurred within 36 months after your death.
Reimbursement for tuition expenses incurred per child within
four years after your death at an accredited institution of higher
education, exclusive of room and board charges.
Maximum Benefit Amount
75% of your life insurance
$5,000
$10,000 (not to exceed $5,000
per year)
$10,000 (not to exceed $5,000
per year)
$20,000 per child (not to exceed
$5,000 per year per child)
4Loss of one hand, one foot or sight of any eye
450% of your accident insurance
4Loss of both hands, both feet, sight in both eyes or combination of 4100% of your accident insurance
any two (e.g., one hand and one foot)
Seat Belt
Portability
Conversion
18
Provides a benefit if the loss occurred while wearing a seat belt in
$10,000
an automobile.
If your appointment ends and you are not disabled and have been on the life insurance plan for at least 12
months, you can continue your life insurance at low group insurance rates without evidence of insurability.
Accident insurance can also be ported if you are under age 65.
If your appointment ends and you are not eligible for portability, you may buy an individual policy of life
insurance without Evidence of Insurability. Conversion does not apply to accident insurance.
Disability
Disability
A disabling illness can result in financial devastation
for your family. The disability program is designed
to replace a portion of your income if you are unable
to work due to an accident or sickness (including
pregnancy).
The disability program is comprised of two plans
that help protect you and your family when you
need it the most. These plans work in conjunction
with any other disability plan for which you may
be eligible, for example the Voluntary Disability
Insurance (VDI) plan that is available to Postdocs
who are on salary (W-2 wages) through the
University.
You are automatically enrolled in the disability
program on your appointment start date as follows:
n
n
Postdocs on stipend/fellowship/outside funding
(not University salary) are enrolled for the Short
Term Disability (STD) and Long Term Disability
(LTD) plans through Standard Insurance. For more
information about STD coverage, please visit
https://benefits.stanford.edu/postdocs-short-termdisability-stipend-paid-postdocs.
Postdocs on salary (W-2 wages) through the
University are enrolled in the University VDI plan
in lieu of the STD plan and enrolled in the LTD plan
through Standard Insurance. For more information
about VDI coverage, please visit https://benefits.
stanford.edu/postdocs-short-term-disability-salarypaid-postdocs.
A Note for Pregnant Postdocs
Please notify the Disability Leave
Coordinator at [email protected] as
soon as you are aware of your pregnancy
to receive additional information about
Postdoc maternity leave. Health information
(including pregnancy) is protected
information and is not shared outside the
Postdoc Benefits Office.
The following chart summarizes the key features of
the Standard Insurance STD plan.
Short Term Disability (STD) Plan (Standard Insurance)
Benefit Begins
If you are hospitalized, the benefit begins on the earlier of the first day of hospitalization or the eighth day
of your disability. If you are not hospitalized the benefit begins on the eighth day of your disability.
Benefit Amount
60% of covered weekly earnings, to a maximum of $987 per week. The minimum benefit is $25 per week.
Maximum Benefit
Period
180 days minus the benefit waiting period. If you are disabled for less than one full week, your benefit is
equal to one-seventh of the STD benefit for each day of disability.
Occupational Loss
Injury or sickness caused on or off the job.
Definition of
Disability
You are considered disabled if, as a result of sickness, injury or pregnancy, you are unable to perform with
reasonable continuity, the material duties of your own occupation.
Benefit Duration
As long as you continue to meet the definition of disability, you are eligible to receive a benefit until your
180th day of disability. On your 181st day of disability, you may be eligible for Long Term Disability (LTD)
benefits.
Benefit Integration
Your benefits may be reduced by the amount of other income replacement benefits you receive, such as
benefits from State Disability programs, VDI programs, Social Security, Workers’ Compensation, etc.
https://benefits.stanford.edu/postdocs
19
Disability
The following chart summarizes the key features of the Stanford University VDI plan.
Voluntary Disability Insurance (VDI) Plan (Liberty Mutual Insurance)
Benefit Begins
If you are hospitalized or treated in a hospital surgical unit or surgical center, the benefit begins on the
earlier of the first day of hospitalization or treatment or the eighth consecutive day of your disability. If you
are not hospitalized or treated in a hospital surgical unit or surgical center, the benefit begins on the eighth
consecutive day of your disability.
Benefit Amount
60% of basic pay, to a maximum of $1,140 per week. This maximum amount may change every January 1.
The minimum benefit is $50 per week.
Maximum Benefit
Payable
52 times your weekly benefit amount within one disability benefit period. If you are disabled for less than
one full week, your benefit is equal to one-seventh of the VDI benefit for each day of disability.
Work Related
Disability benefits may be payable but will be reduced by the amount of any Workers’ Compensation
payments.
Definition of
Disability
You are considered disabled if you are unable to perform your regular or customary work due to physical
or mental illness or injury, including pregnancy, childbirth, or related medical condition.
Benefit Integration/
Reduction
Your benefits may be reduced by the amount of other income replacement benefits you receive, such
as benefits from State Disability programs, Social Security, Workers’ Compensation, etc. or from wages
received from Stanford.
Preexisting
Limitation
Your disability benefits will be limited to the State Plan rate.
The following chart summarizes the key features of the Standard Insurance LTD plan.
Long Term Disability (LTD) Plan (Standard Insurance)
Benefit Begins
On the 181st day of disability.
Benefit Amount
50% of covered monthly earnings, to a maximum of $2,500 per month. The minimum benefit is $100 per
month.
Occupational Loss
Injury or sickness caused on or off the job.
Definition of
Disability
You are considered disabled if, as a result of sickness, injury or pregnancy, you are unable to perform with
reasonable continuity, the material duties as described below:
4Your own occupation – for the first 24 months of LTD coverage
4Any occupation for which you are suited to due to education, training or experience – after the
first 24 months of LTD coverage
Benefit Duration
If you become disabled on or prior to age 61, you are eligible to receive a full benefit up to age 65. If you
become disabled after age 61 benefits may extend beyond age 65 subject to the benefits schedule.
Benefit Integration
Your benefits will be reduced by the amount of other income replacement benefits you receive, such as
benefits from State Disability programs, VDI programs, Social Security or Workers’ Compensation.
Preexisting
Condition
Exclusions
LTD benefits are not payable for any disability that is caused by, contributed to by, or results from a
preexisting condition if the disability begins during the first 12 months you are covered under the LTD plan.
A preexisting condition is any condition resulting from an injury or sickness that is diagnosed or for
which you receive treatment during the 90 day period immediately prior to the date you become covered
under the LTD plan. Treatment includes consultation, care or services provided by a physician including
diagnostic measures, and/or taking prescribed drugs or medicines.
Special Benefit Provisions
There are several special benefit provisions provided under the LTD plan as follows:
n
n
n
20
Rehabilitation Plan – While disabled, you may qualify to participate in an approved rehabilitation plan where
some or all of the expenses you incur would be paid by the plan (e.g., training and education expenses, family
care expenses, job related expenses, etc.).
Survivor Benefit – If you should lose your life while receiving benefit payments, a lump sum payment equal to
three times your gross monthly LTD benefit will be paid to your surviving spouse, registered domestic partner
or unmarried children under age 25.
Conversion Coverage – If your appointment ends, you may be able to continue LTD coverage up to a $4,000
monthly benefit without evidence of insurability ($8,000 with evidence of insurability).
Travel Assistance Programs
Travel Assistance Programs
Whether you’re traveling, working or studying away
from home for days, weeks or months – it’s good to
know someone has you covered.
Basic travel assistance coverage through
UnitedHealthcare Global (previously FrontierMEDEX) is
provided to you at no cost. Extended travel assistance
provides extra coverage at a cost of $1.25 per month.
Review the comparison table below for more
information or contact UnitedHealthcare Global
by phone at (800) 527-0218 or email at
[email protected].
UnitedHealthcare Global Travel Assistance Programs
Description
Basic Travel
Assistance
Extended Travel
Assistance
Coverage
Available for you and your eligible family members* when traveling 100 miles or
more away from your home or internationally
Available for trips
of up to 180 days
Available for
trips more than
180 days in a
12-month period
Pre-trip
assistance
Call anytime to receive vital information before your trip, including: currency
exchange information, health hazards advice and inoculation requirements,
passport and visa information, travel locator services, and more.
þ
þ
Medical
assistance
services
The following services can help you coordinate medical needs worldwide,
including: locating medical care, hotel convalescence arrangements, medical
insurance and prescription drug assistance, and more.
þ
þ
Emergency
transportation
services**
The plan will make arrangements and pay for the cost of the following services:
emergency evacuation, transportation after stabilization, repatriation of remains,
family or friend travel arrangements, and return of dependent children.
þ
þ
Trip assistance
services
Emergency replacement for your credit card, ticket, passport, document, cash,
and assistance with missing baggage, translation, locating legal and bail bond
services, and pet care and return.
þ
þ
Personal
security
services
Real-time security intelligence and security evacuation services.
þ
þ
Dependent
coverage
Family members, including your spouse or registered domestic partner and
children through age 25, regardless of student or marital status, are covered
under your plan.
þ
þ
J-1 and J-2 visa Meets Repatriation and Medical Evacuation coverage for J-1 and J-2 visa
requirements
scholars
þ
This summary is provided for general information only. Since exclusions apply, you should refer to the specific plan documents
(available on the Postdoc Benefits Website) for detailed information. *Eligible family members include your spouse/registered domestic
partner and children through age 25, regardless of student or marital status. **Emergency transportation services must be arranged by
UnitedHealthcare Global. Related medical services, medical supplies and a medical escort are covered where applicable and necessary, as
determined by UnitedHealthcare Global.
https://benefits.stanford.edu/postdocs
21
Postdoc Assistance Program
Postdoc Assistance Program (PAP)
From time to time, you or a family member may
need help in dealing with stress, relationships in the
workplace, family concerns, money worries or other
problems. Sometimes discussing problems with a
friend or colleague isn’t enough. That is when the
PAP can help. The program is convenient, cost-free
and confidential. The PAP is managed by ComPsych
GuidanceResources.
The PAP is designed to help you and your
household members identify and find resources to
solve personal problems – such as family, alcohol,
drug, emotional, stress, legal or financial problems,
which if not resolved, could adversely affect the
quality of your life. Your use of the program is on a
confidential basis. You are automatically enrolled
for the PAP on the start of your appointment.
Confidential Counseling
This no-cost counseling
service helps you
address stress,
relationship and other
personal issues you
and your family may
face. It is staffed by
GuidanceConsultantsSM
– highly trained master’s
and doctoral level
clinicians who will listen
to your concerns and
quickly refer you to inperson counseling and
other resources for:
4Stress, anxiety and
depression
4Job pressures
4Relationship/marital
conflicts
4Grief and loss
4Problems with
children
Financial Information
and Resources
Speak by phone
with Certified Public
Accountants and
Certified Financial
Planners on a wide
range of financial issues,
including:
4Getting out of debt
4Retirement planning
4Credit card or loan
problems
4Estate planning
4Tax questions
4Saving for college
Through the PAP, you and your family members
have up to three face-to-face assessment and
counseling sessions per incident. When you
need these sessions, they will be with licensed,
multilingual clinical social workers, marriage and
family counselors, or clinical psychologists close
to your work or home. When you need additional
services, the PAP works with your mental health
benefits provided through your health plan and can
refer you to community resources as needed.
Your PAP also provides access to a variety of work
and life resources as shown in the table below.
Legal Support
and Resources
Talk to attorneys by
phone and if you
require representation,
ComPsych
GuidanceResources will
refer you to a qualified
attorney in your area
for a free 30-minute
consultation with a 25%
reduction in customary
legal fees thereafter.
Call about:
4Divorce and family
law
4Real estate
transactions
4Debt and bankruptcy
4Civil and criminal
actions
4Landlord/tenant
issues
4Contracts
GuidanceResources
Online®
GuidanceResources
Online is your one stop
for expert information
on the issues that
matter most to you:
relationships, work,
school, children,
wellness, legal, financial,
free time and more.
4Timely articles,
HelpSheetsSM,
tutorials, streaming
videos and selfassessments
4“Ask the Expert”
personal responses to
your questions
4Child care, elder care,
attorney and financial
planner searches
Work-Life Solutions
Work-Life specialists
will do the research for
you, providing qualified
referrals and customized
resources for:
4Child and elder care
4College planning
4Moving and relocation
4Pet care
4Making major
purchases
4Home repair
4Substance abuse
The PAP line is always open – 24 hours a day, 365 days a year and can be accessed via the toll-free number
(855) 666-0519 that provides immediate support in times of crisis and access to all PAP services.
Access the PAP Online
www.guidanceresources.com
Create your own confidential username and password by clicking on “first-time user” and entering “SUPDPAP”
as the Organization Web ID. Once logged in, you can access many PAP benefits and services including
generating a referral for PAP visits with a local counselor.
22
Stanford Help Center and Tax-Deferred Account Retirement Plan
Stanford Help Center
Are you struggling with a difficult issue but reluctant
to get help because of the expense? If so, you should
know that you and your family members are eligible
for up to ten counseling/consultation sessions per
incident provided though the Stanford Help Center.
Who Does the Help Center Serve?
The Help Center provides professional, confidential,
brief counseling to most Stanford University
associates, including Postdocs.
What Does the Help Center Provide?
The Help Center offers a comprehensive range
of services for individuals, couples and families
including counseling, workshops and peer support
groups, as well as work/job stress counseling and
consultation.
Why Should I Consider Coming to the Help Center?
Whether your concerns are personal or work-related,
the Help Center can assist. The center provides
counseling and consultation on concerns including
relationships, parenting, alcohol and drug abuse, grief
and loss, care of elderly parents, retirement issues,
job stress, supervisory issues, and more.
Who Can I Talk to at the Help Center?
Tax-Deferred Account (TDA) Retirement Plan
All salary-paid Postdocs, regardless of the percentage
of appointment, are eligible to contribute salary
on a before-tax basis to the SCRP through the TaxDeferred Account (TDA). The TDA is a defined
contribution retirement plan in which you elect to
contribute a percentage of your salary on a beforetax basis and invest it in one or more of the available
investment options.
You may enroll in the TDA as soon as you receive
your first paycheck. You are able to contribute to
the TDA only with income that you receive from
the University as salary, not as stipend. You may
contribute any amount up to the annual limit of
$17,500 (this amount, determined for the calendar
year 2014, may increase each year for cost-of-living
adjustments). Higher limits apply to participants who
will be age 50 or above before the end of a calendar
year. You are fully vested in the contributions you
make, but the University does not provide matching
contributions to those enrolled in the TDA.
Additional information and instructions on
how to enroll in the TDA can be obtained from
https://benefits.stanford.edu/postdocs-tax-deferredaccount.
The Help Center is staffed by licensed clinical
social workers, marriage and family therapists, and
psychologists. Bilingual counseling services are
also available. For more information, or to make an
appointment, go to http://helpcenter.stanford.edu or
call (650) 723-4577.
https://benefits.stanford.edu/postdocs
23
Monthly Contribution Rates
The following chart shows the 2015 monthly contributions applicable to the Stanford University Postdoctoral
Scholar Benefits Program.
Monthly Cost
Total Cost
Institutional
Cost/Allowance*
Your Cost
Medical – Stanford HealthCare Alliance (SHCA)
Postdoc Only
$571.16
$571.16
$0.00
Postdoc + Spouse/Registered Domestic Partner
$1,256.55
$1,005.24
$251.31
Postdoc + Child(ren)
$1,028.10
$873.88
$154.22
Postdoc + Family
$1,713.49
$1,456.47
$257.02
Medical – Blue Shield of California PPO
Postdoc Only
$619.71
$571.16
$48.55
Postdoc + Spouse/Registered Domestic Partner
$1,363.37
$1,005.24
$358.13
Postdoc + Child(ren)
$1,115.49
$873.88
$241.61
Postdoc + Family
$1,859.14
$1,456.47
$402.67
Postdoc Only
$38.20
$38.20
$0.00
Postdoc + Spouse/Registered Domestic Partner
$78.39
$38.20
$40.19
Dental – Delta Dental PPO
Postdoc + Child(ren)
Postdoc + Family
$75.37
$38.20
$37.17
$125.69
$38.20
$87.49
$6.51
$6.51
$0.00
Vision – Vision Service Plan (VSP)
Postdoc Only
Postdoc + Spouse/Registered Domestic Partner
$10.97
$6.51
$4.46
Postdoc + Child(ren)
$11.22
$6.51
$4.71
Postdoc + Family
$18.73
$6.51
$12.22
$1.25
$0.00
$1.25
Extended Travel Assistance – UnitedHealthcare Global
Postdoc + Eligible Family Members**
Disability, Life and Accident (Standard Insurance Company), Postdoc Assistance Program (ComPsych GuidanceResources)
Short Term Disability
$15.50
$15.50
$0.00
Long Term Disability
$1.83
$1.83
$0.00
Life
$1.00
$1.00
$0.00
Accident
$0.35
$0.35
$0.00
Postdoc Assistance Program (PAP)
$1.14
$1.14
$0.00
$19.82
$19.82
$0.00
Total (Disability, Life and Accident, PAP)
*Institutional costs are funded from a variety of sources depending on each individual Postdoc’s appointment arrangement.
**Upon your enrollment, eligible family members (spouse/registered domestic partner and children through age 25, regardless of
student or marital status) are automatically covered.
24
Monthly Contribution Rates
Postdoc Premium Payment Information
The health premium payment process is an
automatic direct debit setup from your personal
bank account.
You will be required to enter your bank account
information into ClearBenefits, the online
enrollment website, upon enrollment into a benefit
plan that requires Postdoc contributions.
On or after the 19th of each month, your health
premiums will automatically be deducted from your
bank account. At the time of the first deduction, if
any retroactive premiums are due, those will also be
debited from your bank account. Additionally, if the
19th falls on a weekend, the funds will be pulled the
following business day. Please note that the actual
date of deduction may differ depending on your
banking institution.
Newly Appointed Postdocs – Steps for Entering Your
Bank Information
Note: If you have already logged in to ClearBenefits
to set up your account, please see the Existing
Postdocs instructions on the right side of this page.
n
n
n
n
n
Launch ClearBenefits at https://stanford.
clearbenefits.com
Enter your User ID: SUP + your Postdoc ID
number (without the leading zeros)
Enter your Password: SUP + your Postdoc ID
number (without the leading zeros)
n
n
n
In the “Personal Info” section, complete all
required fields. In order to set up your personal
bank account (for premium payments), you will
need to select your “Type of Account,” Checking
or Savings, and will be required to enter your:
–Bank Routing #
Enter your User ID: SUP + your Postdoc ID
number (without the leading zeros)
Enter your Password: SUP + your Postdoc
ID number (without the leading zeros) or the
password you created. If you forgot your
password and are unable to reset it, please email
[email protected] for assistance.
Select “My Info”
n
Select “Edit”
n
In order to set up your personal bank account (for
premium payments), you will need to select your
“Type of Account,” Checking or Savings, and will
be required to enter your:
–Bank Account Holder Name
–Bank Name
–Bank Routing #
–Bank Account #
n
–Bank Name
Launch ClearBenefits at https://stanford.
clearbenefits.com
n
Select “Begin Setup”
–Bank Account Holder Name
When you have completed all the required
information, select “Finish”
How to Make Changes to Your Bank Account
–Bank Account #
n
Existing Postdocs – Steps for Entering Your Bank
Information
When you have completed all the required
information, select “Finish”
You must enter your new bank account information
in ClearBenefits by the 12th of the month. To make
a change, please follow the instructions for Existing
Postdocs (above).
Additional Information and Questions
More information regarding the Postdoc premium
payment process can be obtained from the Postdoc
Benefits Website and the Postdoc Benefits Office.
https://benefits.stanford.edu/postdocs
25
Frequently Asked Questions
Frequently Asked Questions
Q
The following is a compilation of frequently asked
questions regarding the Postdoc Benefits Program:
What is the Blue Shield Preferred Provider
Organization?
Blue Shield’s Preferred Provider Organization (PPO)
contracts with health care providers (doctors,
hospitals and medical groups) to provide medical
services at discounted prices. The plan is designed
to lower your out-of-pocket costs when you see a
network provider for your care. You can see other
doctors who are not contracted with Blue Shield, but
your out-of-pocket costs will be higher and you may
need to file a claim.
Q
Q
How do I find a PPO doctor?
Visit Blue Shield’s provider directory at
www.blueshieldca.com/stanfordpostdoc. If your
current doctor is not in Blue Shield’s network, Blue
Shield will work with you to help transition your
care to a Blue Shield provider. Call Blue Shield
Member Services at (800) 873-3605. Stanford
cannot guarantee that any doctor, medical group
or hospital will continue to participate in any health
plan’s network.
In an EPO plan, you must see a physician and
receive services in the Blue Shield network, except
for emergency care. You do not need to choose
a primary care physician, and any services you
receive are covered subject to a copay. In an EPO,
certain services require preauthorization.
What is the Stanford HealthCare Alliance (SHCA) health
plan?
How does the SHCA plan work?
SHCA is a coordinated group of health care
providers affiliated with Stanford Hospitals &
Clinics and Lucile Packard Children’s Hospital who
take responsibility for delivering care and working
together to carefully coordinate your care.
How is the SHCA plan different from an Exclusive
Provider Organization (EPO) or a Preferred Provider
Organization (PPO)?
With SHCA, you choose an SHCA physician who
coordinates all of your care throughout the SHCA
network. All of your care occurs in the SHCA
network, except for emergency care. There are
no deductibles or claims to file. All services are
subject to a copay and certain services require
preauthorization. A dedicated member care
specialist will assist you with finding a primary
care physician or specialist, scheduling
appointments, and answering questions about
enrollment and eligibility, and much more. For
more information, call Member Care Services at
(855) 345-SHCA (7422).
The Blue Shield PPO lets you see almost any
licensed provider for your care, and you have
coverage worldwide for both routine care and
emergencies.
SHCA is a select network health plan in which
Stanford Hospitals & Clinics and Lucile Packard
Children’s Hospital physicians and affiliated
providers in multiple specialties take responsibility
for delivering care and working together to carefully
coordinate the care of our plan members. SHCA is
Stanford-quality health care provided by Stanfordaffiliated doctors to Stanford Postdocs. The SHCA
network is comprised of more than 300 primary care
physicians and 2300 specialists to ensure you get
the highest quality care, no matter what ails you.
26
Q
SHCA is Stanford-quality health care provided by
Stanford doctors to Stanford Postdocs. The SHCA
network is comprised of more than 300 primary care
physicians and 2,300 specialists to ensure you get
the highest quality care, no matter what ails you.
Q
In a PPO plan, Blue Shield covers services both innetwork and out-of-network. In-network services are
available at a negotiated rate after the deductible is
met. Out-of-network services are paid at the Blue
Shield allowable amount after the deductible is met.
You pay a copayment for an office visit if you see a
doctor in network, and a deductible and coinsurance
apply for all other services.
Why should I select the SHCA plan?
SHCA gives you access to a true health partner in
your SHCA primary care physician (PCP), who will
coordinate your care throughout the SHCA network.
SHCA providers use a common electronic medical
record system, which improves coordination of care
and outcomes and ensures SHCA doctors know
your medical history.
As an SHCA member, you may either request an
electronic consult or come in to see one of our
doctors – it is your preference. Members also have
access to Stanford Coordinated Care, which helps
people dealing with complex chronic medical
conditions to improve their health status through
coordination of multiple specialists.
Frequently Asked Questions
Finally, your SHCA member care specialist will
help you navigate your health care with Stanford
Hospital & Clinics and Lucile Packard Children’s
Hospital physicians.
Q
Q
If you already regularly use Stanford Hospital
& Clinics and Lucile Packard Children’s Hospital
affiliated physicians through one of the other
medical plans, you can continue to access them but
at a lower monthly premium.
Q
Q
What are the benefits/advantages of the SHCA plan?
As an SHCA member, you will enjoy low premiums,
no claim submission, electronic appointment
scheduling, access to Stanford-associated facilities
and providers, coordination of your care by a
Stanford primary care physician, and personalized
care coordination and navigation by your member
care specialist.
How is the SHCA plan different from the other Stanford
health plans?
The SHCA plan is similar to an Exclusive Provider
Organization (EPO) plan, in which you receive all of
your care within a defined network of providers and
facilities. Unlike in an EPO, the SHCA plan requires
you to select a primary care physician, who will
coordinate all of your care throughout the SHCA
network.
Q
Q
Stanford’s Preferred Provider Organization (PPO)
plan covers services both in and out of network.
You pay a copayment for an office visit if you see a
doctor in network, and a deductible and coinsurance
apply for all other services.
Q
Q
Q
Is the SHCA provider network the same as the Blue
Shield network for the EPO and PPO?
No. The SHCA provider network is specifically
designed to include Stanford Hospitals & Clinics
and Lucile Packard Children’s Hospital affiliated
providers and those providers who will work
together to carefully coordinate your care. There
may be some overlap where SHCA providers are
also part of the Blue Shield network, but there is no
guarantee that all Blue Shield network providers
also participate in SHCA.
Do I need to select a primary care physician (PCP) if I
enroll in the SHCA?
Yes, you designate a PCP when completing your
online enrollment through ClearBenefits.
Q
Q
How can I find out about SHCA primary care physicians
at Stanford Hospital & Clinics and Lucile Packard
Children’s Hospital with open practices?
You can find out about SHCA primary care
physicians by visiting the SHCA website at
http://stanfordhealthcarealliance.org or by calling
Member Care Services at (855) 345-SHCA (7422).
If I’m enrolled in the SHCA plan, can I see doctors
outside of Stanford Hospital & Clinics and Lucile Packard
Children’s Hospital?
The SHCA network has the ability to meet nearly
all your health care needs and if services are
available in the network, you must see an SHCA
network provider. In the rare circumstance where
you require care that is unavailable through SHCA,
SHCA would need to authorize services to be
provided outside the network. If you have any
questions about seeing a non-SHC provider, please
call Member Care Services at (855) 345-SHCA (7422).
I want to join the SHCA plan, but I don’t want to stop
seeing my non-Stanford affiliated doctor. Can I continue
seeing this non-Stanford doctor if I select SHCA?
No, you must select a primary care physician in the
SHCA network.
How can I see an SHCA specialist physician at Stanford
Hospital & Clinics and Lucile Packard Children’s Hospital?
You should work with your SHCA primary care
physician to coordinate referrals to specialists who
are part of SHCA.
Can my Stanford Hospital & Clinics or Lucile Packard
Children’s Hospital doctor refer me to a specialist who is
not in the SHCA network?
You may only see a specialist who is not part of the
SHCA network if the specialty care you require is
not available through Stanford Hospital & Clinics
and Lucile Packard Children’s Hospital and is prior
authorized by SHCA.
If I’m enrolled in the SHCA plan, what are my options for
urgent care?
Contact Member Care Services at (855) 345-SHCA
(7422) to find out about receiving care at an urgent
care center. Stanford Hospital & Clinics offers
urgent care services at Hoover Pavilion.
If I’m enrolled in the SHCA plan, what are my
emergency room benefits?
In any emergency always call 911. If you
need emergency care, you may seek care at
the nearest emergency room. SHCA does
provide an emergency care benefit. For more
information, contact Member Care Services at
(855) 345-SHCA (7422).
https://benefits.stanford.edu/postdocs
27
Frequently Asked Questions
Q
Q
Q
Q
Q
28
Does the SHCA plan cover prescription drugs? What is
the formulary? Will my costs increase?
Q
Yes, there is a prescription drug benefit under
the SHCA plan. Prescriptions are covered after a
$10 copay for generic drugs, and a $30 copay for
brand-name drugs. The SHCA plan also covers nonformulary drugs after a $75 copay. To learn more
about your prescription drug coverage, call Member
Care Services at (855) 345-SHCA (7422).
Under the SHCA plan, will I be able to go online and
access my medical records, make appointments online
and view my children’s medical records?
Yes, all of the care you receive at Stanford Hospital
& Clinics and Lucile Packard Children’s Hospital is
tracked and coordinated using an electronic medical
record system. As SHCA member, you will have
access to your records through the MyHealth portal.
Will I have coverage while I’m traveling out of the area?
If I get sick or injured while traveling, can I see a nonStanford Hospitals & Clinics (SHC) physician or go to a
non-SHC facility without penalty?
Yes, you can access emergency care and it will be
covered as detailed in your plan summary. Please
call Member Care Services at (855) 345-SHCA (7422)
for more information.
I have enrolled in the Delta Dental plan; how do I find a
convenient network dentist?
Go to www.deltadentalins.com to find a Delta Dental
Preferred PPO network dentist close to home or work.
Under Find a Dentist, select Delta Dental PPO and
choose California. Enter your search criteria, then click
the Submit button. You’ll see a list of all the dentists
matching your search. Dentists participating in the
Delta Dental PPO network offer the maximum savings.
You also have the option of calling (800) 765-6003 to
find a dentist.
Yes, Delta Dental PPO network dentists have agreed
to offer their services to their members at reduced
contracted fees. This means you will have lower
out-of-pocket costs when you visit dentists in the
Delta Dental network. If you visit dentists outside
of the network, you may be billed for the difference
between the payment they receive from Delta Dental
and their usual fees. Refer to the cost difference
example in the Dental section of this guide for more
information.
Q
Does the Postdoctoral Scholar Benefits Program include
a vision plan?
Q
I moved; how do I change my address with the health
insurance carriers?
Sometimes I don’t have time to go to the doctor; is there
a way I can talk to my doctor online?
Yes, new for 2015, SHCA plan members can select
an online PCP who can assist with: diagnosing
illnesses, prescribing or renewing medications,
ordering lab tests or scans, and selecting a clinic for
an in-person appointment. For more information on
this program, see page 9. In addition, both SHCA
and Blue Shield of California PPO members can call
NurseHelp 24/7 toll-free to talk with a registered
nurse anytime. You can obtain immediate answers
and reliable information about minor illnesses
and injuries, chronic conditions, medical tests and
medications, and preventive care. See page 12 for
more information.
Will I save money if I visit a network dentist?
Yes, Postdoctoral Scholars are offered a vision plan
through Vision Service Plan (VSP). Review the plan
details in this benefits guide. Since VSP does not
issue ID cards, your vision care provider will need your
full name, date of birth and the last four digits of your
Social Security number. For additional information,
visit www.vsp.com.
Update your address by logging in to your
ClearBenefits profile at https://stanford.clearbenefits.
com. You will need your Postdoc ID number to
login to ClearBenefits. Your ID number is in the
upper left hand corner of your Postdoc ID card. Your
ClearBenefits user ID is SUP+ID#, without the leading
zeros, for example: SUP7654321. Your default
password when you sign in for the first time is the
same as your login name. If you have not completed
your new account setup in the ClearBenefits system,
you will be prompted to update your address. If you
have completed your new account setup but wish to
change your address, you can change your address
from the “Quick Links” and click the “Change my
home address” link.
Your updated address will load from ClearBenefits
to the health insurance systems. Remember to
update Stanford You, the Stanford database, with
your current address. See the Updating Personal
Information During the Year section of this guide for
more information.
Legal Notices
Important Notice About Prescription Drug
Coverage and Medicare
Please read this notice carefully and keep it where
you can find it. This notice has information about
your current prescription drug coverage available
under the Postdoc medical plans and about
your options under Medicare’s prescription drug
coverage. This information can help you decide
whether or not you want to join a Medicare drug
plan. If you are considering joining, you should
compare your current coverage, including which
drugs are covered at what cost, with the coverage
and costs of the plans offering Medicare prescription
drug coverage in your area. Information about
where you can get help to make decisions about
your prescription drug coverage is at the end of this
notice.
HIPAA Privacy Notice
The Health Insurance Portability and Accountability
Act of 1996 (HIPAA), requires health plans to
protect the confidentiality of your private health
information. More detailed information is provided
in the health plans’ notice of HIPAA privacy. You
may request a copy of the notice by contacting the
Postdoc Benefits Office.
There are two important things you need to know
about your current coverage and Medicare’s
prescription drug coverage:
n
Women’s Health and Cancer Rights Act
If you have had or are going to have a mastectomy,
you may be entitled to certain benefits under the
Women’s Health and Cancer Rights Act of 1998
(WHCRA). For individuals receiving mastectomyrelated benefits, coverage will be provided in
a manner determined in consultation with the
attending physician and the patient, for:
nAll
stages of reconstruction of the breast on which
the mastectomy was performed;
nSurgery
and reconstruction of the other breast to
produce a symmetrical appearance;
nProstheses;
and
nTreatment
of physical complications of the
mastectomy, including lymphedema.
These benefits will be provided subject to the
same deductibles and coinsurance applicable
to other medical and surgical benefits provided
under the Stanford HealthCare Alliance and Blue
Shield of California PPO plans. If you have any
questions concerning this provision, please see the
Contacts section of this guide for information about
contacting your medical plan.
n
Medicare prescription drug coverage became
available in 2006 to everyone with Medicare.
You can get this coverage if you join a Medicare
Prescription Drug Plan or join a Medicare Advantage
Plan (like an HMO or PPO) that offers prescription
drug coverage. All Medicare drug plans provide at
least a standard level of coverage set by Medicare.
Some plans may also offer more coverage for a
higher monthly premium.
Stanford University has determined that the
prescription drug coverage offered under the
Postdoc medical plans are, on average for all
plan participants, expected to pay out as much as
standard Medicare prescription drug coverage pays
and is therefore considered Creditable Coverage.
Because your existing coverage is Creditable
Coverage, you can keep this coverage and not pay
a higher premium (a penalty) if you later decide to
join a Medicare drug plan.
When can you join a Medicare drug plan?
You can join a Medicare drug plan when you first
become eligible for Medicare and each year from
October 15th through December 7th.
https://benefits.stanford.edu/postdocs
29
Legal Notices
However, if you lose your current creditable
prescription drug coverage, through no fault of your
own, you will also be eligible for a two (2) month
Special Enrollment Period (SEP) to join a Medicare
drug plan.
What happens to your current coverage if you decide
to join a Medicare drug plan?
If you decide to join a Medicare drug plan, your
current medical coverage will not be affected. Your
current coverage pays for other health expenses
in addition to prescription drugs. If you enroll in
a Medicare prescription drug plan, you and your
eligible dependents will still be eligible to receive
all of your current health benefits. However, if you
have chosen Medicare as your primary health plan,
you will not be able to receive any benefits under
your current coverage.
More information about your options under
Medicare prescription drug coverage and more
detailed information about Medicare plans that offer
prescription drug coverage is in the “Medicare &
You” handbook. You’ll get a copy of the handbook
in the mail every year from Medicare. You may also
be contacted directly by Medicare drug plans.
For more information about Medicare prescription
drug coverage:
If you do decide to join a Medicare drug plan and
drop your current coverage, be aware that you
and your dependents will not be able to get this
coverage back until the January 1 following the next
annual Open Enrollment period.
n
When will you pay a higher premium (penalty) to join
a Medicare drug plan?
n
You should also know that if you drop or lose your
current coverage and don’t join a Medicare drug
plan within 63 continuous days after your current
coverage ends, you may pay a higher premium (a
penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without
creditable prescription drug coverage, your
monthly premium may go up by at least 1% of the
Medicare base beneficiary premium per month for
every month that you did not have that coverage.
For example, if you go nineteen months without
creditable coverage, your premium may consistently
be at least 19% higher than the Medicare base
beneficiary premium. You may have to pay this
higher premium (a penalty) as long as you have
Medicare prescription drug coverage. In addition,
you may have to wait until the following October to
join.
30
For more information about this notice or your
current prescription drug coverage, contact the
person listed below. NOTE: You’ll get this notice
each year. You will also get it before the next
period you can join a Medicare drug plan, and if this
Postdoc coverage changes. You also may request a
copy of this notice at any time.
n
Visit www.medicare.gov
Call your State Health Insurance Assistance
Program (see the inside back cover of your copy of
the “Medicare & You” handbook for their telephone
number) for personalized help
Call (800) MEDICARE ((800) 633-4227); TTY users
should call (877) 486-2048
If you have limited income and resources, extra help
paying for Medicare prescription drug coverage is
available. For information about this extra help,
visit Social Security on the web at
www.socialsecurity.gov, or call them at
(800) 772-1213 (TTY (800) 325-0778).
Remember: Keep this Creditable Coverage notice.
If you decide to join one of the Medicare drug plans,
you may be required to provide a copy of this notice
when you join to show whether or not you have
maintained creditable coverage and, therefore,
whether or not you are required to pay a higher
premium (a penalty).
Notice Date:
October 15, 2014
Name of Entity/Sender:Postdoc Benefits Office
Contact-Position/Office:Benefits Coordinator
Address:3160 Porter Drive
Suite 250
Palo Alto, CA 94304-8443
Phone Number:
(650) 724-9490
Legal Notices
Premium Assistance Under Medicaid and the
Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or
CHIP and you’re eligible for health coverage from
your employer, your state may have a premium
assistance program that can help pay for coverage,
using funds from their Medicaid or CHIP programs.
If you or your children aren’t eligible for Medicaid
or CHIP, you won’t be eligible for these premium
assistance programs but you may be able to buy
individual insurance coverage through the Health
Insurance Marketplace. For more information, visit
www.healthcare.gov.
If you or your dependents are already enrolled
in Medicaid or CHIP and you live in a state listed
below, contact your State Medicaid or CHIP office to
find out if premium assistance is available.
If you or your dependents are NOT currently
enrolled in Medicaid or CHIP, and you think you or
any of your dependents might be eligible for either
of these programs, contact your state Medicaid or
CHIP office or dial (877) KIDS-NOW or
www.insurekidsnow.gov to find out how to apply. If
you qualify, ask your state if it has a program that
might help you pay the premiums for an employersponsored plan.
If you or your dependents are eligible for premium
assistance under Medicaid or CHIP, as well as
eligible under your employer plan, your employer
must allow you to enroll in your employer plan if
you aren’t already enrolled. This is called a “special
enrollment” opportunity, and you must request
coverage within 60 days of being determined
eligible for premium assistance. If you have
questions about enrolling in your employer plan,
contact the Department of Labor at
www.askebsa.dol.gov or call (866) 444-EBSA (3272).
If you live in one of the following states, you may
be eligible for assistance paying your employer
health plan premiums. The following list of states
is current as of July 31, 2014. Contact your State for
more information on eligibility.
Alabama – Medicaid
Website: http://www.medicaid.alabama.gov
Phone: (855) 692-5447
Alaska – Medicaid
Website: http://health.hss.state.ak.us/dpa/programs/
medicaid/
Phone (Outside of Anchorage): (888) 318-8890
Phone (Anchorage): (907) 269-6529
Arizona – CHIP
Website: http://www.azahcccs.gov/applicants
Phone (Outside of Maricopa County): (877) 764-5437
Phone (Maricopa County): (602) 417-5437
Colorado – Medicaid
Medicaid Website: http://www.colorado.gov/
Medicaid Phone (In state): (800) 866-3513
Medicaid Phone (Out of state): (800) 221-3943
Florida – Medicaid
Website: https://www.flmedicaidtplrecovery.com/
Phone: (877) 357-3268
Georgia – Medicaid
Website: http://dch.georgia.gov/ - Click on Programs,
then Medicaid, then Health Insurance Premium
Payment (HIPP)
Phone: (800) 869-1150
Idaho – Medicaid
Medicaid Website: http://healthandwelfare.idaho.gov/
Medical/Medicaid/PremiumAssistance/tabid/1510/
Default.aspx
Medicaid Phone: (800) 926-2588
Indiana – Medicaid
Website: http://www.in.gov/fssa
Phone: (800) 889-9949
Iowa – Medicaid
Website: www.dhs.state.ia.us/hipp/
Phone: (888) 346-9562
Kansas – Medicaid
Website: http://www.kdheks.gov/hcf/
Phone: (800) 792-4884
Kentucky – Medicaid
Website: http://chfs.ky.gov/dms/default.htm
Phone: (800) 635-2570
Louisiana – Medicaid
Website: http://www.lahipp.dhh.louisiana.gov
Phone: (888) 695-2447
Maine – Medicaid
Website: http://www.maine.gov/dhhs/ofi/publicassistance/index.html
Phone: (800) 977-6740
TTY: (800) 977-6741
Massachusetts – Medicaid and CHIP
Website: http://www.mass.gov/MassHealth
Phone: (800) 462-1120
Minnesota – Medicaid
Website: http://www.dhs.state.mn.us/
(Click on Health Care, then Medical Assistance)
Phone: (800) 657-3629
Missouri – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/
pages/hipp.htm
Phone: (573) 751-2005
Montana – Medicaid
Website: http://medicaidprovider.hhs.mt.gov/
clientpages/clientindex.shtml
Phone: (800) 694-3084
Nebraska – Medicaid
Website: www.ACCESSNebraska.ne.gov
Phone: (855) 632-7633
https://benefits.stanford.edu/postdocs
31
Legal Notices
Nevada – Medicaid
Medicaid Website: http://dwss.nv.gov/
Medicaid Phone: (800) 992-0900
New Hampshire – Medicaid
Website: http://www.dhhs.nh.gov/oii/documents/
hippapp.pdf
Phone: (603) 271-5218
New Jersey – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/
humanservices/dmahs/clients/medicaid/
Medicaid Phone: (609) 631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: (800) 701-0710
New York – Medicaid
Website: http://www.nyhealth.gov/health_care/
medicaid/
Phone: (800) 541-2831
North Carolina – Medicaid
Website: http://www.ncdhhs.gov/dma
Phone: (919) 855-4100
North Dakota – Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/
medicaid/
Phone: (800) 755-2604
Oklahoma – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: (888) 365-3742
Oregon – Medicaid
Website: http://www.oregonhealthykids.gov and
http://www.hijossaludablesoregon.gov
Phone: (800) 699-9075
Pennsylvania – Medicaid
Website: http://www.dpw.state.pa.us/hipp
Phone: (800) 692-7462
Rhode Island – Medicaid
Website: www.ohhs.ri.gov
Phone: (401) 462-5300
South Carolina – Medicaid
Website: http://www.scdhhs.gov
Phone: (888) 549-0820
South Dakota - Medicaid
Website: http://dss.sd.gov
Phone: (888) 828-0059
Texas – Medicaid
Website: https://www.gethipptexas.com/
Phone: (800) 440-0493
Utah – Medicaid and CHIP
Website: http://health.utah.gov/upp
Phone: (866) 435-7414
Vermont– Medicaid
Website: http://www.greenmountaincare.org/
Phone: (800) 250-8427
Virginia – Medicaid and CHIP
Medicaid Website: http://www.coverva.org/programs_
premium_assistance.cfm
Medicaid Phone: (800) 432-5924
CHIP Website: http://www.coverva.org/programs_
premium_assistance.cfm
CHIP Phone: (855) 242-8282
Washington – Medicaid
Website: http://www.hca.wa.gov/medicaid/
premiumpymt/pages/index.aspx
Phone: (800) 562-3022 ext. 15473
32
West Virginia – Medicaid
Website: www.dhhr.wv.gov/bms/
Phone: (877) 598-5820, HMS Third Party Liability
Wisconsin – Medicaid
Website: http://www.badgercareplus.org/
pubs/p-10095.htm
Phone: (800) 362-3002
Wyoming – Medicaid
Website: http://health.wyo.gov/healthcarefin/
equalitycare
Phone: (307) 777-7531
To see if any other states have added a premium
assistance program since July 31, 2014, or for more
information on special enrollment rights, contact
either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
(866) 444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
(877) 267-2323, Menu Option 4, Ext. 61565
Genetic Information Nondiscrimination Act
Congress passed the Genetic Information
Nondiscrimination Act (GINA) establishing a
national and uniform standard to protect workers
from genetic discrimination. In addition to
prohibitions on discrimination in employment
practices, GINA prohibits group health insurers and
group health plans from adjusting premiums or
contributions based on genetic information. Also,
GINA amended the HIPAA privacy rules to include
genetic information in the definition of protected
health information.
Legal Notices
HIPAA Special Enrollment Rights
You have special enrollment rights if you acquire a
new dependent, or if you decline coverage under
the Stanford University Postdoctoral Scholar health
plan for yourself or an eligible dependent while
other coverage is in effect and later lose that other
coverage for certain qualifying reasons.
Loss of Other Coverage (Excluding Medicaid or a
State Children’s Health Insurance Program). If you
decline enrollment for yourself or for an eligible
dependent (including your spouse/registered
domestic partner) while other health insurance or
group health plan coverage is in effect, you may be
able to enroll yourself and your dependents if you
or your dependents lose eligibility for that other
coverage. However, you must request enrollment
within 30 days after your or your dependents’
other coverage ends (or after the employer stops
contributing toward the other coverage).
Loss of Coverage for Medicaid or a State Children’s
Health Insurance Program. If you decline
enrollment for yourself or for an eligible dependent
(including your spouse/registered domestic partner)
while Medicaid coverage or coverage under a state
children’s health insurance program is in effect, you
may be able to enroll yourself and your dependents
in this plan if you or your dependents lose eligibility
for that other coverage. However, you must request
enrollment within 60 days after your or your
dependents’ coverage ends under Medicaid or a
state children’s health insurance program.
New Dependent by Marriage, Birth, Adoption
or Placement for Adoption. If you have a new
dependent as a result of marriage, birth, adoption or
placement for adoption, you may be able to enroll
yourself and your new dependents. However, you
must request enrollment within 30 days after the
marriage, birth, adoption or placement for adoption.
Eligibility for Medicaid or a State Children’s Health
Insurance Program. If you or your dependents
(including your spouse/registered domestic partner)
become eligible for a state premium assistance
subsidy from Medicaid or through a state children’s
health insurance program with respect to coverage
under this plan, you may be able to enroll yourself
and your dependents in this plan. However, you
must request enrollment within 60 days after your
or your dependents’ determination of eligibility for
such assistance.
Summary of Benefits and Coverage
The Patient Protection and Affordable Care Act (also
known as the Health Care Reform law) requires that
you receive a Summary of Benefits and Coverage
(SBC). The SBC is designed to help you understand
and evaluate your health plan choices. To obtain
copies of the SBC for each of the Leland Stanford
Junior University-sponsored medical plans, please
visit the Postdoc Benefits Website at
https://benefits.stanford.edu/postdocs. Paper copies
are also available, free of charge, from the Postdoc
Benefits Office by calling (650) 724-9490.
https://benefits.stanford.edu/postdocs
33
Legal Notices
Health Insurance Marketplace Notice
Effective January 1, 2014, the Patient Protection
and Affordable Care Act (PPACA) – also known as
“Health Care Reform” – requires most Americans to
have health insurance. Individuals who do not have
coverage will be required to pay a penalty.
The Health Insurance Marketplace (“health
insurance exchange”) was created to ensure
that everyone has access to affordable health
insurance. The Marketplace is an option for
someone who does not have employer-provided
health coverage or for someone who chooses not
to enroll in employer-provided health coverage.
Because Stanford University offers a medical plan
that meets the specified affordable and minimum
value requirements under the PPACA, you are NOT
eligible for a subsidy through the Marketplace, even
if you choose not to enroll in a Stanford University
medical plan.
What is the individual mandate tax?
Under the PPACA, starting in 2014, most Americans
are required to have health insurance or pay
a penalty. If you elect coverage through Stanford
University, you will satisfy this requirement. For
more information about the individual mandate,
please visit: http://www.irs.gov/uac/Questions-andAnswers-on-the-Individual-Shared-ResponsibilityProvision.
What this means for you
n
n
If it is discovered that you are receiving a subsidy
when eligible for a Stanford University medical
plan, you will be responsible for refunding the full
amount of the subsidy to the Centers for Medicare &
Medicaid Services.
Why am I receiving this notice?
This notice provides you with information about the
Health Insurance Marketplace and where you can
access a website that contains more information
about health plans offered to you by either your
state or the U.S. Department of Health and Human
Services.
Stanford University is required to send the enclosed
notice to every Postdoc to comply with rules under
the federal PPACA.
What do I need to do?
You’re currently eligible to participate in a
Stanford University-sponsored medical plan. If
you participate in the medical plan, you and the
University share in the cost of your coverage. Your
share of the cost is paid with after-tax dollars.
If you choose not to participate in a Stanford
University medical plan and you buy insurance in
the Marketplace, you will be responsible for paying
the entire premium yourself with after-tax dollars.
34
n
Stanford University has you and your family
covered. As a benefits-eligible Postdoc, you
and your eligible dependents have access
to health care coverage through Stanford
University.
Our plans are affordable. You’ll hear about
new coverage options available in the
Health Insurance Marketplace, but in most
cases, Stanford University’s coverage will
continue to provide the greatest value.
And because our plans meet the federally
required “minimum value standards,” you
are NOT eligible for federal subsidies.
We’ll keep you updated. As we get updates,
we’ll provide resources and support to help
you understand the impact of Health Care
Reform and to feel confident about your
personal coverage decisions.
Questions?
Call (800) 318-2596;
TTY: (855) 889-4325
or visit www.healthcare.gov.
Contacts
Benefit Contacts and Resources
Group #
Stanford University Postdoc Benefits Office
Denise Livengood, Benefits Coordinator
Cecilia Avila, Disability Leave Coordinator
Phone
Website/Email
(650) 724-9490
(650) 724-5645
https://benefits.stanford.edu/postdocs
[email protected]
[email protected]
(650) 724-9490
https://stanford.clearbenefits.com
ClearBenefits Online Enrollment
Enrollment
Stanford You
Stanford Database
–
COBRA
BENU
P.O. Box 160
Temecula, CA 92593-0160
https://stanfordyou.stanford.edu
(888) 699-7755 (phone)
(866) 305-9622 (fax)
[email protected]
(855) 345-SHCA (7422)
(800) 873-3605
(877) 304-0504
(800) 541-6652
(800) 810-2583 (toll free)
(804) 673-1177 (collect)
(800) 443-5005
(866) 346-7200
http://stanfordhealthcarealliance.org
www.blueshieldca.com/stanfordpostdoc
(888) 886-4596
[email protected]
2843
(800) 765-6003
www.deltadentalins.com
12268985
(800) 877-7195
www.vsp.com
640844
(800) 368-2859
Medical
Stanford HealthCare Alliance
Blue Shield of California PPO
NurseHelp 24/7
Medical Prior Authorization
976247
977900
BlueCard Providers
Pharmacy Services Prior Authorization
Mail Service Pharmacy
Prenatal Education and Incentive
Program
Dental
Delta Dental PPO
Vision
Vision Service Plan (VSP)
www.bluecardworldwide.com
www.myprimemail.com
Disability
Standard Insurance Company
(STD & LTD)
Liberty Mutual (VDI)
(800) 896-9375
https://benefits.stanford.edu/postdocsshort-term-disability-stipend-paidpostdocs
https://benefits.stanford.edu/postdocsshort-term-disability-salary-paidpostdocs
Life and AD&D
Standard Insurance Company
640844
(800) 628-8600
[email protected]
(800) 527-0218
+1 (401) 453-6330
[email protected]
(855) 666-0519
www.guidanceresources.com
Organization Web ID: SUPDPAP
(650) 723-1831
(650) 723-4577
Travel Assistance Programs
UnitedHealthcare Global Basic Travel
Assistance
UnitedHealthcare Global Extended
Travel Assistance
9061
9061E
Postdoc Assistance Program (PAP)
ComPsych GuidanceResources
Other Resources
Bechtel International Center
Stanford Help Center
Payroll Office
Stanford ID Card Office
(650) 498-2273
www.stanford.edu/dept/icenter
http://helpcenter.stanford.edu
http://fingate.stanford.edu/
https://itservices.stanford.edu/service/
campuscard/cardoffice
Stanford Retirement Manager (TDA
Plan)
Stanford Physical Education &
Recreation
WorkLife Office
(888) 793-8733
www.netbenefits.com
(650) 724-9872
www.stanford.edu/dept/pe
(650) 723-2660
http://worklife.stanford.edu
(650) 961-5324
www.ssa.gov
(650) 363-2919
www.ssa.gov
Social Security
Mountain View Office
700 E. El Camino Real, Suite 350
Mountain View, CA 94040
Redwood City Office
601 Allerton St., 2nd Floor
Redwood City, CA 94063
35
Important Information About
Medicare Prescription Drug Coverage
If you (and/or your dependents) have Medicare
or will become eligible for Medicare in the
next 12 months, a federal law gives you more
choices about your prescription drug coverage.
Please refer to pages 29 – 30 for more details.
This guide provides a brief summary of the benefit plans in effect on January 1, 2015 generally offered to
appointed Postdocs of Leland Stanford Junior University. It is not a Summary Plan Description (SPD). However,
this guide serves as the “Summary of Material Modification” to the Postdoc benefit plans in accordance with
the requirements of the Employee Retirement Income Security Act of 1974, as amended (ERISA). If there is a
discrepancy between this guide and the applicable insurance contract, agreement, SPD, or plan document, the
applicable insurance contract, agreement, SPD or plan document will prevail.
Every effort is made to ensure this guide contains the most current information available. Please refer to the
date of publication below, and keep in mind a more current version may be available on the Postdoc Benefits
Website at https://benefits.stanford.edu/postdocs.
Stanford University reserves the right to change (including, but not limited to, the right to amend, suspend or
terminate) or make exceptions to its policies, procedures and benefit plans, or to change contributions at its
discretion at any time and without prior notice.
Postdoc Benefits Office
3160 Porter Drive, Suite 250
Palo Alto, CA 94304-8443
Phone: (650) 724-9490
Fax: (650) 723-7766
https://benefits.stanford.edu/postdocs
I M P R E S S C O M M U N I C AT I O N S I N C .
Revised 3-27-2015
PROPRIETARY FORMULAS