educated choices spring_summer 2013

WorkLife Office: Helping You Integrate Your Personal and Professional Lives

Emergency Room or Urgent Care: Where Should You Seek Help?

Everything You Want to Know About Stanford’s Health Plans

Spring/Summer

2013 • Edition 2

CHOICESEducated

Participants in a Health

Improvement Class

Dear Colleagues:

What does the word “health” mean to you?

The World Health Organization defines health as “a state of complete physical, mental and

social well-being and not merely the absence of disease or infirmity.”

In this spring issue of Educated Choices, we’re going to take a deeper dive into health care at

Stanford. We will explain why Stanford offers the types of health plans that it does and how these

plans work. We will also showcase the benefits and services Stanford offers its employees that

may help you avoid and/or manage the conditions that take a steep toll on our pocketbooks and

our health.

We recognize, however, that good health is not measured simply by the number on a scale or the

absence of disease. It means being supported in all areas of your life. That’s why this issue of Educated

Choices offers profiles of the university’s WorkLife Office and Faculty & Staff Help Center—two fantastic

resources available to you as a Stanford employee.

All of us in University Human Resources hope we can play a positive role in helping you achieve your

goals of health, well-being, and professional and personal fulfillment.

Best wishes,

David A. Jones

Vice President of Human Resources

Educated Choices is produced by HR Initiatives, part of University Human Resources. The information provided in this publication is intended to educate Stanford employees on subjects pertinent to their utilization of Stanford’s health plans and other benefits. The information presented is not a substitute for a consultation with a doctor.

University Human Resources: 3160 Porter Drive, Suite 250, Palo Alto, CA 94304. Email: [email protected] .

Photo: Jennifer Sarbahi/Stanford University

Inside This IssueHow Can the WorkLife Office Help You? ............................................................... 4–5

Stanford Health Plans 101 .........................................................................................6–9

Resources for Prevention and Improved Health ...................................................... 10

Emergency Room or Urgent Care:

Where Should You Seek Help? .......................................................................................11

Choosing a Health Plan ......................................................................................... 12-13

Health Plan Terminology .....................................................................................14–15

In the Spotlight: Faculty & Staff Help Center .............................................................16

This material may describe various benefits offered by Stanford University and is not the official plan document for any. Benefits discussed here are governed by the plan or program documents, Stanford policies, and applicable state and federal laws. If there is a conflict between the wording of this information and any policy, governing document or law, the policy, governing documents, and applicable laws govern. Stanford reserves the right to alter, amend or terminate any of the benefits it offers at any time. Please refer to appropriate program documents for plan details, eligibility rules and possible taxation.

Nothing in this material should be construed as an implied or otherwise endorsement of services or products mentioned.

benefits.stanford.edu 3

How Can the WorkLife Office Help You?

4 benefits.stanford.edu

Israel Magallon

Public Safety Officer,

Department of Public Safety;

and his daughter

When the competing demands of work, personal and family responsibilities have you at wit’s end, do you know where to turn for guidance and support?

The WorkLife Office, part of University Human Resources, offers programs,

resources and support throughout every stage of life—from child care and

parenting support to active aging and elder care.

“Our staff and faculty are so busy contributing to

the Stanford community and the university’s mission

that they sometimes need help navigating the many

demands in their lives,” said Phyllis Stewart Pires,

director of WorkLife Strategy. “The WorkLife Office

exists to provide the support, information and tools

that members of our community need to maintain

their well-being and integrate their work and

personal lives.”

The WorkLife Office is ready to help you navigate

the following areas in your quest to achieve

work-life integration:

On-Site Child Care and Parenting Resources:

Help in finding care near where you live or work,

get information related to your specific needs

Financial Assistance Programs: Child Care

Subsidy Grant, emergency back-up care, faculty

child care assistance, adoption reimbursement

Navigating Work and Life: Resources and

consultation on setting goals and priorities and

identifying your support network

Education and Resources: In-person resource and referrals, educational

seminars, lactation resources, adoption information, website resources

Active Aging and Elder Resources: Caregiver resources including back-up

care, preparing for retirement, staying healthy and identifying new passions

Where Can I Go for WorkLife Help?

On- and Off-Campus

• 215 Panama Street,

Poplar Modular

• 140 Comstock Circle,

Escondido Village

• 3160 Porter Drive

(off Page Mill Road,

Palo Alto)

By Phone and Email

• 650-723-2660

• Email lists: ParentNet,

WorkLife, Over the

Rainbow, SeniorNet

On the WorkLife Website

• worklife.stanford.edu

1000+ Stanford affiliates received resource and referral services covering

a wide range of topics such as finding child care, addressing parenting

concerns and beginning the adoption process, saving them 3 to 10 hours

of their own time searching for answers

319 days were “saved” because faculty could access back-up child or elder care through the Faculty Back-Up Program, meaning they were at work knowing a loved one was cared for

1000+ Stanford affiliates took advanta

ge

of educational events, resource fairs a

nd

family support events to gain valuable

time-saving resources and conveniently

talk directly to skilled experts who

otherwise would require time-consuming

travel and scheduling

468 pregnant Stanford affiliates or their partners received advice and resources to navigate maternity and a smooth return to work following the birth of a child

800+ children were served by Stanford’s comprehensive child care system with full- and part-time care for children from infancy to school-age; providing a high-quality, reliable early care experience


Israel Magallon

Public Safety Officer,

Department of Public Safety;

and his daughter

Stanford Health Plans 101Part one of a two-part series about your health care at Stanford, why costs keep rising and what it all means for you:

A Q&A Session with Neal Evans, Stanford’s Health & Welfare Director

Q 1. What factors affect the rise in health-related costs at Stanford?

A The answer to this question is complex, as there are

many drivers of health care costs, including the cost

of developing new drugs and medical technologies and

treatments, and inappropriate utilization of health care services.

Americans are also growing older, getting heavier and sicker.

Obesity and obesity-related diseases (including but not limited

to diabetes, hypertension, heart disease and stroke) are on the

rise. Because these conditions are so damaging to one’s health

and require ongoing care, they also become very expensive

to treat. These expenses are not simply passed along to the

individuals affected by these conditions; they are distributed

to everyone in the form of higher health care costs.

At Stanford, we’re experiencing these same realities.

The average age of a Stanford benefits-eligible

employee is 47 (and rising each year), so we’re

seeing an increase in diseases related to

an aging population,

such as cancer.

Advancements in medicine to treat diseases like cancer

are more effective than ever before, but they’re also more

expensive. In fact, Stanford’s cost per participant for health

care has increased between 9 and 13 percent per year on

average between 2002 and 2012.

We want to ensure that our faculty and staff are as

healthy as possible and continue to have access to

world-class health care. At the same time, we’re no

different from other employers who are affected by

rising costs of health care.

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$71 million$71 million $130 million$130 millionThe amount Stanford spent

on employee health care in FY 2007.The amount Stanford is projected to spend in FY 2013.

Stanford’s health care costs have ALMOST DOUBLED over the last six years!

]


Q 2. Why should I be concerned about cost?

A Stanford offers a number of health care options to

employees: The Exclusive Provider Organization (EPO),

Preferred Provider Organization (PPO) and High-Deductible

Health Plan (HDHP) are “self-insured” plans, which means

that Stanford (not the insurance companies) pays for your

health care—from doctor’s visits to surgery and everything in

between. So, Stanford assumes the risk for all costs, not an

insurance company.

Stanford spends more than $100 million (an expense that has

nearly doubled in the last six years) to provide health care to

employees through the EPO, PPO and HDHP options. We pay

Blue Shield of California for access to its network of contracted

providers and claims administration. The dollars for paying

the actual claims are not coming from Blue Shield but from

Stanford, as well as from employees’ paycheck contributions

for coverage in the medical plan they select and copayments

for such things as doctor’s visits. In addition, employees who

select a plan with a deductible (such as the PPO or HDHP) are

responsible for the first portion of their medical expenses (the

deductible) before the plan pays any benefit.

This self-insured model is different from fully insured plans

like Kaiser Permanente, in which an employer (in our case,

Stanford) pays a premium to an insurance company to

assume the financial responsibility for employees’ health care.

For all of Stanford’s health plans, if claims for the year are

higher than expected, then any costs over budget will most

likely be reflected in next year’s premium.

Moreover, beginning in 2018, an excise tax (also referred to

as the “Cadillac tax”) will be levied on employer-sponsored

health plans that exceed government-mandated thresholds.

If Stanford does nothing to address our employees’ health

and medical plan structure starting now, then we face an

estimated $14 million excise tax penalty yearly—and this cost

will be passed onto employees.

Q 3. Why does Stanford offer four health plans?

A We want to offer our employees a choice of health

plans so that they can select the plan that best meets

their needs and those of their dependents. There are many

options through which employers can provide health care to

their employees. One option is offering a Health Maintenance

Organization (HMO) plan, such as Kaiser Permanente, in

which the employer pays a premium and the health plan

provides coverage and assumes the claims risk (called fully

insured). Employers may also choose to create a customized

health plan by paying an insurance company (such as Blue

Shield) for access to a network of providers, but the employer

pays the costs of employee claims (called self insured).

Stanford offers its employees a choice of four different

medical plans: Kaiser Permanente HMO, Blue Shield Exclusive

Provider Organization (EPO), Blue Shield Preferred Provider

Organization (PPO) and High-Deductible Health Plan (HDHP).

Our plans offer similar benefits with different cost-sharing

methods (such as copayments and deductibles) and different

care models (from HMOs, in which all care is received within

the HMO network; to PPOs, in which patients may seek care

outside of the preferred provider network). The cost of the

plans, including monthly premiums and copays, are different

heart diseaseheart diseaseThe costliest health conditionand the leading cause of deathin the United States, according tothe Agency for Healthcare Researchand Quality (part of the U.S. Department of Health and Human Services), costing $43.6 billion (women) and $47.3 billion (men) in 2008.

E$14 million$14 million

Excise tax that Stanford and its employees will have to pay in 2018

under the A�ordable Health Care Actif Stanford’s health plans stay on

their current cost trajectory.


depending on how the plan is structured. It is your responsibility

to select the plan that best meets your unique health needs

and fits within your personal budget, and then use that plan

appropriately by making informed health care decisions.

Q 4. Why do my contributions towards my Stanford health coverage rise each year?

A The short answer is because the cost of health care has

risen every year. Medical plan premiums (the cost of

having medical coverage) are based upon how much it costs

to deliver care to all employees and dependents enrolled in

any specific medical plan.

Each year at Stanford, we set a budget at the beginning of

the plan year based upon what we estimate we’re going

to spend on each plan. If we spend more than what was

budgeted, then any overrun costs will most likely be included

in the next year’s premium. How much we spend each year is

influenced by many factors, such as: 1) the demographics of

the employees who are enrolled in a plan; 2) the number of

“large claims” a plan may have in a given year; and 3) whether

or not participants use their plan appropriately. For example,

if you have a sore throat but go to the emergency room for

care instead of a primary care doctor or urgent care facility,

the cost is much higher. (See the article, “Emergency Room

or Urgent Care—Where Should You Seek Help?” on page 11

for more information.) For Stanford’s benefits programs, how

much the university contributes to your coverage each year

also plays a large role in how much your contribution may

increase year after year.

Q 5. How are the medical plan premiums set, and how are my contributions determined?

A Kaiser Permanente sets rates based upon how much

they spend delivering care to our employees and what

they expect to spend per employee in the next year. For self-

funded medical plans managed by Blue Shield, we calculate

the rate in a similar way by asking, “How much do we believe

we’ll spend on medical costs in the next year?”

Once we know what the medical plan premiums are for

each plan, we must determine how much employees will

contribute to the cost. Stanford’s current methodology for

delivering medical benefits and determining employees’

contributions is called “managed competition.” SFrom 2010 to the end of 2013, the

number of large claims (those over $200,000) for Stanford’s

EPO, PPO and HDHP plans climbed from 12 to 25 and the total costs

for these claims jumped from

$3.9 to 10 million$3.9 to 10 million

$2.6 trillion$2.6 trillionThe amount the United States

spends on health care services—more than any other country.

$

Under this model, health plans with different delivery

models, such as a Health Maintenance Organization (HMO)

or Preferred Provider Organization (PPO), may be offered.

However, all the benefits provided by the plans must be as

similar as possible (for example, the cost of an office visit

must be the same as a copay). Therefore, the plans must

compete on price by delivering quality care as inexpensively

as possible through their delivery model.

Each year, the plans present their premiums for the next year.

The medical plan with the lowest premium becomes the

“lowest-cost plan.” For that year, the premiums for this plan

determine what Stanford will contribute to all the other plans

that are offered. In 2013, Stanford’s lowest-cost plan is the

Kaiser Permanente HMO. We pay 100 percent of the cost for

an employee to be covered under Kaiser Permanente HMO

and 82 percent of the cost for employee-only coverage under

the Exclusive Provider Organization (EPO), PPO and High-

Deductible Health Plan (HDHP) offered through Blue Shield. If

you select the EPO, PPO or HDHP, you pay the remaining costs

of the plan you select through your payroll deductions.

Kaiser Permanente has been Stanford’s low-cost plan for

many years. Stanford’s self-funded medical plans (EPO, PPO

and HDHP) are competing with Kaiser on the efficiency of

delivering care.

Q 6. How can I help keep my costs low and save money on a Stanford health plan?

A You can keep your costs low regardless of which

Stanford medical plan you are enrolled in by utilizing

health care appropriately and making educated decisions,

including but not limited to: selecting generic drugs instead

of brand-name prescription drugs; avoiding the emergency

room except for true emergencies; staying healthy with

Stanford’s BeWell program and HIP classes; and participating

in Stanford Coordinated Care to manage chronic conditions.

Above all, getting regular preventive care and addressing health

issues before they become serious and require more intensive

treatment will help you save money and stay healthy.

Stanford offers a variety of benefits, programs

and resources to help you improve and

maintain your health and keep money

in your pocket. (See “Resources

for Prevention and Improved

Health” on page 10.) The

steps that you take to make

informed decisions and live

a healthy lifestyle have a

direct impact on the cost

of your health care and the

quality of your life.


$117.1 million$117.1 millionProjected FY 2013

Blue Shield plan costs.

What do you want to know about Stanford’s health plans? Let us know! We want to hear what’s on your mind.

We’ll answer questions in part two of the “Stanford Health Plans 101” series in the fall issue of Educated Choices.

HAVE A QUESTION?

bmTake the pop-up survey at

benefits.stanford.edu Email us at

[email protected]

—OR—

RESOURCES FOR PREVENTION AND IMPROVED HEALTHThe cost of poor health is steep—not only financially but also emotionally and physically. Stanford offers health plans,

programs and services to help support your efforts to maintain good health.

Wellness Programs

BeWell

Participating in BeWell@Stanford is one of the easiest things

you can do to commit to your health. Benefits-eligible

employees can earn taxable incentives for completing the

Stanford Health and Lifestyle Assessment (SHALA), an online

health risk assessment; completing a Profile, which includes a

health screening, advising session and online plan; participating

in a Stanford-sponsored medical plan; and agreeing to share

your SHALA and health screening information. You may also

earn additional money by completing five “Berries”—

health-related activities offered by BeWell.

Learn how to get healthy and earn money with BeWell at

bewell.stanford.edu .

Health and Fitness Resources

Physical Education, Recreation and Wellness

Through Stanford Athletics, you have access to nearly 20

athletic, recreation and wellness facilities, including one of

the world’s finest golf courses; a driving range; tennis courts;

a 75,000-square-foot sports and recreation center; playing

fields; and an aquatic center.

Find a class or activity that interests you at

pe.dept.stanford.edu .

Health Improvement Program (HIP)

You have more than 150 fitness and health education classes

throughout campus 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 $20 classes

per quarter.

To find a HIP class or listen to a pre-recorded HIP webinar,

visit hip.stanford.edu .

Emotional Support and Well-Being

Faculty & Staff Help Center

Stanford’s Faculty & Staff Help Center provides free,

professional and confidential counseling to Stanford-

affiliated individuals, couples and families on a variety of

issues, including job stress, relationship issues, parent-child

concerns, alcohol and drug abuse, care of elderly parents,

grief and loss, retirement issues and referral to outside

resources. Counseling is available for up to 10 sessions for

each situation.

To learn more, call the Help Center at 650-723-4577 or visit

helpcenter.stanford.edu .

Chronic Disease Management

Stanford Coordinated Care

Stanford Coordinated Care (SCC) is a dedicated team of

medical professionals and care coordinators who help

people with chronic illnesses lead a healthy life and smoothly

navigate their health care experiences. You may qualify for

SCC if you have conditions including but not limited to:

diabetes, heart disease and/or asthma/chronic lung disease.

You may also qualify if you have been prescribed more than

five medications.

Call Stanford Coordinated Care at 650-724-1800 or visit the

SCC website at stanfordhospital.org/coordinatedcare .

Health Plans

Kaiser Permanente, and Blue Shield EPO, PPO and HDHP

Benefits-eligible employees may choose from four different

Stanford-sponsored health plans. (See the article, “Stanford

Health Plans 101,” on pages 6–9 for more information.) For

details, visit benefits.stanford.edu .


RESOURCES FOR PREVENTION AND IMPROVED HEALTH

Everyone is bound to have a health problem that needs immediate

attention at some point in their lives—and where we go for medical

services can have a big impact on the care we receive and how

much it costs.

Did you know there is a difference—actually, a very significant difference—

between seeking care at an emergency room and an urgent care clinic? Generally, an emergency is a condition you believe

threatens your life or body part and requires immediate attention in order to preserve life or prevent impairment. On the other

hand, urgent care centers can treat medical problems such as broken bones that require care within 24 hours.

What should you do if you have an immediate medical problem? First, it is a good idea to call your medical provider or

health insurer’s advice nurse. He or she can give you advice on whether to go to an ER, urgent care center or your primary

care doctor’s office, or if you should treat yourself at home. Contacting your health insurer before seeking care may also

help prevent you from being held responsible for charges for seeking care in the wrong setting, such as a visit to the ER for a

condition that is not a true emergency.

Where should you seek care? Here are some examples of common medical conditions that are treatable at most urgent care

centers and those best managed at an ER:

Urgent Conditions Emergency Conditions

Emergency Room or Urgent Care—

Where Should You Seek Help?

Emergency Room(closest to campus)

Stanford University Medical CenterEmergency Department

900 Quarry Road, (near the intersection of Campus Drive)

650-723-5111

Open 24 hours a day every day of the year

Urgent Care Center(closest to campus)

Palo Alto Medical Foundation (PAMF)Palo Alto Urgent Care Center

795 El Camino Real, Palo Alto

650-321-4121

Open 7 a.m. to 9 p.m. every day of the year

Emergency Room(closest to campus)

Stanford University Medical CenterEmergency Department

900 Quarry Road, (near the intersection of Campus Drive)

650-723-5111

Open 24 hours a day every day of the year

Urgent Care Center(closest to campus)

Palo Alto Medical Foundation (PAMF)Palo Alto Urgent Care Center

795 El Camino Real, Palo Alto

650-321-4121

Open 7 a.m. to 9 p.m. every day of the year

• Severe headaches/ migraines

• Sprains/strains

• Urinary tract infection

• Nausea/vomiting/ diarrhea

• Dizziness

• Abdominal pain

• Minor cuts/ lacerations

• Fevers

• Chest pain

• Major bleeding

• Sudden, unexplained loss of consciousness

• Broken bones with severe deformities

• Stroke

• Motor vehicle accidents

Tessa St. Rose, Clinical Research Coordinator, Cancer Clinical Trials Office (left); and Nini Estevez, MPH, CCRC, Hematology Clinical Research Supervisor, Cancer Clinical Trials Office



Whichscenario

bestdescribesyou??

I don’t want to be surprised by a big medical bill.

I am relatively healthy, and other than my check up, I don’t see a doctor regularly.

I don’t mind receiving all of my care within a single health network, but I don’t want to spend a lot out of my paycheck.

I am getting older and starting to experience some health issues. I get regular preventive care and occasionally see a specialist.

I want a medical plan that is easy to navigate, but I like my current PAMF doctors.

I have kids who get the usual colds and scrapes every year.

We’re fairly healthy, but my spouse has high blood pressure, and I have a family history of cancer.

I take two di�erent kinds of prescription drugs regularly. I’ve ended up in the ER a few times.

I have available cash to cover a large deductible in case I have health care expenses before my Health Savings Account is fully funded.

I am interested in enrolling in Stanford Coordinated Care to manage my chronic illnesses and improve my well-being. I want to take advantage of the university incentive to be in the SCC program.

I earn a decent salary and want to take advantage of as many pre-tax deductions as possible. I like the idea of a Health Savings Account so I can lower my taxable income while saving money for health care expenses when I retire.

Kaiser Permanente (HMO)

This is Stanford’s low-cost plan.

Care is available only within the Kaiser Permanente network.

You choose a primary care physician (PCP) and receive a referral before seeing a specialist.

You pay a fixed copay for o�ce visits, emergency room visits and hospital stays.

Preventive care, screenings and immuni-zations are provided at no cost.

Kaiser only covers emergency care received outside of its network if you contact Kaiser within 48 hours of receiving care.

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Choosing a Health PlanEach of Stanford’s health plans has di�erent benefits and costs that you’ll want to consider depend-ing on your care needs, health goals and financial situation. Listed below are highlights of each of Stanford’s health plans to help you better understand which plan may be best for you.

Exclusive Provider Organization (EPO)

You may only use network doctors, and there is no coverage outside of the network.


You must contact Blue Shield to preauthorize certain non-emergency care, and for elective procedures and treatments.

The EPO covers emergency care for injury or illness worldwide as long as you contact Blue Shield within 48 hours of receiving emergency care.

Preferred Provider Organization (PPO)

The plan is designed to lower your out-of-pocket costs when you see a network provider for your care.

You can see other doctors who are not contracted with Blue Shield, but your out-of-pocket costs will be higher.

You see almost any licensed provider for your care, and you have coverage worldwide for both routine care and emergencies.

O�ce visits are covered in full after you pay a low copayment. There is no deductible or coinsurance unless your doctor orders services such as a lab or X-ray.

High-Deductible Health Plan (HDHP)

The plan o�ers lower premiums compared to Blue Shield EPO and PPO.

You have the opportunity to use a Health Savings Account (HSA) to set aside tax-free money to pay for eligible health care expenses.

You have access to both in-network and out-of-network benefits just like the traditional PPO o�ered by Stanford.

The plan protects you by limiting how much you’re responsible for paying every year (called an out-of-pocket maximum) so you don’t have to worry about catastrophic medical expenses.

I have serious, ongoing health issues and see various di�erent specialists to manage my care.

I like to choose my own specialists and go in or out of network depending on my needs. I am OK with paying higher monthly premiums for this flexibility.


Whichscenario

bestdescribesyou??

I don’t want to be surprised by a big medical bill.

I am relatively healthy, and other than my check up, I don’t see a doctor regularly.

I don’t mind receiving all of my care within a single health network, but I don’t want to spend a lot out of my paycheck.

I am getting older and starting to experience some health issues. I get regular preventive care and occasionally see a specialist.

I want a medical plan that is easy to navigate, but I like my current PAMF doctors.

I have kids who get the usual colds and scrapes every year.

We’re fairly healthy, but my spouse has high blood pressure, and I have a family history of cancer.

I take two di�erent kinds of prescription drugs regularly. I’ve ended up in the ER a few times.

I have available cash to cover a large deductible in case I have health care expenses before my Health Savings Account is fully funded.

I am interested in enrolling in Stanford Coordinated Care to manage my chronic illnesses and improve my well-being. I want to take advantage of the university incentive to be in the SCC program.

I earn a decent salary and want to take advantage of as many pre-tax deductions as possible. I like the idea of a Health Savings Account so I can lower my taxable income while saving money for health care expenses when I retire.

Kaiser Permanente (HMO)

This is Stanford’s low-cost plan.

Care is available only within the Kaiser Permanente network.

You choose a primary care physician (PCP) and receive a referral before seeing a specialist.


Preventive care, screenings and immuni-zations are provided at no cost.

Kaiser only covers emergency care received outside of its network if you contact Kaiser within 48 hours of receiving care.

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Choosing a Health PlanEach of Stanford’s health plans has di�erent benefits and costs that you’ll want to consider depend-ing on your care needs, health goals and financial situation. Listed below are highlights of each of Stanford’s health plans to help you better understand which plan may be best for you.

Exclusive Provider Organization (EPO)

You may only use network doctors, and there is no coverage outside of the network.


You must contact Blue Shield to preauthorize certain non-emergency care, and for elective procedures and treatments.

The EPO covers emergency care for injury or illness worldwide as long as you contact Blue Shield within 48 hours of receiving emergency care.

Preferred Provider Organization (PPO)

The plan is designed to lower your out-of-pocket costs when you see a network provider for your care.

You can see other doctors who are not contracted with Blue Shield, but your out-of-pocket costs will be higher.

You see almost any licensed provider for your care, and you have coverage worldwide for both routine care and emergencies.

O�ce visits are covered in full after you pay a low copayment. There is no deductible or coinsurance unless your doctor orders services such as a lab or X-ray.

High-Deductible Health Plan (HDHP)

The plan o�ers lower premiums compared to Blue Shield EPO and PPO.

You have the opportunity to use a Health Savings Account (HSA) to set aside tax-free money to pay for eligible health care expenses.

You have access to both in-network and out-of-network benefits just like the traditional PPO o�ered by Stanford.

The plan protects you by limiting how much you’re responsible for paying every year (called an out-of-pocket maximum) so you don’t have to worry about catastrophic medical expenses.

I have serious, ongoing health issues and see various di�erent specialists to manage my care.

I like to choose my own specialists and go in or out of network depending on my needs. I am OK with paying higher monthly premiums for this flexibility.


HEALTH PLAN TERMINOLOGY

ALLOWABLE AMOUNT:

FULLY INSURED:

COPAY:

COINSURANCE:

EPO:

DEDUCTIBLE:

FORMULARY:

The allowable amount is what Blue Shield uses to determine how much to pay when you see a provider outside the Blue Shield network. The allowable amount is based on a variety of factors and generally reduces the amount paid by Blue Shield (which, in turn, increases what you have to pay).

A fully insured health plans is one in which an employer pays the health insurance premiums for coverage while the health insurance company is responsible for paying any medical costs from eligible claims.

An out-of-pocket expense in which the insured (Stanford employee) pays a specified amount for health care services such as doctor visits and prescriptions drugs at the time the service is provided, with the health insurer paying the remaining costs.

The portion of covered expenses the insured (Stanford employee) must pay in addition to any copayments, access fees and deductible.

An Exclusive Provider Organization (EPO) provides complete medical services from an exclusive network of doctors, hospitals and other care providers. Generally, you receive no benefit if you get care from a provider who is not part of the EPO’s network.

The amount of covered expenses that a covered person must incur in a calendar year and is responsible to pay before we pay certain covered expenses.

A formulary is a list of approved prescription drugs covered by Blue Shield. Blue Shield has three tiers: generic, brand and non-formulary. These three tiers provide access to as many drugs as possible, but brand and formulary tiers are more expensive, so they increase your out-of-pocket costs.



HDHP:

HSA:

IN NETWORK:

OUT OF NETWORK:

OUT-OF-POCKET MAXIMUM:

PPO:

SELF INSURED:

A High-Deductible Health Plan (HDHP) is a type of health plan that typically consists of a lower premium, higher deductible and no copayments. All expenses incurred are credited toward the deductible until it is met. Many of these plans can also be combined with a Health Savings Account (HSA).

A Health Savings Account (HSA) provides HDHP participants with a tax-free way to save for qualified health care expenses, such as the out-of-pocket health care expenses that HDHP participants pay until the deductible is met.

Health care providers who are contracted with Blue Shield. When you see an in-network provider, you receive 100 percent coverage for preventive care and 80 percent coverage for all other eligible services after you meet your deductible. By receiving care from an in-network doctor, you are charged the lowest, pre-negotiated Blue Shield rate for that service. Staying within network is the best way to keep your out-of-pocket expenses low.

Health care providers who are not contracted with Blue Shield. You have the freedom to see an out-of-network provider, but you will be charged a higher rate compared to seeing an in-network provider.

An annual limit on how much you are responsible for paying out of pocket every year so you don’t have to worry about catastrophic medical events.

A Preferred Provider Organization (PPO) is a type of health plan that allows plan participants (Stanford employees) to choose the doctors and hospitals from which they want to receive services.

A self-insured health plan is one in which an employer (Stanford) provides health benefits to employees with its own funds. The employer assumes the risk for payments of the claims for benefits.


IN THE SPOTLIGHT: Faculty & Staff Help Center

3160 Porter Drive, Suite 250

Palo Alto, CA 94304-8443

FIRST-CLASS MAIL

PRESORTED

U.S. POSTAGE PAID

PALO ALTO, CA

PERMIT NO. 28

Stanford’s Faculty & Staff Help Center (FSHC) provides free,

professional and confidential counseling to individuals,

couples and families. The Help Center is staffed by licensed

clinical social workers, marriage and family therapists, and

psychologists representing different ages, backgrounds and

ethnicities. The Help Center also offers workshops and peer

support groups to help Stanford employees who are dealing

with a variety of issues, including:

The Help Center offers short-term counseling—up to 10

sessions per issue—that focuses on problem recognition

and resolution, and offers referrals to outside agencies

and resources if further counseling is needed. Sessions are

completely confidential.

• How to contact us: 650-723-4577 or

[email protected]

• Where to find us: Mariposa House, 585 Capistrano

Way (on campus); satellite offices at SLAC, the

Medical Center and in San Jose

• When we’re available: Monday through Thursday,

8 a.m. to 6 p.m.; and Friday from 8 a.m. to 5 p.m. • Job stress

• Anxiety/Depression

• Relationship issues

• Parent-child concerns

• Alcohol and drug abuse

• Care of elderly parents

• Grief and loss

• Retirement issues 2,288 faculty and staff

utilized some aspect of FSHC’s services from 2011 to 2012.

educated choices spring_summer 2013

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