Making the Right Choice
Stanford offers a variety of medical plan options to help you meet the health care needs of you and your family. As a full-time employee, Stanford contributions pay the full cost of Employee Only coverage for Kaiser Permanente. For all other plans, Stanford pays a significant portion of the costs for you and your family. Part-time employees receive one-half the contribution of full-time employees.
How Do HMOs Work?
A Health Maintenance Organization (HMO) is a health care group that provides services and supplies through its own network of doctors, hospitals and other health care facilities. When you enroll in an HMO plan, you will be asked to select a Primary Care Physician (PCP) from the network to coordinate all your health care needs (except with Kaiser Permanente).
You have no deductible. Instead, you pay a copayment for each office visit and hospital stay. You do not have to file a claim form. Emergency care is covered world-wide, but all other care is covered only when you see your PCP or get a referral.
Is an HMO right for you?
HMOs provide quality care and coverage at rates that are more affordable than a PPO. You select a doctor from the HMO's network to coordinate all your care, and you rarely have to worry about claim forms. If it's important for you to see a particular doctor, you should call your doctor's office to confirm if he/she is in the plan's network, or check the plan's online provider directory. You also need to live within the HMO's service area (usually a 30-mile radius of their facilities), so check with the plan before enrollment.
How Does The Blue Shield PPO Plan Work?
The Preferred Provider Organization (PPO) plan gives you the freedom to go to any Blue Shield provider in their large network of doctors, hospitals and other facilities. You may see health care providers of your choice outside the network.
In-Network
For most in-network providers and services, you pay a deductible, and then the plan pays 80% of most covered costs. You do not have to file a claim. Most providers will submit claims to Blue Shield for you. For routine office visits and preventive care, you only pay a copayment for each visit — the deductible doesn't apply.
Out-Of-Network
For out-of-network care your annual deductible is larger. After you meet your deductible, the plan pays 60% of most covered costs based on Blue Shield's Allowable Amount. You will need to file a claim before the plan will reimburse your out-of-pocket expenses. You are also responsible for any remaining amounts that Blue Shield does not pay.
Why choose a PPO?
A PPO generally charges higher premiums than an HMO, but offers more flexibility with providers you use. Your out-of-pocket costs are lower and more predictable when you receive care from network providers.
How Does The Blue Shield High-Deductible PPO Plan Work?
The High Deductible PPO plan works the same way as the Blue Shield PPO but has a higher deductible. There are no copayments for any services. Instead, all benefits (including prescription drugs) are covered after you've met your deductible. If you get care in the Blue Shield network, the High Deductible PPO pays 80% of most covered costs after you've met your deductible. For out-of-network providers and services, the plan pays 60% of most covered costs based on Blue Shield's Allowable Amount.
Unlike the other medical plans Stanford offers, the High Deductible PPO provides mental health and substance abuse benefits through its own network, rather than through United Behavioral Health (UBH).
Health Savings Account Compatible
The Blue Shield High-Deductible PPO meets federal guidelines for a Health Savings Account (HSA).
Why choose a high-deductible PPO?
The High Deductible PPO plan gives you the same flexibility as the PPO plan, plus it enables you to set aside funds on a tax-deductible basis using a personal Health Savings Account (HSA).
