1. No category

Fred Turner
The Akiko Yamazaki and Jerry Yang University
Fellow in Undergraduate Education and
Associate Professor of Communication
2015
FACULTY
BENEFITS
SUMMARY
Effective January 1, 2015
Table of Contents
Who Is Eligible for Stanford Benefits?............................... 4
Commit to Your Health with BeWell@Stanford............ 21
What is My Contribution to My Health Plan?................... 7
Fitness and Healthy Living Classes
with Health Improvement Program (HIP)...................... 22
When Does Coverage Start?................................................ 8
What Happens if I Don’t Enroll?.......................................... 9
Medical Plans....................................................................... 10
Health Savings Account (HSA).......................................... 12
Prescription Drugs............................................................... 12
Mental Health and Substance Abuse.............................. 13
Dental Plans......................................................................... 14
Vision Care............................................................................ 15
Flexible Spending Accounts.............................................. 16
Life and Accident Insurance.............................................. 18
Disability (Wage Replacement)......................................... 19
Retirement Savings Plan.................................................... 20
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2015 Faculty Benefits Summary | benefits.stanford.edu
Tuition Grant Program (TGP)............................................ 23
Stanford WorkLife Office.................................................... 24
Unemployment Insurance................................................. 25
Workers’ Compensation.................................................... 25
Other Resources and Services.......................................... 26
Faculty Information Resources......................................... 27
2015 Benefits Plan Comparison Charts.......................... 28
2015 Dental Plan Comparison Charts............................. 34
Legal Notices........................................................................ 36
Contact Information........................................................... 44
Dear Faculty Member,
Stanford University is committed to providing you a comprehensive
benefits package from health, life and disability insurance to educational
assistance and work-life integration resources.
We understand that selecting benefits is an important process. In addition
to providing an overview of your benefits, this Faculty Benefits Summary
includes health plan comparison charts and other information to assist you
with selecting a plan that is the best fit for you and your family.
Whether you are new to Stanford or a current employee choosing to
change benefits during Open Enrollment, this guide is intended to help
you make educated choices so you get the most out of your Stanford
experience.
For updates or additional information regarding your benefits, visit the
Stanford Benefits website, http://benefits.stanford.edu.
In good health,
Stanford Benefits
benefits.stanford.edu | 2015 Faculty Benefits Summary
3
Dan Elison Azagury
Assistant Professor of Surgery (General Surgery),
Stanford University Medical Center,
wife Tatiana Maratchi
along with son Leo and daughter Olivia
Who Is Eligible for
Stanford Benefits?
You Are Eligible for Stanford
Benefits If You Are:
• Scheduled to work in a benefits-eligible
position for at least six months; and
• A full-time employee working between
75 and 100 percent time; or
• A part-time employee working between
50 and 74 percent time.
Your Eligible Family Members
Are Your:
• Spouse, same or opposite sex, if not
legally separated
• Registered domestic partner
• Children to age 26
»» Natural children
»» Stepchildren
»» Legally adopted children
»» Children for whom you are the
legal guardian
»» Foster children
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2015 Faculty Benefits Summary | benefits.stanford.edu
»» Children placed with you for adoption
»» Children of your registered domestic
partner who depend on you for support
and live with you in a regular parent/
child relationship
»» Unmarried children for whom you are
legally responsible to provide health
coverage under the terms of a Qualified
Medical Child Support Order (QMCSO)
• Unmarried children over the age limit if:
»» Dependent on you for primary financial
support and maintenance due to a
physical or mental disability;* incapable
of self-support; and
»» The disability existed before reaching
age 19.
* You may be asked to provide documentation or
proof of disability to your medical plan provider for
review and approval of continued coverage. In most
cases, coverage for a disabled child can continue
as long as the child is incapable of self-support,
unmarried and fully dependent on you for support.
WHO IS ELIGIBLE FOR STANFORD BENEFITS?
Does Your Spouse/Registered Domestic Partner Work at Stanford?
You may not elect coverage as an employee and also receive coverage
as the dependent of another Stanford employee or retiree. Only one
university-employed parent may cover eligible dependent children.
YOUR SAME-SEX
SPOUSE
YOUR REGISTERED DOMESTIC PARTNER
You may cover your same-sex
is registered with the State of California. You do not have to live in
spouse under your Stanford
benefits if you married in a
state that recognizes same-sex
marriage. To receive the benefit
of pre-tax deductions, you must
reside in a state that recognizes
same-sex marriage.
You may cover your registered domestic partner if your partnership
California to register with the state. Visit the California Domestic
Partners Registry at www.ss.ca.gov/dpregistry for information
about domestic partnership in California.
You may register your domestic partner if you share a common
residence and your domestic partner is:
• Age 18 or older
• A member of your household for the coverage period
• Not related to you in any way that would prohibit
legal marriage
• Not legally married to anyone else or the same-sex
domestic partner of anyone else
benefits.stanford.edu | 2015 Faculty Benefits Summary
5
When May I Change
My Benefits Elections?
Changes to your benefits elections are
allowed during the Open Enrollment
period and when a Life Event occurs.
Kathryn Ann Moler
Professor of Applied Physics
and Ai Leen Koh, Research Scientist
Open Enrollment
The annual Open Enrollment period is an opportunity
for employees to change their health care elections,
add or drop eligible dependents from coverage or
re-elect flexible spending accounts.
Life Events
Certain events in your life allow you to make
election changes without the need to wait for
Open Enrollment. Examples of a life event include
the following:
• Job status (job change for you, your
spouse/domestic partner)
• Family (marriage, divorce, birth/
adoption of a baby)
Additional information regarding the types of Life
Events and the changes you can make to your
benefits is included in the Life Events section of the
Benefits website, http://benefits.stanford.edu.
Adding Dependents to
Your Benefits
Stanford University requires proof of dependent
eligibility for the dependents you cover. For a list of
acceptable documentation, view the Dependent
Eligibility Documentation Requirements,
available on the Stanford Benefits website at
http://benefits.stanford.edu.
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2015 Faculty Benefits Summary | benefits.stanford.edu
Why Must I Provide
My Dependent’s Social
Security Number?
When you add a new dependent, you will be
prompted to include their social security number.
Centers for Medicare and Medicaid Services (CMS),
the agency that monitors the claims collections
from employers for Medicare, requires all employers
to provide the social security number of any
employee and dependent covered through an
employer-sponsored medical plan. CMS uses this
to cross-reference any Medicare participant who
also has coverage through an employer.
30 DAYS
You have 30 days from the date you added
your dependent to fax the documentation to
Stanford Benefits at 973-837-3330 or mail to:
Stanford Benefits
P.O. Box 199747
Dallas, TX 75219-9747
Please include your Stanford University ID
number on each document you submit.
What Is My Contribution to My Health Plan?
Stanford University pays for the majority of the cost of your
health and wellness benefits. Your individual contribution
is the amount that the university does not cover.
Stanford-Provided Benefits—
You Pay Nothing!
Stanford is one of the few employers in the Bay
Area that still offer an employee health plan that
is 100 percent employer-paid. Stanford covers the
costs for the following benefits:
• Employee-only coverage under the
lowest-cost medical plans (for full-time
employees only)
• Delta Dental Basic PPO dental coverage
for you and your eligible dependents
(full-time employees only)
• Employee-only basic life insurance
• Employee-only long-term
disability insurance
• Business Travel Accident (BTA) insurance
Employee Shared- and
Full-Cost Benefits
If you do not select one of the lowest-cost medical
plans, you pay the difference between what Stanford
pays for the lowest-cost plan and the cost of the plan
you select. You and Stanford also share the cost of
covering your dependents in the medical plans.
There are other benefits for which Stanford pays
the majority of the cost, and benefits for which you
pay the full cost. These include:
• Dependent coverage in the
lowest-cost plan
• Coverage in a medical plan that is
not the lowest-cost plan (You pay
the difference in the cost between
the lowest-cost plan and the plan
you select.)
• The Delta Dental Enhanced PPO dental
plan (You pay the difference in cost
between this plan and the Delta Dental
Basic PPO plan.)
• Accidental Death & Dismemberment
(AD&D) insurance for you and your
eligible dependents
• Flexible Spending Accounts (FSAs) for
health care and dependent day care
(unless you receive a Child Care
Subsidy Grant)
• Supplemental Life Insurance
• Dependent Life Insurance for your
spouse/registered domestic partner
and children
• Long-Term Care Insurance for you, your
spouse/registered domestic partner and
certain other family members
benefits.stanford.edu | 2015 Faculty Benefits Summary
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When Does Coverage Start?
The date your coverage starts depends on the plan, when you enroll and, in
some cases, the amount of coverage you select.
If you are an existing employee, changes you make during
Open Enrollment take effect January 1, 2015.
If you are a new hire, coverage under most plans starts on
your date of hire, with the exception of the following:
• If you elect more than three-times salary for Supplemental
Life Insurance for yourself and more than $25,000 for
your spouse/ partner for Supplemental Dependent Life
Insurance, coverage starts after Evidence of Insurability
(EOI) is submitted to, reviewed and approved by the
insurance company. See page 18 for more information
on life insurance and an explanation of EOI.
• Long-Term Care Insurance begins the date your
application is approved by CNA.
• The medical, dental and vision plans have no pre-existing
condition exclusions. This means you are covered for any
eligible condition as soon as your coverage starts.
• Coverage for enrolled dependents begins on the date of
the qualified Life Event (job, family or personal change)
if you provide the appropriate Dependent Eligibility
Documentation within 30 days of the date you make
your benefits elections. Generally, the date of the event
is the date your coverage starts, with the exception of
the following:
»» Increases to your Flexible Spending Accounts
election are not retroactive. An increase will cover
claims you incur starting from the date of the change.
»» Any increase in Supplemental Life Insurance and
Supplemental Dependent Life Insurance will require
you to submit EOI, and coverage starts after it is
submitted to, and reviewed and approved by the
insurance company.
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2015 Faculty Benefits Summary | benefits.stanford.edu
NEED MEDICAL SERVICES
BEFORE YOU RECEIVE
YOUR ID CARD?
If you made no changes to your medical
plan election for Open Enrollment, simply
use your current medical ID card.
If you changed elections for 2015 during
Open Enrollment, your ID card should be
sent to you by the end of the 2014 calendar
year. If you have not received it and need
medical care on or after January 1, 2015,
print a copy of your Confirmation Statement
as proof of coverage until you receive your
new ID card.
Your doctor’s office or pharmacy may also
verify coverage by calling us at 877-905-2985
or 650-736-2985 (Monday through Friday
from 7 a.m. to 5 p.m. PST), and pressing
option 9. If you need a prescription filled
while waiting for your ID card, you might have
to pay the full cost and then submit a claim
to your medical plan for reimbursement.
What Happens If I Don’t Enroll?
Initial Enrollment As a New Hire
As a new hire, if you do not elect benefits within the
31 days of your date of hire, you’ll receive default
coverage. Default coverage is assigned only to
you and does not include your spouse/registered
domestic partner or your dependents.
Full-Time Employees
If you work 75 to 100 percent time and do not
enroll within 31 days of your hire date, you receive
the following default coverage:
• Blue Shield High-Deductible
Health Plan (HDHP)
• Delta Dental Basic PPO
unless you have a Life Event change. Find more
information on Life Event changes on the Benefits
website at http://benefits.stanford.edu.
WAIVING MEDICAL COVERAGE
If you are a full-time employee and have medical
or dental coverage elsewhere, you must log on to
MyBenefits and actively waive coverage.
If you waive your medical coverage, you will
receive a $25 credit (if you work in a full-time,
benefits-eligible position) or a $12.50 credit (if
you work in a part-time, benefits eligible position)
provided as taxable income in each paycheck.
• Basic Life Insurance
• Long-Term Disability (LTD)
• Business Travel Accident (BTA) insurance
Part-Time Employees and
VA Doctors
If you are a part-time employee working between
50 and 74 percent time, or are a VA doctor, you will
be assigned:
• Basic Life Insurance
• Long-Term Disability (LTD)
• Business Travel Accident (BTA) insurance
You will not have medical or dental coverage.
However, you will receive a $12.50 credit for waived
medical in your paycheck. You will also not have
the opportunity to change your assigned default
coverage or enroll in any other health and life
benefits until the next Open Enrollment period,
Annual Open Enrollment for
Existing Employees
If you are an existing Stanford employee (not a new
hire) and you don’t make your benefits elections
by the end of the Open Enrollment period, your
benefits elections from the prior year will roll over
automatically, with the exception of the following:
• Health care and/or a dependent day
care Flexible Spending Account.
• Child Care Subsidy Grant if one had
been awarded to you.
• Health Savings Account (HSA). You must
re-enroll in the HSA to contribute money
and receive contributions from Stanford.
If you do not re-enroll, your election
will default to waive participation in the
HSA. (Note: You may enroll in the HSA
and elect $0.00 employee contributions
to receive the employer contribution
provided by the university.)
benefits.stanford.edu | 2015 Faculty Benefits Summary
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Medical Plans
Stanford offers a variety of medical insurance plans, all of which
provide coverage for pre-existing conditions, prescription drugs, and mental
health and substance abuse. Choosing and personalizing your benefits
depends on your specific health care needs, doctor preferences, budget
and the type of plan you prefer.
Stanford HealthCare Alliance (SHCA)
Stanford HealthCare Alliance (SHCA) is a select
network health plan in which Stanford Health Care
physicians and affiliated providers in multiple
specialties take responsibility for working together
to carefully coordinate and deliver your care. SHCA
features an expanded network of primary and
specialty care physicians who are affiliated with
Stanford Health Care and Stanford Children’s Health
to allow for seamless coordination of the high-quality
care you expect from this world-class institution.
Your SHCA Member Care Services team provides
personalized assistance to you in scheduling
appointments, selecting physicians, navigating
your care experience and answering all claims and
billing issues. SHCA covers your expenses only if
you go to an SHCA network doctor and/or facility
except for an urgent or life-threatening emergency.
With Stanford HealthCare Alliance, you:
• Have no deductible
• Have no claims to file
• Pay a fixed copay for each office visit,
emergency room visit and hospital stay
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2015 Faculty Benefits Summary | benefits.stanford.edu
You are encouraged to select a primary care
physician (PCP) to coordinate and provide all of
your primary care. If you need to see a specialist,
you should coordinate the referral with your
Stanford HealthCare Alliance PCP.
To enroll in the Stanford HealthCare Alliance you
must live within the service area (based on your
home zip code).
Kaiser Permanente (HMO)
Kaiser Permanente is a Health Maintenance
Organization (HMO) that provides patient services,
hospitalization, supplies and prescription drugs
through its own network of doctors, hospitals and
other Kaiser-affiliated health care facilities. Kaiser
covers your expenses only if you go to a Kaiser
provider or facility. You are also covered if you have
a life-threatening emergency when you are outside
a Kaiser service area.
When you enroll in Kaiser, you may select a primary
care physician (PCP) to manage your care using
Kaiser’s network of physicians and facilities. Most
likely, you’ll need approval from your PCP before
seeing a specialist.
MEDICAL PLANS
Kaiser offers cost-effective managed care and
places a strong emphasis on wellness and
preventive care. With Kaiser, you:
• Have no deductible
• Have no claims to file
• Pay a fixed copay for each office visit,
emergency room visit and hospital stay
To enroll in Kaiser, you must live within a Kaiser
service area (based on your home ZIP code).
Blue Shield Exclusive Provider
Organization (EPO)
The EPO is similar to an HMO because you must
use the physicians and facilities within the EPO
network, unless you have a life-threatening
emergency. When you see a provider in the EPO’s
network, there are no deductibles or claims to file.
You pay a fixed copayment for each office visit,
emergency room visit and hospital stay. If you go
to a doctor or hospital outside the EPO’s network,
you pay the full cost for the care you receive. With
the EPO, you do not need to select a primary care
physician. You may go to any doctor, specialist or
hospital within the network.
Blue Shield Preferred Provider
Organization (PPO)
A PPO provides you with the flexibility to go to the
provider or medical facility of your choice—even if
your provider or the facility is not in the Blue Shield
network. If you see providers and go to facilities
within the Blue Shield network, however, your outof-pocket costs are much lower than if you go out
of network for your care.
• In network: You pay a deductible,
and then, the plan pays 80 percent of
covered costs. You do not have to file
a claim—your provider will submit it to
Blue Shield for you. For routine office
visits, you pay $20 for each visit ($50 for
a specialist). Preventive care is provided
at no charge.
• Out of network: Your annual deductible is
larger. The plan pays 60 percent of covered
costs (based on Blue Shield’s allowed
amount), and you must file a claim to be
reimbursed for out-of-pocket costs. You
are also responsible for any remaining
amounts that Blue Shield does not pay.
Blue Shield High-Deductible
Health Plan (HDHP)
The Blue Shield High-Deductible Health Plan
(HDHP) works the same as the Blue Shield PPO
plan, but there are no fixed copays with this plan.
Instead, all benefits—including prescription
drugs—are covered after you meet your deductible.
(A family deductible applies to claims for all family
members until it is met. There is no individual
limit for each covered family member.) This is the
only plan available through Stanford that works in
conjunction with a Health Savings Account.
• In network: After you have paid the
deductible, the plan pays 80 percent of
covered costs (the amount Blue Shield
will pay for a specific service). You do not
have to file a claim, as your provider will
submit the claims to Blue Shield for you.
Preventive care is provided at no charge.
• Out of network: Your annual deductible
is the same as your in-network deductible.
The plan pays 60 percent of covered
costs (based on Blue Shield’s allowed
amount), and you must file a claim for
reimbursement of out-of-pocket costs.
You are also responsible for any remaining
amounts that Blue Shield does not pay.
Remember: Preventive care is not
covered if obtained out of network.
benefits.stanford.edu | 2015 Faculty Benefits Summary
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Health Savings
Account (HSA)
If you are interested in setting aside tax-deductible
dollars for future health care expenses through
a Health Savings Account (HSA) you must be
enrolled in the Blue Shield High-Deductible Health
Plan (HDHP). Note: If you have an HSA, you cannot
also have a health care Flexible Spending Account.
In 2015, the HSA limit (the amount you contribute)
is $3,350 for employee only, and $6,650 for
employee + dependents.
Because of the tax savings and flexibility to
reimburse yourself for medical expenses, an HSA is
worth considering. You may even set up your HSA
with Blue Shield’s financial partner, HealthEquity,
at the same time you elect coverage in the HDHP.
If you have questions about how HSAs work with
your HDHP, visit http://www.healthequity.net/
stanford, or call HealthEquity at 877-857-6810.
If you are enrolled in the HDHP, you may set up
an HSA directly with HealthEquity or through a
financial institution of your choice. There are two
advantages in choosing HealthEquity:
• You may fund your HSA through
payroll deductions.
• Stanford contributes to your HSA
($300 for employee only and $600
for employee + family). Note: These
amounts are for employees who set up
their account(s) with HealthEquity after
electing the High-Deductible Health
Plan through MyBenefits. If you enroll
any time after January 1, the amount
Stanford contributes will be prorated
based on the number of pay periods
remaining in the calendar year after
you set up your account.
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2015 Faculty Benefits Summary | benefits.stanford.edu
Prescription Drugs
Your medical plan provides prescription drug
coverage, so be sure to take your ID card when
you have a prescription filled. In 2015, all five
health plans will cover prescriptions at 100%
once the out-of-pocket maximum is met. The
High-Deductible Health Plan (HDHP) requires you
to pay 20 percent of the cost for all prescription
drugs after you have satisfied the deductible. If
you fill your prescriptions at a Blue Shield network
pharmacy, your costs are lower. You can find a list
of these pharmacies on the Blue Shield website at
https://www.blueshieldca.com.
For all other plans, the cost of your prescription
depends on whether or not it can be dispensed in
its generic form and if it is included in your plan’s
list of approved drugs (known as a formulary).
MEDICARE AND HSA
When you reach age 65, you must defer coverage
under Medicare Parts A and B to continue to
contribute to the HSA. If you have enrolled in
Medicare Parts A and B, you are no longer eligible
to contribute to the HSA. However, you will still
have access to any monies in your HSA account.
Once you become Medicare eligible, your HSA
contributions will automatically stop. If you
are not enrolled in the Medicare Parts A and B
and want to continue the HSA, you will need
to contact the Benefits Service Center to have
them re-enroll you.
Mental Health and Substance Abuse
Mental health and substance abuse treatment are covered
by your medical plan. For details, contact your plan or see
the comparison chart at the back of this booklet.
New Non-Network Mental Health Coverage for 2015
The allowed amount for non-network outpatient services (psychologists, therapists, counselors, etc.)
has changed for employees who elect a Blue Shield EPO, PPO, High-Deductible Health Plan (HDHP) or
Stanford HealthCare Alliance. Below are details on the non-network service changes:
PLAN
2014 NON-NETWORK
COVERAGE
2015 NON-NETWORK COVERAGE
Blue Shield EPO
Did not cover nonnetwork services.
80% of up to $300 in allowed charges for professional services
will be covered per visit, for a maximum benefit of $240.*
Blue Shield PPO
60% of non-network
services were covered
after deductible.
80% of up to $300 in allowed charges for professional services
will be covered per visit, for a maximum benefit of $240*.
Blue Shield High
Deductible Health
Plan (HDHP)
60% of non-network
services were covered
after deductible.
80% of up to $300 in allowed charges for professional services
will be covered per visit, for a maximum benefit of $240*.
Stanford HealthCare
Alliance (SHCA)
Did not cover nonnetwork services.
80% of up to $300 in allowed charges for professional services
will be covered per visit, for a maximum benefit of $240*.
For all other services, 60% of allowed charges will be covered.
For all other services, 60% of allowed charges will be covered.
* Example, if bill charge is $350, 80% of $300 will be covered. 80% x $300 = $240.
Faculty Staff Help Center
Stanford’s Faculty Staff Help Center provides up to
10 sessions of professional, confidential, short-term
counseling and consultation services free of charge to
Stanford employees, retirees and their dependents.
You can learn more about the service at
http://helpcenter.stanford.edu.
FACULTY STAFF HELP
CENTER HAS MOVED!
The Faculty Staff Help Center’s main office
has relocated from the Mariposa House to
the Keck Science Building (380 Roth Way).
benefits.stanford.edu | 2015 Faculty Benefits Summary
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Dental Plans
Dr. Kari C. Nadeau
Associate Professor of Pediatrics,
Allergy & Immunology,
School of Medicine
Good dental care can affect your overall health and wellness. In addition
to coverage for basic and major services, Stanford’s coverage includes
diagnostic and preventive checkups and cleanings.
Stanford offers comprehensive dental benefits through Delta Dental’s network of dentists with two plans:
Delta Dental Basic PPO
Delta Dental Enhanced PPO
Stanford covers the entire cost of this plan for
full-time employees. The Basic PPO plan does
not include orthodontic treatment and coverage
for implants.
This plan requires an employee contribution
but provides a higher level of coverage for some
services when you use Delta Dental PPO providers.
The Enhanced PPO plan includes orthodontic
treatment and coverage for implants.
Note: If you waive dental coverage at any time, you will not be able to enroll in a dental plan for two years
unless you have a Life Event change.
You may view more details about Stanford’s dental coverage in the comparison chart located at the back
of this Faculty Benefits Summary or visit the Benefits website at http://benefits.stanford.edu.
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2015 Faculty Benefits Summary | benefits.stanford.edu
Vision Care
Abbas Milani
Hoover Institute Research Fellow and
The Hamid and Christina Moghadam
Director of Iranian Studies Department
Vision Service Provider (VSP) is an employee-based benefit that provides
vision care through its Signature Choice network of providers. For a
provider in your area, call VSP or go to the VSP website at http://vsp.com.
You can find VSP contact information in the Contacts section of the
Stanford Benefits website at http://benefits.stanford.edu.
VISION CARE
COVERAGE
COST WHEN USING
A VSP PROVIDER
Eye Exam
Once every calendar year
$25 copay
Lenses
Once every calendar year*
(includes basic and bifocals)
Plan pays 100%
Frames
Once every calendar year
Plan pays 100%
up to $150 retail value
Once every calendar year in lieu of
frames and lenses
Contact Lenses
Extras
• Medically necessary
Plan pays 100%
• Elective (fitting and materials)
Plan pays 100% up to $150
Including scratch-resistant lenses,
anti-reflective lenses, additional
prescription glasses or sunglasses
Discount through your
VSP provider
* $40 copay for progressive lenses
benefits.stanford.edu | 2015 Faculty Benefits Summary
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Christian Linder
Assistant Professor of
Civil and Environmental
Engineering
Flexible Spending Accounts
Flexible Spending Accounts (FSA) allow you to set aside before-tax money to
pay for certain health care expenses including deductibles, copayments, certain
services not covered by your health plan and dependent day care expenses.
Here’s how they work: you authorize contributions
to be taken out of your paycheck before taxes are
calculated. You pay your provider and file a claim
for reimbursement. You then get reimbursed with
the before-tax dollars in your spending account.
Note: Whether you are newly electing an FSA or if
you had an FSA in 2014, Stanford’s vendor, Benesyst
(a TASC Company), will send you a debit MasterCard
for the 2015 year. The debit Visa card distributed
in 2014 will not be accepted effective January 1, 2015.
The debit MasterCard will have your 2015 FSA
election loaded on it and may only be used in the
plan year the expenses were incurred.
Two Types of Flexible
Spending Accounts
Health Care FSA
You may use this account to pay for medical and
dental copayments, deductibles, prescription
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2015 Faculty Benefits Summary | benefits.stanford.edu
eyeglasses or contact lens expenses not covered by
VSP or your medical plan, orthodontia, and certain
over-the counter medications. The IRS limit for
the amount of pre-tax money that employees may
contribute to their health care FSA in 2015 is $2,500.
This spending account includes a debit card for
your convenience.
When you use your FSA debit card for eligible
expenses at a participating pharmacy or doctor,
the provider is immediately reimbursed the full
amount from your account. Please note that the
IRS requires proof of payment on some claims. Be
sure to save all itemized receipts when using your
FSA debit card.
You may be asked for a copy of your receipts to
prove your purchase (called substantiation).
You may also submit claims electronically, or by
mail or fax. Please include an itemized receipt or
Explanation of Benefits with the claim form. Some
FLEXIBLE SPENDING ACCOUNTS
services may require a letter of medical necessity
to certify that the expense is necessary to treat a
medical condition.
When you elect a health care FSA, you may submit
expenses for yourself and your eligible dependents,
even if you are not covering your dependents under
your medical, dental or vision plans. If you increase
the amount of your health care spending account
during the calendar year due to a Life Event change,
the amount of the increase is effective as of the
date of the increase. The increased amount is not
retroactive and will not cover claims incurred prior
to the effective date of your increase.
Note: The debit card may only be used in the plan
year the expenses were incurred.
Dependent Day Care FSA
You may use this account to pay non-medical
day care expenses for your eligible dependent
children up to age 13, elder dependents and
disabled dependents. (You may only pay for your
dependents’ health care expenses through a health
care FSA.) The IRS limit for pre-tax contributions
to your dependent care FSA in 2015 is $5,000
per household. If you received a CCSG grant, the
amount will be included in your total dependent
care FSA annual amount. The combined total
cannot exceed the $5,000 annual limit. When
you file a claim for reimbursement, you can only
be reimbursed up to the amount that is in your
account at the time you submit a claim.
For more information on how these plans work and which expenses are eligible, visit the
Stanford Benefits website at http://benefits.stanford.edu, and click on the “Medical &
Life” section and then the “Flexible Spending Accounts” section.
NEW IN 2015: $500 CARRYOVER FOR HEALTH CARE FSA
An Internal Revenue Service (IRS) change to the health care Flexible Spending
Account (FSA) modifies the “use it or lose it” rule and allows participating active
employees to carry over up to $500 in unused funds from one year to the next.
Stanford University will be implementing the new carryover provision for 2015, which
means you will be able to defer up to $500 of unused funds from your 2014 health care
FSA into your 2015 health care FSA. (The $500 carryover is in addition to the $2,500
annual contribution limit for the 2015 year.) Any 2014 FSA monies over $500 will be
forfeited. The carryover funds may be accessed starting May 1, 2015, once all 2014 FSA
expenses have been reimbursed. For more information on the FSA carryover or for a
list of FAQs, visit the Stanford Benefits website at http://benefits.stanford.edu.
benefits.stanford.edu | 2015 Faculty Benefits Summary
17
Life and Accident Insurance
Basic Life Insurance
Stanford automatically provides insurance
coverage in an amount equal to your annual
appointment salary (up to a $50,000 maximum).
Supplemental Life Insurance
for Yourself
You may purchase additional coverage from one to
eight times your salary, up to a $1.5 million maximum.
Newly hired employees must complete an online
Evidence of Insurability (EOI) form for coverage
levels above three-times salary. For existing
employees, any increase in your coverage amount
requires EOI. You must be actively at work to apply
for or increase coverage.
Supplemental Life Insurance
for Your Spouse/Registered
Domestic Partner
You may purchase coverage up to 50 percent
of your total coverage (combined Basic and
Supplemental) or $250,000, whichever is less.
For newly hired employees, coverage more
than $25,000 requires your spouse or partner to
complete EOI. For existing employees, any increase
in this benefit requires EOI.
Supplemental Life Insurance for
Your Dependent Child(ren)
You may purchase coverage for your dependent
children in amounts of $5,000, $10,000 or $25,000
(up to 50 percent of your total coverage). One
policy covers each of your dependent children for
the same amount.
18
2015 Faculty Benefits Summary | benefits.stanford.edu
Accidental Death &
Dismemberment Insurance
(AD&D)
AD&D insurance provides protection to you or your
beneficiaries if you die or are seriously injured in an
accident. It does not cover a death resulting from
illness or natural causes. See the AD&D Insurance
Summary on the Stanford Benefits website at
http://benefits.stanford.edu for information on
how this plan works.
You may purchase AD&D insurance from one to
eight times your salary, up to $1.5 million. You
may also purchase AD&D insurance for your
spouse/registered domestic partner and/or
your dependent child(ren). The coverage levels
are similar to the Supplemental Dependent Life
Insurance plan. To enroll your dependents, you
must have coverage for yourself equal to or greater
than their coverage. You must be actively at work to
apply for or increase coverage.
Business Travel Accident Insurance
Stanford provides you with Business Travel
Accident Insurance in case you are accidentally
injured or die during an official university business
trip. Enrollment is automatic, and Stanford pays
the full cost of coverage.
EVIDENCE OF INSURABILITY
Depending on the amount of supplemental life
insurance you purchase, you may be required to
provide Evidence of Insurability (EOI), also known
as “proof of good health.” If the amount you request
requires EOI, you will be prompted to complete an
online EOI short form as part of the enrollment process.
Disability (Wage Replacement)
Voluntary Short-Term
(Non-Work Related)
Disability Insurance
Stanford automatically enrolls you in a shortterm disability plan, called Voluntary Disability
Insurance (VDI). The plan pays 60 percent of your
appointment salary, up to a certain maximum.
Generally, coverage begins on the eighth day of
your disability or on the first day of hospitalization.
You pay the cost of this coverage. You may choose
to reject automatic enrollment in Stanford’s VDI
plan and instead enroll in California State Disability
Insurance (SDI). You must complete a VDI Rejection
Notice and submit it to the Payroll Department.
You may always return to the VDI plan as long as
you complete an SDI Rejection Notice and submit
it to the Payroll Department. For more information
on SDI, visit California’s Employment Development
Department website.
Long-Term Disability (LTD)
As part of your benefits, Stanford provides LongTerm Disability (LTD) coverage that pays you a
monthly benefit if you meet the plan guidelines.
Enrollment is automatic, and Stanford pays the full
cost of coverage.
Once you qualify, the plan provides a benefit of
66 2/3 percent of your monthly appointment salary.
This amount may be reduced by payments you receive
from other sources, such as Workers’ Compensation or
Voluntary Short-Term Disability Insurance.
Long-Term Care (LTC) Insurance
LTC insurance is an optional, after-tax benefit that helps
pay many of the day-to-day expenses for nursing home
and in-home care not generally covered by medical or
disability plans. LTC insurance is provided through CNA.
NEW in 2015
In addition to enrollment and customer service, CNA
will take over direct billing for all long-term care
insurance coverage, starting in 2015. Those that were
enrolled in LTC insurance in 2014 will receive direct
billing information from CNA in late October. Please note
that Stanford’s last payroll deduction will be December
22; employees enrolled in LTC insurance coverage will
receive a direct bill from CNA in late January.
LTC insurance is available to you, your spouse/
registered domestic partner, parents, grandparents,
and the parents and grandparents of your spouse/
registered domestic partner. You must be actively
at work to apply for or increase coverage.
You can apply for coverage at any time, but if you apply
for yourself within the 31-day new hire enrollment
period, you do not have to complete Evidence of
Insurability (EOI) and coverage is guaranteed. If you apply
at a later time, you are required to complete EOI and
coverage is not guaranteed.
Your eligible dependents or family members may
also apply at any time, but must complete EOI and
coverage is not guaranteed.
You may find more information about disability
insurance and long-term care insurance on the
Stanford Benefits website at http://benefits.
stanford.edu under the “Medical & Life” section.
benefits.stanford.edu | 2015 Faculty Benefits Summary
19
Dr. Laurence C. Baker
Professor of Health Research and Policy;
Stanford Health Policy Fellow
Retirement Savings Plan
Participating in a retirement savings plan is one of the best things you can do
to save for your future.
• Start immediately: Start saving for
retirement after your first paycheck.
You decide how much you want
to contribute to the plan, and the
deduction is automatically taken out
of your paycheck.
• Maximize your dollars: Your contributions
come out of your paycheck before
federal and state taxes are taken out.
This reduces your taxable income, and
you pay less in taxes.
The Stanford Contributory Retirement Plan
(SCRP) offers a variety of investment options and
allows you to make before-tax contributions from
your paycheck directly to a savings account. At the
end of your first year of service, Stanford rewards
you with a Basic Contribution to a retirement
account based on your salary and years of service.
You receive this money from Stanford even if you
do not make contributions to the plan out of your
own paycheck. If you do decide to contribute
money toward your retirement out of your
20
2015 Faculty Benefits Summary | benefits.stanford.edu
paycheck, you become eligible for Stanford’s
Match Contribution—up to an additional five
percent of your earnings each pay period. Over
time, your contributions and Stanford’s Basic and
Match Contributions, may add up to significant
retirement savings.
You are always fully vested in both the contributions
you make and those you receive from Stanford.
Visit the Stanford Benefits website at
http://benefits.stanford.edu to learn more
about Stanford’s retirement savings plan and to:
• See the plan details in the Summary
Plan Description (SPD).
• Use the Before-Tax Calculator
to help you determine your
maximum contribution.
• Schedule a free financial counseling
appointment with a representative from
Fidelity, Vanguard or TIAA-CREF.
Commit to Your Health with BeWell@Stanford
The BeWell@Stanford employee incentive program encourages benefitseligible employees and their spouses/registered domestic partners to
adopt (or maintain) healthy lifestyle behaviors. By committing to health and
wellness, employees not only feel better, but also earn rewards!
In 2015, benefits-eligible employees can earn up
to $580 in a taxable incentive for completing The
Stanford Health and Lifestyle Assessment (SHALA)
and the following activities by November 30:
1. Wellness Profile ($480)*
This includes health screenings,
advising session, online plan and
advisor-endorsed action.
2. Six BeWell Berries ($100)
Berries are health-related activities that help
employees put wellness goals into action.
Choose from a variety of Berry options,
including exercise classes, fitness assessments,
stress workshops and self-reported activity.
* In addition to completing the steps above, BeWell
participants must also be enrolled in a Stanfordsponsored medical plan in 2015 and agree to share
their SHALA and health screening information in
order to receive the maximum employee incentive.
Participants who choose not to share information
nor enroll in a Stanford-sponsored medical plan are
still eligible to receive a $200 taxable incentive. Your Spouse or Partner Can
Benefit, Too!
A spouse or registered domestic partner of a BeWell
participant may earn a $240 taxable incentive if he or
she completes the SHALA and Wellness Profile, agrees
to share the results of these screenings and is enrolled
in a Stanford-sponsored medical plan. A spouse/
registered domestic partner is only eligible to receive
the incentive if the employee earns the incentive.
Other Rewards
In addition to monetary incentives, BeWell
participants also receive other rewards, including
access to free Stanford athletic and arts events
throughout the year.
Learn how to get healthy and earn rewards with
BeWell at http://bewell.stanford.edu.
WHY SHARE YOUR
INFORMATION?
Your SHALA and health screening information
is used to help you identify ways to improve
your health and/or manage any chronic
conditions you may have.
BeWell advisors will review the information
with you and may use your results to suggest
appropriate health promotion resources, both
on campus or with your medical plan. Your
medical plan also may use your information
for the purpose of health promotion and/or
disease management outreach.
Rest assured that BeWell and Stanford are
committed to protecting the privacy and
security of your health information.
benefits.stanford.edu | 2015 Faculty Benefits Summary
21
Tara Bryant
Hospital Technician,
Clinical Decision Unit
Fitness and Healthy Living Classes with
Health Improvement Program (HIP)
Did you know you have more than 250 fitness and health education classes
available to you each quarter through the Health Improvement Program
(HIP), part of the School of Medicine?
If you are a BeWell participant and have completed
your SHALA, you are eligible for two discounted $30
group fitness classes per quarter. Some of the group
fitness classes include cross-training, indoor cycling,
yoga, Pilates, tai chi, swimming, dance and more.
To find a class, register for a class or listen to a prerecorded webinar, visit http://hip.stanford.edu.
In addition, many of the Healthy Living classes are
eligible for STAP funds. You may find STAP-eligible
HIP programs on the searchable HIP schedule.
Examples include:
Through the Department of Athletics, Physical
Education and Recreation, you have access to a
variety of athletic, recreation and wellness facilities,
including two 75,000-square-foot sports and
recreation centers; a recreational pool; a driving
range; tennis courts; indoor climbing walls; playing
fields and a world-class aquatic center.
• Healthy Living: Nutrition and weight
management, stress management,
disease prevention and management,
and more.
• Behavior Change: Coaching and
counseling, weight management,
smoking cessation and more.
22
2015 Faculty Benefits Summary | benefits.stanford.edu
Physical Education, Recreation
and Wellness
With all of these facilities at your disposal, you have
lots of opportunity to find an activity that fits your
needs and interests and to get fit.
Find a class or activity that interests you at
http://recreation.stanford.edu.
Tuition Grant Program (TGP)
Stanford will assist with up to four years of undergraduate college tuition
costs at approved colleges and universities for eligible dependent children.
Faculty in a university appointment for six months or longer are eligible for
this benefit as soon as their appointment begins.
For the 2014–15 fiscal year, the maximum available
amount is $22,092 depending on employment
status, the amount of time worked (prorated if you
work less than 100 percent time) and tuition cost.
For more information on the TGP, call 877-905-2985
or 650-736-2985 (press option 5) or visit TGP at
http://hreap.stanford.edu.
Dan Elison Azagury
Assistant Professor of Surgery
(General Surgery), Stanford University
Medical Center, wife Tatiana Maratchi
along with son Leo and daughter Olivia
benefits.stanford.edu | 2015 Faculty Benefits Summary
23
Stanford WorkLife Office
Stanford provides an array of programs and services to assist you with child
care, elder care and living-well resources. Information about on-site child
care and community resources is available. Financial assistance is available
to eligible employees for child care expenses, adoption, and emergency and
back-up child or elder care. Elder care resources are offered for both local and
long-distance care giving.
Child Care Subsidy Grant
Program (CCSG)
Stanford provides up to $5,000 per year in taxfree grants for eligible child care expenses. Grant
amounts are based on the applicant’s (and their
spouse/registered domestic partner’s) adjusted
gross income and the number of eligible children
age nine or younger.
Faculty Child Care Assistance
Program (FCCAP)
Stanford provides a salary supplement to eligible
faculty to offset qualified child care expenses.
Award levels are based on an applicant’s (and their
spouse/registered domestic partner’s) household
adjusted gross family income. Awards range from
$5,000 to $20,000.
Junior Faculty Dependent Care
Travel Grant Program
Junior faculty can receive a taxable grant of up
to $1,000 for qualified dependent care expenses
incurred when traveling to attend professional
meetings, conferences, workshops and professional
development opportunities, or to conduct approved
research or scholarship.
Adoption Assistance
Stanford reimburses eligible adoption expenses up
to $10,000 per adoption, with a maximum lifetime
benefit of $20,000 per family.
Emergency and Back-Up
Dependent Care
Stanford offers help with child/elder care if a
regular caregiver is ill or on vacation, or if a child/
elder is mildly ill and is in need of temporary care.
The Back-Up Care Advantage (BUCA) Program is
for faculty and provides both in-home dependent
care from credentialed in-home care agencies and
trained caregivers as well as in-center care for a
small copay.
Eldercare
The WorkLife Office supports family caregiving
through a partnership with Avenidas to provide
resources, referrals and monthly Caregivers’
Seminars. For Stanford faculty, Avenidas offers free
and discounted consultations with a social worker.
Additional information on these programs and others is available on the WorkLife website
at http://worklife.stanford.edu, or by calling 650-723-2660.
24
2015 Faculty Benefits Summary | benefits.stanford.edu
Unemployment Insurance
All employees have unemployment insurance coverage for qualifying periods
of unemployment. Stanford pays the full cost of coverage.
Workers’ Compensation
Workers’ Compensation provides benefits for a work-related illness or injury.
Stanford continues to pay your base salary for the first five working days after
a work-related accident, and then Workers’ Compensation payments start.
Pre-Designation of Personal Physician
In the event you sustain an injury or illness related
to your employment, you may be treated for such
injury or illness by your personal medical doctor
(M.D.), doctor of osteopathic medicine (D.O.) or
medical group if:
• Your employer offers group
health coverage;
• The doctor is your regular physician,
who shall be either a physician who has
limited his or her practice of medicine
to general practice or who is a boardcertified or board-eligible internist,
pediatrician, obstetrician-gynecologist
or family practitioner, or has previously
directed your medical treatment, and
retains your medical records;
• Your “personal physician” may be a
medical group if it is a single corporation
or partnership composed of licensed
doctors of medicine or osteopathy, which
operated an integrated multispecialty
medical group providing comprehensive
medical services predominately for nonoccupational illnesses and injuries;
• Prior to the injury, your doctor agrees to
treat you for work injuries or illnesses;
• Prior to the injury, you provided your
employer the following in writing:
1. Notice that you want your personal
doctor to treat you for a workrelated injury or illness, and
2. Your personal doctor’s name and
business address.
Visit the Risk Management website at http://stanford.edu/dept/risk-management
for more information.
benefits.stanford.edu | 2015 Faculty Benefits Summary
25
Other Resources and Services
Stanford Coordinated Care
Stanford Coordinated Care (SCC) is a team of
medical professionals and care coordinators who
help people with chronic illnesses lead a healthy
life and smoothly navigate their health care
experiences. SCC can help you manage chronic
health conditions, coordinate your medical care—
no matter how many specialists you see—
and provide you with care at our clinic or
collaborate with your primary care provider. Visit
http://stanfordhealthcare.org/medical-clinics/
coordinated-care.html, or call 650-724-1800.
Direct Deposit/
Withholding Information
Learn how to sign up for direct deposit of your
Stanford paycheck at the Axess website at
http://axess.stanford.edu.
News and Information
The Stanford Report includes daily news and
events at Stanford and is sent to all employees
electronically. View past issues of The Stanford
Report, at http://news.stanford.edu/sr/. Stanford
employees also receive The Stanford Employee
Insider, a quarterly digital newsletter featuring
employment-related news and updates produced
by University Human Resources. View past issues
and subscribe to the newsletter at http://uhr.
stanford.edu/stanford-insider. SLAC employees
also receive SLAC Today via email.
Stanford Events
For information on lectures, concerts, athletic events,
exhibits and much more, sign up for Stanford for You,
a free monthly e-newsletter about fun, affordable
events on campus. Register for Stanford for You at
http://foryou.stanford.edu.
26
2015 Faculty Benefits Summary | benefits.stanford.edu
Parking &
Transportation Services
Stanford supports many commuter programs
including free transit on CalTrain and VTA. For
information about the programs, mass transit,
ride-sharing incentives and parking at Stanford,
visit the Parking & Transportation Services website
at http://transportation.stanford.edu, or call
650-723-9362.
Note: SLAC employees are not eligible for the
commuter program.
Housing Program
The University has several financial programs
designed to assist eligible faculty with the purchase
of a home. The University also provides to eligible
faculty long-term residential ground leases for oncampus housing, as well as rental housing on and
off the campus.
For information about housing programs and
eligibility, visit the Faculty Staff Housing website at
http://fsh.stanford.edu, or call 650-725-6893.
Faculty Information Resources
The University Faculty Handbook provides an overview of policies,
procedures and other information related to faculty appointments
at Stanford. To review the information or print a copy, go to
http://facultyhandbook.stanford.edu.
• For faculty policies, procedures,
forms and helpful links, go to
http://facultyaffairs.stanford.edu.
For questions, email facultyaffairs@
stanford.edu or call 650-723-3622.
• For policies specific to your school, go
to your school’s website or contact your
dean’s office at http://facultyaffairs.
stanford.edu/other_contacts.
• View the Research Policy Handbook at
http://rph.stanford.edu to learn about
the conduct of research at Stanford,
including the Faculty Policy on Conflict
of Commitment and Interest.
• The Global Operations Guide provides
practical and logistical information for
faculty and staff of regulatory issues that
are likely to be encountered by those
working internationally. To view the
guide, visit the Global Business Services
website at http://stanford.edu/group/
fms/globalops/guide.
• The Office of the Vice Provost for Faculty
Development & Diversity supports the
faculty through a variety of programs
and resources for new and pre-tenured
faculty in professional development,
and for department chairs and deans
in recruitment, retention and diversity.
For more information, visit
http://facultydevelopment.stanford.edu.
• The Office of Diversity & Access at
http://stanford.edu/dept/diversityaccess
may provide additional information.
benefits.stanford.edu | 2015 Faculty Benefits Summary
27
$20 copay primary/$50 copay
specialist
PENALTY for not pre-authorizing:
the services will be considered
not covered by the plan and the
member is responsible for the full
amount of the service.
Pre-authorization from your
primary care provider is required
for the following services:
Advanced Imaging (CT, MRI,
MRA and PET); all electively
scheduled inpatient admissions;
all elective outpatient procedures
(example- endoscopic procedures,
arthroscopic procedures,
epidural steroid injections, etc.);
physical therapy; durable medical
equipment; speech therapy.
There is no benefit if you see a
non-network provider, except for
emergency care or when clinically
appropriate and prior authorized
by Stanford HealthCare Alliance.
The Stanford HealthCare Alliance
ACO plan requires you designate
a primary care provider to
coordinate all of your care. You
may visit any Stanford HealthCare
Alliance network doctor or
hospital. Some services require
prior authorization from your
primary care physician.
Stanford HealthCare Alliance
ACO Plan - Group #976248
Benefits Plan Comparison Charts
Office copay
Pre-Authorization
Requirement
Overview
Benefit
Description
Network: $20 copay primary/$50
copay specialist
Non-Network: 60% after deductible
PENALTY for not pre-authorizing:
benefit reduced to 50% of Blue
Shield Allowed Amount. Maximum
reduction of $1,000. You pay
balance of all charges not covered
by Blue Shield. Out-of-Pocket
Maximum does not apply. Certain
benefits may be denied in full for
failure to pre-authorize.
PENALTY for not pre-authorizing:
benefit reduced to 50% of Blue
Shield Allowed Amount. You pay
balance of all charges not covered
by Blue Shield. Out-of-Pocket
Maximum does not apply.
$20 copay primary/$50 copay
specialist
Pre-authorization required for
all hospital stays and certain
outpatient procedures.
When you see a non-network
provider you are responsible for
the balance of your bill that is not
covered by Blue Shield. The Out-ofPocket Maximum does not apply to
the balance of the bill not covered
by Blue Shield.
When you see a non-network
provider you are responsible for
the balance of your bill that is not
covered by Blue Shield. The Out-ofPocket Maximum does not apply to
the balance of the bill not covered
by Blue Shield.
benefits.stanford.edu | 2015 Faculty Benefits Summary
$20 copay primary/$50 copay
specialist
PENALTY for not pre-authorizing:
not covered.
PENALTY for not pre-authorizing:
benefit reduced to 50% of Blue
Shield Allowed Amount. Maximum
reduction of $1,000. You pay
balance of all charges not covered
by Blue Shield. Out-of-Pocket
Maximum does not apply. Certain
may be denied in full for failure to
pre-authorize.
Network: 80% after deductible
Non-Network: 60% after deductible
Pre-authorization required for all
elective inpatient and outpatient
procedures.
28
You may use only Kaiser
Permanente doctors and facilities
except in emergencies.
Kaiser Permanente HMO (CA)
Group #7145 (Northern CA)
Group #230178 (Southern CA)
Pre-authorization required for
all hospital stays and certain
outpatient procedures.
This plan is compatible with an
individual Health Savings Account
(HSA), that you establish at a
financial institution of your choice.
You may visit any doctor or
hospital. You receive a higher
level of benefits when you use
Blue Shield PPO providers. You
are responsible for ensuring all
providers are in the network.
Blue Shield High Deductible
PPO Plan - Group #170293
You may visit any doctor or
hospital. You receive a higher
level of benefits when you use
Blue Shield PPO providers. You
are responsible for ensuring all
providers are in the network.
Blue Shield PPO Plan
Group #170292
Pre-authorization required for all
elective inpatient and outpatient
procedures.
There is no benefit if you see a
non-network provider, except for
emergency or urgent care.
For certain services or procedures
Blue Shield may require use of
certain providers within their
network.
You may visit any Blue Shield PPO
network doctor or hospital.
Blue Shield EPO Plan
Group #976109
2015 Benefits Plan Comparison Charts
Benefits Plan Comparison Charts
Prenatal Visits
100%
A single out-of-pocket maximum
applies to all coverage under
the plan, including medical and
prescription drugs. (This will
cover prescriptions and medical
expenses at 100% once the out-ofpocket maximum is met.)
A single out-of-pocket maximum
applies to all coverage under
the plan, including medical and
prescription drugs. (This will
cover prescriptions and medical
expenses at 100% once the out-ofpocket maximum is met.)
Maternity
$3,000 per individual
$6,000 per family
$3,000 per individual
$6,000 per family
Out-of-Pocket
Maximum
100%
100% after applicable copays
100% after applicable copays
Coinsurance
No deductible
Blue Shield EPO Plan
Group #976109
No deductible
Stanford HealthCare Alliance
ACO Plan - Group #976248
Deductible
Benefit
Description
Network: $20 copay (first visit)
Non-Network: 60% after deductible
A single out-of-pocket maximum
applies to all coverage under
the plan, including medical and
prescription drugs. (This will
cover prescriptions and medical
expenses at 100% once the out-ofpocket maximum is met.)
Non-Network:
$7,500 per individual
$15,000 per family
100%
29
A single out-of-pocket maximum
applies to all coverage under
the plan, including medical and
prescription drugs. (This will
cover prescriptions and medical
expenses at 100% once the out-ofpocket maximum is met.)
$1,500 per individual
$3,000 per family
100% after applicable copays
No deductible
Kaiser Permanente HMO (CA)
Group #7145 (Northern CA)
Group #230178 (Southern CA)
benefits.stanford.edu | 2015 Faculty Benefits Summary
Network: 80% after deductible
Non-Network: 60% after deductible
A single out-of-pocket maximum
applies to all coverage under
the plan, including medical and
prescription drugs. (This will
cover prescriptions and medical
expenses at 100% once the out-ofpocket maximum is met.)
Combined Network or
Non-Network
$3,500 per individual
$7,000 per family
Non-Network: 60% of allowed
charges after deductible, including
prescriptions
Non-Network: 60% of allowed
amount after deductible
Network:
$3,500 per individual
$7,000 per family
Network: 100% for preventive care;
80% after deductible for all other
services, including prescriptions
Network: 100% for preventive care
after applicable copays; 80% after
deductible for other services
The family deductible applies to
claims for all family members until
the deductible is met. There is no
individual limit for each covered
family member.
Combined network or non-network
Non-network: $1,000 per
individual/$3,000 family
The family deductible applies to
claims for all family members until
the deductible is met. There is no
individual limit for each covered
family member.
$1,500 per individual/$3,000 per
family
Blue Shield High Deductible
PPO Plan - Group #170293
Network: $500 per
individual/$1,500 per family
Blue Shield PPO Plan
Group #170292
Stanford HealthCare Alliance
ACO Plan - Group #976248
OUTPATIENT CARE
[no visit limit]
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
* The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
OUTPATIENT CARE
[no visit limit]
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
* The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
* The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
* The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
Pre-certification is required by you
or your provider.
INPATIENT CARE
$100 copay per admission
OUTPATIENT CARE
[no visit limit]
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
Pre-certification is required by you
or your provider.
INPATIENT CARE
$100 copay per admission
OUTPATIENT CARE
[no visit limit]
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
OUTPATIENT CARE
[no visit limit]
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
OUTPATIENT CARE
[no visit limit]
Network: $20 copay per visit
Non-Network: 80% of billed
charges (up to $300 maximum
allowed charges) for professional
services only.
The maximum allowed amount
will not exceed $300 for each office
visit. For example, if the billed
charge is $350, the plan will pay
80% of {the lesser of $300 or the
billed charge} = 80% x $300 = $240.
30
Transitional Residential Recovery
Services
$100 copay per admission
OUTPATIENT CARE
[no visit limit]
$20 copay per visit, individual
$5 copay per visit, group
INPATIENT DETOXIFICATION
$100 copay per admission
OUTPATIENT CARE
[no visit limit]
$20 copay per visit, individual
$10 copay per visit, group
INPATIENT CARE
$100 copay per admission
Kaiser Permanente must approve
mental health care.
Kaiser Permanente HMO (CA)
Group #7145 (Northern CA)
Group #230178 (Southern CA)
benefits.stanford.edu | 2015 Faculty Benefits Summary
INPATIENT CARE
Network: 80% after deductible
Non-Network: 60% after deductible
INPATIENT CARE
Network: 100% after deductible
Non-Network: 60% after deductible
Pre-certification is required by you
or your provider.
Non-Network: 80% of billed
charges
Non-Network: 60% of allowed
charges
OUTPATIENT CARE
[no visit limit]
OUTPATIENT CARE
[no visit limit]
Pre-certification is required by you
or your provider.
Network: 80% after deductible
INPATIENT CARE
$100 copay per admission
Network: 100% after deductible
Blue Shield must approve mental
health care.
INPATIENT CARE
$100 copay per admission
Blue Shield High Deductible
PPO Plan - Group #170293
INPATIENT CARE
Pre-Certification is required by you
or your provider.
Blue Shield PPO Plan
Group #170292
INPATIENT CARE
Pre-Certification is required by you
or your provider.
Blue Shield EPO Plan
Group #976109
Stanford HealthCare Alliance must
approve mental health care.
Benefits Plan Comparison Charts
Substance Abuse
Mental Health
Mental Health/Autism/Substance Abuse
Benefit
Description
100%
Home Health Care
Benefits Plan Comparison Charts
Office visit copayment, or
Emergency Room copayment,
depending on the facility.
Urgent Care
100%
Office visit copayment, or
Emergency Room copayment,
depending on the facility.
$100 copay (waived if admitted)
In-network providers only
In-network providers only
$100 copay (waived if admitted)
Up to 20 visits per year
Up to 20 visits per year
Emergency Room
$20 copay
$20 copay
Chiropractors
100% after $50 copay
100% after $50 copay
Office copay may apply.
Office copay may apply.
In-network providers only
In-network providers only
100%
Up to 20 visits per year
Up to 20 visits per year
100%
$20 copay
Blue Shield EPO Plan
Group #976109
$20 copay
Stanford HealthCare Alliance
ACO Plan - Group #976248
Ambulance
Charges
Allergy Tests
Acupuncture
Other Services
Benefit
Description
Lab/ancillary/professional charges
paid at 80% after deductible,
network or non-network
(copay waived if admitted)
Non-Network: 60% after deductible
Non-Network: 60% after deductible
[3 visits per day max]
31
Up to 100 two-hour visits/calendar
year
100%
$20 copay at Kaiser Permanente
facility
$100 copay (waived if admitted)
American Specialty Health (ASH)
Plans Participating Chiropractors
Up to 40 combined chiropractic
and acupuncture visits per year
$15 copay
100% after $50 copay
$20 copay
American Specialty Health (ASH)
Plans Participating Acupuncturists
Up to 40 combined chiropractic
and acupuncture visits per year
$15 copay
Kaiser Permanente HMO (CA)
Group #7145 (Northern CA)
Group #230178 (Southern CA)
benefits.stanford.edu | 2015 Faculty Benefits Summary
Network: 80% after deductible
Network: 80% after deductible
$50 copay; lab/other services 80%
after deductible, network or nonnetwork
Network or Non-Network: 80%
after deductible
Non-Network: 80% after deductible
Non-Network: $100 copay per visit
Lab/ancillary/professional charges
paid at 80% after deductible for
Network or Non-Network
Network: 80% after deductible
Up to 20 combined network and
non-network visits per year
Non-Network: 60% after deductible
Network: 80% after deductible
Network or Non-Network: 80%
after deductible (if medically
approved)
Non-Network: 60% after deductible
Network: 80% after deductible
Up to 20 combined Network and
Non-Network visits per year
Non-Network: 60% after deductible
Network: 80% after deductible
Blue Shield High Deductible
PPO Plan - Group #170293
Network: $100 copay per visit
Up to 20 combined network and
non-network visits per year
Non-Network: 60% after deductible
Network: 80% after deductible
Network or Non-Network: 80%
after deductible (if medically
approved)
Non-Network: 60% after deductible
Network: $50 copay
Up to 20 combined Network and
Non-Network visits per year
Non-Network: 60% after deductible
Network: 80% after deductible
Blue Shield PPO Plan
Group #170292
Limited to screen and refraction
exams only
100%
$20 copay primary/$50 copay
specialist
$50 copay
Limited to screen and refraction
exams only
Laboratory
Charges
Office Visits
Vision Care
Network: 50% of Blue Shield
allowed charges for professional
and diagnostic services; limited
to three cycles of intrauterine
insemination (IUI).
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Network: 50% of Blue Shield
allowed charges after deductible
for professional and lab services;
limited to three cycles of
intrauterine insemination (IUI).
Network: 80% after deductible
Network: 80% after deductible
Network: 50% of Blue Shield
allowed charges after deductible
for professional and lab services;
limited to three cycles of
intrauterine insemination (IUI).
Pre-Certification required by you or
your provider.
Blue Shield High Deductible
PPO Plan - Group #170293
Pre-Certification required by you or
your provider.
Blue Shield PPO Plan
Group #170292
100%
100%
Discount program available for
vision hardware
$20 copay primary/$50 copay
specialist
100%
Non-Network: 60% after deductible
Non-Network: 60% after deductible
100%
32
Eye exams only. Discount program
for vision hardware
100%
$20 copay primary/$50 copay
specialist
100%
Fertility Drugs: Covered under drug
benefits at 50%; In Vitro, GIFT, and
ZIFT: Not covered.
50%
$100 copay per admission
Kaiser Permanente HMO (CA)
Group #7145 (Northern CA)
Group #230178 (Southern CA)
benefits.stanford.edu | 2015 Faculty Benefits Summary
Network: 80% after deductible
Limited to screen and refraction
exams only
Limited to screen and refraction
exams only
Network: 80% after deductible
Network: 100%
Non-Network: Not covered
Non-Network: 60% after deductible
Network: 100%
Non-Network: Not covered
Non-Network: 60% after deductible
Network: 80% after deductible
Non-Network: 60% after deductible
Non-Network: 60% after deductible
Network: $20 copay primary/$50
copay specialist
Network: 80% after deductible
Network: 80% after deductible
In Vitro, GIFT, and ZIFT: Not covered Non-Network: Not covered
Non-Network: Not covered
In Vitro, GIFT, and ZIFT: Not covered Fertility drugs: see Pharmacy
In Vitro, GIFT, and ZIFT: Not covered In Vitro, GIFT, and ZIFT: Not covered
Fertility drugs: see Pharmacy
Fertility drugs: see Pharmacy
Fertility drugs are covered at 50%
after deductible, up to $5,000
lifetime maximum
Benefits Plan Comparison Charts
X-rays
$50 copay
Network: 50% of Stanford
HealthCare Alliance allowed
charges for professional and
diagnostic services; limited to three
cycles of intrauterine insemination
(IUI).
Infertility
Treatment
Pre-Certification required by you
or your provider. $100 copay per
admission
Pre-Certification required by you
or your provider. $100 copay per
admission
Hospital Stay
Blue Shield EPO Plan
Group #976109
Stanford HealthCare Alliance
ACO Plan - Group #976248
Benefit
Description
Must use Blue Shield mail-order service
Must use Blue Shield mail-order service
Travel immunizations not covered.
Benefits Plan Comparison Charts
100%
Travel immunizations not covered.
100%
Immunizations
Well-Woman Visits
100%
100%
Mammograms
100%
100%
100%
(as part of the office visit)
100%
(as part of the office visit)
$20 generic; $60 brand name; $150
non-formulary—up to a 90-day
supply
100%
33
Office visit copay applies if
provided during doctor office visit
100%
100%
100%
Brand: $30 up to a 30-day supply;
$60 for a 31-100 day supply
Generic: $10 up to a 30-day supply;
$20 for a 31-100 day supply
KAISER PERMANENTE
MAIL ORDER PHARMACY
Brand: $30 for up to a 30-day
supply, $60 for a 31- to 60-day
supply, or $90 for a 61- to 100-day
supply
KAISER PERMANENTE PHARMACY
Generic: $10 for up to a 30-day
supply, $20 for a 31- to 60-day
supply, or $30 for a 61- to 100-day
supply
Kaiser Permanente HMO (CA)
Group #7145 (Northern CA)
Group #230178 (Southern CA)
benefits.stanford.edu | 2015 Faculty Benefits Summary
Network: 100%
Non-Network: Not covered
Travel immunizations not covered.
Travel immunizations not covered.
Network: 100%
Non-Network: Not covered
Network: 100%
Non-Network: Not covered;
Network: 100% if part of annual
preventive
Non-Network: Not covered
Network: 100% if part of annual
preventive
Non-Network: Not covered
Must use Blue Shield mail-order service
80% after deductible
Fertility drugs: see Infertility
Treatment
Network or Non-Network: 80%
after deductible
Blue Shield High Deductible
PPO Plan - Group #170293
Network: 100%
Non-Network: Not covered;
Network: 100% if part of annual
preventive
Non-Network: Not covered
Network: 100% if part of annual
preventive
Non-Network: Not covered
Must use Blue Shield mail-order service
$20 generic; $60 brand name; $150
non-formulary—up to a 90-day
supply
Fertility drugs covered at 50%
(deductible does not apply); max
benefit of $5,000 per lifetime
Fertility drugs covered at 50%
(deductible does not apply); max
benefit of $5,000 per lifetime
Fertility drugs covered at 50%
(deductible does not apply); max
benefit of $5,000 per lifetime
$20 generic; $60 brand name; $150
non-formulary—up to a 90-day
supply
Non-Network pharmacy: Member
pays copayment plus 25% of billed
charges
Non-Network pharmacy: Member
pays copayment plus 25% of billed
charges
Non-Network pharmacy: Member
pays copayment plus 25% of billed
charges
Blue Shield Network pharmacy:
$10 generic; $30 brand name; $75
non-formulary -- up to a 30-day
supply
Blue Shield PPO Plan
Group #170292
Blue Shield Network pharmacy:
$10 generic; $30 brand name; $75
non-formulary—up to a 30-day
supply
Blue Shield EPO Plan
Group #976109
Stanford HealthCare Alliance uses the
Blue Shield Network pharmacy: $10
generic; $30 brand name; $75 nonformulary—up to a 30-day supply
Stanford HealthCare Alliance
ACO Plan - Group #976248
Pap Smears
Preventive Care
Mail-Order Drug
Program
Pharmacy (Retail)
Prescription Drugs
Benefit
Description
$150 per family
Preventive and Diagnostic service: Network: 100%
Non-Network: 80% (deductible waived)
Preventive and Diagnostic service: Network: 100%
Non-Network: 80% (deductible waived)
Fluoride Treatments
Routine Exams
Benefits Plan Comparison Charts
Preventive and Diagnostic service: Network: 100%
Non-Network: 80% (deductible waived)
Combined Orthodontia lifetime maximum benefit of $1,500
Non-Network: 50% of Delta’s approved fee
Network: 50% of Delta’s approved fee
Non-Network: $1,500 per individual
Network: $3,000 per individual
- Preventive and diagnostic: 80% of usual & customary charges
- Basic procedures: 60% of usual & customary charges
- Major restorative procedures: 50% of usual & customary charges
Non-Network:
- Preventive and diagnostic: 100% of the negotiated rate
- Basic procedures: 80% of the negotiated rate
- Major restorative procedures: 50% of the negotiated rate
benefits.stanford.edu | 2015 Faculty Benefits Summary
Preventive and diagnostic service: 100% (deductible waived)
Balance billing by your dentist may apply. You are responsible for these charges.
Preventive and diagnostic service: 100% (deductible waived)
Balance billing by your dentist may apply. You are responsible for these charges.
Preventive and diagnostic service: 100% (deductible waived)
Balance billing by your dentist may apply. You are responsible for these charges.
Not covered
$1,000 per individual
You are responsible for amounts not covered by the dental plan.
- Preventive and diagnostic: 100% of usual & customary charges
- Basic procedures: 80% of usual & customary charges
- Major restorative procedures: 50% of usual & customary charges
$50 per individual
You are encouraged to obtain a predetermination of benefits from Delta for services
greater than $300, or for crowns or bridges
The benefit level does not depend on what providers you use.
This plan pays most benefits at a percentage.
Non-network: $50 per individual/$150 family
Network:
Delta Dental Basic PPO
Plan#3365
Delta Dental PPO is the dentist network for this plan.
Network: $0 per individual/$0 per family
You are encouraged to obtain a predetermination of benefits from Delta for services
greater than $300, or for crowns or bridges.
If your network dentist does not provide or authorize your care, the charges are
considered out-of-network.
This plan pays in-network benefits when your care is either provided or authorized by
your Delta Dental PPO network dentist.
Delta Dental Enhanced PPO
Plan #3366
Cleanings
Preventative Type of Care
Orthodontia
Annual Maximum
Coinsurance
Deductible
Overview
Benefit Description
2015 Dental Plan Comparison Charts
34
80% after deductible
Network: 80%
Basic procedures service: Network: 80%
Non-Network: 60% after deductible
Basic procedures service: Network: 80%
Non-Network: 60% after deductible
Basic procedures service: Network: 80%
Non-Network: 60% after deductible
Fillings
Root Canals
Sealants
Major Restorative procedures service: Network: 50%
Non-Network: 50% after deductible
Major Restorative procedures service: Network: 50%
Non-Network: 50% after deductible
Major Restorative procedures service: Network: 50%
Non-Network: 50% after deductible
Major Restorative procedures service: Network: 50%
Non-Network: 50% after deductible
Not covered
Crown
Dentures
Implants
Onlays
Splinting
Benefits Plan Comparison Charts
Major Restorative procedures service: Network: 50%
Non-Network: 50% after deductible
Bridges
Major Procedures
Basic procedures service: Network: 80%
Non-Network: 60% after deductible
Not covered
benefits.stanford.edu | 2015 Faculty Benefits Summary
Major Restorative procedures service: 50% after deductible
Not covered
Major Restorative procedures service:
50% after deductible
Major Restorative procedures service:
50% after deductible
Major Restorative procedures service:
50% after deductible
Basic procedures service: 80% after deductible
Basic procedures service: 80% after deductible
Basic procedures service: 80% after deductible
Basic procedures service: 80% after deductible
Basic procedures service:
Non-Network: 60% after deductible
Delta Dental Basic PPO
Plan#3365
Preventive and diagnostic service: 100% (deductible waived)
Balance billing by your dentist may apply. You are responsible for these charges.
Basic procedures service:
Preventive and Diagnostic service: Network: 100%
Non-Network: 80% (deductible waived)
Delta Dental Enhanced PPO
Plan #3366
Extractions
Anesthesia
Basic Procedures
X-rays
Benefit Description
35
Legal Notices
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
plan’s notice of HIPAA privacy. You may request
a copy of the notice by contacting the Stanford
Benefits Office.
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:
• All stages of reconstruction of the
breast on which the mastectomy
was performed;
• Surgery and reconstruction of
the other breast to produce a
symmetrical appearance;
• Prostheses; and
• Treatment 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 our medical plans. If you have any questions
concerning this provision, please contact your
medical provider.
36
2015 Faculty Benefits Summary | benefits.stanford.edu
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 employee 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.
There are two important things you need to know
about your current coverage and Medicare’s
prescription drug coverage:
• 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 employee 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.
TRAILING
LEGALSTORY
NOTICES
LABEL
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.
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.
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 January 1 following the next
annual Open Enrollment period.
When will you pay a higher premium
(penalty) to join a Medicare drug plan?
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.
For more information about this notice or your
current prescription drug coverage, visit the
website or call the number 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 employee coverage changes. You also
may request a copy of this notice at any time.
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:
• Visit http://www.medicare.gov
• Call your State Health Insurance
Assistance Program 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 the Social Security website at
http://www.socialsecurity.gov, or call them at
(800) 772-1213 (TTY (800) 325-0778).
benefits.stanford.edu | 2015 Faculty Benefits Summary
37
TRAILING
LEGALSTORY
NOTICES
LABEL
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: Benefits Office
Contact-Position/Office: Benefits Manager
Address:
3160 Porter Drive
Suite 250
Palo Alto, CA 94304-8443
Phone Number:
(650) 736-2985 (option 9)
Eric L. Stein, Senior Associate Athletic Director and
Pamela Mahlow, Associate Director for Recreation,
Department of Athletics, Physical Education and Recreation
Medicaid and the Children’s
Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or
CHIP and you are eligible for health coverage from
your employer, your state may have a premium
assistance program that can help pay for coverage.
These states use funds from their Medicaid or CHIP
programs to help people who are eligible for these
programs, but also have access to health insurance
through their employer. If you or your children are
not eligible for Medicaid or CHIP, you will not be
eligible for these premium assistance programs.
If you or your dependents are already enrolled
in Medicaid or CHIP and you live in a state listed
below, you can contact your state Medicaid or CHIP
office to find out if premium assistance is available.
38
2015 Faculty Benefits Summary | benefits.stanford.edu
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, you can contact your
state Medicaid or CHIP office or dial (877) KIDS-NOW
(543-7669) or visit the website at http://www.
insurekidsnow.gov to find out how to apply. If you
qualify, you can ask the state if it has a program
that might help you pay the premiums for an
employer-sponsored plan.
Once it is determined that you or your dependents
are eligible for premium assistance under Medicaid
or CHIP, as well as eligible under your employer
plan, your employer must permit you to enroll in
your employer plan if you are not 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, you can contact the Department of Labor
electronically at https://www.dol.gov or by calling
toll-free at (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, 2013. You should contact
your state for further information on eligibility.
To see if any more states have added a premium
assistance program since July 31, 2013, or for more
information on special enrollment rights, you can
contact either:
• U.S. Department of Labor
Employee Benefits Security Administration
http://www.dol.gov/ebsa
(866) 444-EBSA (3272)
• U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
http://www.cms.gov
(877) 267-2323, Menu Option 4, Ext. 61565
TRAILING
LEGALSTORY
NOTICES
LABEL
Alabama
Medicaid
http://www.medicaid.
alabama.gov
(855) 692-5447
Iowa
Medicaid
http://www.dhs.state.ia.us/
hipp
(888) 346-9562
Alaska
Medicaid
http://health.hss.state.
ak.us/dpa/programs/
medicaid
(888) 318-8890 (Outside of
Anchorage)
(907) 269-6529 (Anchorage)
Kansas
Medicaid
http://www.kdheks.gov/hcf
(800) 792-4884
Kentucky
CHIP
http://www.azahcccs.gov/
applicants
(877) 764-5437 (Outside of
Maricopa County)
(602) 417-5437 (Maricopa
County)
Medicaid
http://chfs.ky.gov/dms/
default.htm
(800) 635-2570
Louisiana
Medicaid
http://www.lahipp.dhh.
louisiana.gov
(888) 695-2447
Maine
Medicaid
http://www.maine.gov/dhhs/
ofi/public-assistance/index.
html
(800) 977-6740
TTY (800) 977-6741
Massachusetts
Medicaid and CHIP
http://www.mass.gov/
MassHealth
(800) 462-1120
Minnesota
Medicaid
http://www.dhs.state.mn.us
Click “Health Care”, then
“Medical Assistance”
(800) 657-3629
Missouri
Medicaid
http://www.dss.mo.gov/
mhd/participants/pages/
hipp.htm
(573) 751-2005
Montana
Medicaid
http://medicaidprovider.
hhs.mt.gov/clientpages/
clientindex.shtml
(800) 694-3084
Nebraska
Medicaid
http://www.
ACCESSNebraska.ne.gov
(800) 383-4278
Nevada
Medicaid
http://dwss.nv.gov
(800) 992-0900
Arizona
Colorado
Medicaid
http://www.colorado.gov
(In state): (800) 866-3513
(Out of state): (800) 221-3943
Florida
Medicaid
http://www.
flmedicaidtplrecovery.com
(877) 357-3268
Georgia
Medicaid
http://dch.georgia.gov
Click on “Programs”, then
“Medicaid”, then “Health
Insurance Premium Payment
(HIPP)”
(800) 869-1150
Idaho
Medicaid
http://www.
accesstohealthinsurance.
idaho.gov
(800) 926-2588
CHIP
www.medicaid.idaho.gov
(800) 926-2588
Indiana
Medicaid
http://www.in.gov/fssa
(800) 889-9949
benefits.stanford.edu | 2015 Faculty Benefits Summary
39
TRAILING
LEGALSTORY
NOTICES
LABEL
New
Hampshire
Medicaid
http://www.dhhs.nh.gov/oii/
documents/hippapp.pdf
(603) 271-5218
New Jersey
Medicaid
http://www.state.nj.us/
humanservices/dmahs/
clients/medicaid
(609) 631-2392
CHIP
http://www.njfamilycare.
org/index.html
(800) 701-0710
40
South Carolina
Medicaid
http://www.scdhhs.gov
(888) 549-0820
South Dakota
Medicaid
http://dss.sd.gov
(888) 828-0059
Texas
Medicaid
http://www.gethipptexas.com
(800) 440-0493
Utah
Medicaid
http://health.utah.gov/upp
(866) 435-7414
New York
Medicaid
http://www.nyhealth.gov/
health_care/medicaid
(800) 541-2831
Vermont
North Carolina
Medicaid
http://www.ncdhhs.gov/dma
(919) 855-4100
Medicaid
http://www.
greenmountaincare.org
(800) 250-8427
Virginia
North Dakota
Medicaid
http://www.nd.gov/dhs/
services/medicalserv/
medicaid
(800) 755-2604
Medicaid
http://www.dmas.virginia.
gov/rcp-hipp.htm
(800) 432-5924
Oklahoma
Medicaid and CHIP
http://www.
insureoklahoma.org
(888) 365-3742
Oregon
Medicaid and CHIP
http://www.
oregonhealthykids.gov
Spanish: http://www.
hijossaludablesoregon.gov
(800) 699-9075
Pennsylvania
Medicaid
http://www.dpw.state.
pa.us/hipp
(800) 692-7462
Rhode Island
Medicaid
http://www.ohhs.ri.gov
(401) 462-5300
2015 Faculty Benefits Summary | benefits.stanford.edu
CHIP
http://www.famis.org
(866) 873-2647
Washington
Medicaid
http://hrsa.dshs.wa.gov/
premiumpymt/Apply.shtm
(800) 562-3022 ext. 15473
West Virginia
Medicaid
http://www.dhhr.wv.gov/bms
(877) 598-5820, HMS Third
Party Liability
Wisconsin
Medicaid
http://www.badgercareplus.
org/pubs/p-10095.htm
(800) 362-3002
Wyoming
Medicaid
http://www.health.wyo.gov/
healthcarefin/index.html
(307) 777-7531
TRAILING
LEGALSTORY
NOTICES
LABEL
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.
HIPAA Special Enrollment Rights
You have special enrollment rights if you acquire
a new dependent, or if you decline coverage
under the Stanford University employee 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 Stanford University
sponsored medical plans, please visit the Benefits
website at http://benefits.stanford.edu and
search for “SBC” in the “Resource Library.” Paper
copies are also available, free of charge, from the
Benefits Office by calling (650) 736-2985 (option 9).
benefits.stanford.edu | 2015 Faculty Benefits Summary
41
TRAILING
LEGALSTORY
NOTICES
LABEL
Health Insurance
Marketplace Notice
Effective January 1, 2014, the Affordable Care Act—
also known as “health care reform”—requires most
Americans to have health insurance. Individuals
who don’t have coverage by January 1, 2014, 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 you
have the option for employer-provided health
coverage, it is unlikely that you will be eligible for
federal subsidies.
Why am I receiving this notice?
This notice provides you with information about
the Health Insurance Marketplace and where you
can access 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 employee to comply with rules
under the federal Affordable Care Act (ACA).
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 plan and you buy insurance in the
Marketplace, you will be responsible for paying the
entire premium yourself with after-tax dollars.
42
2015 Faculty Benefits Summary | benefits.stanford.edu
What is the individual mandate tax?
Under the ACA, 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/Newsroom/Affordable-CareAct-Tax-Provisions-Questions-and-Answers.
WHAT THIS MEANS FOR YOU
• Stanford has you and your family covered.
As a benefits-eligible employee, 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’s coverage will continue to provide
the greatest value. And because our plans
exceed the federally required “minimum value
standards,” it is unlikely that our employees
will be 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 https://www.healthcare.gov.
TRAILING
LEGALSTORY
NOTICES
LABEL
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.
This guide provides a brief summary of the benefit plans in effect on January 1, 2014, generally offered
to employees of Stanford University. It is not a Summary Plan Description (SPD). However, this guide
serves as the “Summary of Material Modification” to the employee 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. Keep in mind a
more current version may be available on the Benefits website at http://benefits.stanford.edu.
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.
Benefits Office
3160 Porter Drive, Suite 250
Palo Alto, CA 94304-8443
Phone: (650) 736-2985 (option 9)
Fax: (650) 723-7766
http://benefits.stanford.edu
benefits.stanford.edu | 2015 Faculty Benefits Summary
43
Medical
Blue Shield Plans
(blueshieldca.com)
Stanford HealthCare Alliance
(stanfordhealthcarealliance.org)
Kaiser Permanente
(kp.org)
Medical Plans
800-873-3605
Mail-Order Prescriptions
866-346-7200
Member Care Services
855-345-7422
HMO
800-464-4000
Mail-Order Prescriptions
800-464-4000
Health Savings Account: HealthEquity
(healthequity.com/stanford)
Vita Administration Company
(vitacompanies.com)
877-857-6810
Direct Pay Administrator for Leave Billing & COBRA
800-424-3052
Dental
Delta Dental
(deltadentalca.org/stanford)
800-765-6003
Mental Health and Substance Abuse Counseling
Stanford Faculty & Staff Help Center
(helpcenter.stanford.edu)
650-723-4577
Vision
Vision Service Provider (VSP)
(vsp.com)
800-877-7195
Flexible Spending Accounts
Benesyst (TASC)
(partners.benesyst.net/Stanford)
855-842-4913
Life & Disability
CNA Insurance Company (Long-Term Care)
(ltcbenefits.com)
Password: stanfordgltc
800-528-4582
Liberty Mutual (Short- and Long-Term Disability)
(mylibertyconnection.com)
Claimant Service ID: stanford
800-896-9375
Prudential Insurance Company of America
(Life Insurance, AD&D)
800-524-0542
Retirement Savings Plans
Stanford Retirement Manager
(netbenefits.com)
888-793-8733
TIAA-CREF
(tiaa-cref.org)
800-842-2888
Staff Retirement Annuity Plan (SRAP)
650-736-2985
(press option 3)
Stanford Benefits Service Center: 877-905-2985 or 650-736-2985 (press option 9)