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Faculty Benefits Summary Effective January 1, 2014


Table of Contents Who Is Eligible for Stanford Benefits?...........................................................2 Contributing to Your Plans..............................................................................4 Want More Money in Your Pocket and Better Health? BeWell@Stanford...........................................................5 Fitness and Healthy Living Classes With the Health Improvement Program (HIP).............................................................6 Need Medical Services Before You Receive Your ID Card?..................................................................7 When Coverage Starts......................................................................................7 What Happens If I Don’t Enroll?......................................................................8 Medical Plans.....................................................................................................9 Prescription Drugs...........................................................................................12 Mental Health & Substance Abuse...............................................................13 Dental Plans.....................................................................................................13 Vision Care........................................................................................................14 Flexible Spending Accounts..........................................................................15 Life and Accident Insurance..........................................................................16 Disability (Wage Replacement).....................................................................18 Unemployment Insurance.............................................................................19 Workers Compensation.................................................................................19 Retirement Savings Plans..............................................................................20 Stanford WorkLife Office................................................................................21 Tuition Grant Program (TGP)........................................................................21 Other Resources and Services......................................................................22


Dear Faculty Member, Stanford University is committed to providing you with comprehensive benefits as part of your total rewards package to meet the needs of you and your family. It is your responsibility to select the plans and options that are the best fit for you and your eligible dependents. In this Faculty Benefits Summary, you will find an overview of the benefit plans and programs Stanford offers to eligible employees—from health, life and disability insurance to educational assistance and child care resources. Whether you are new to Stanford or a current employee making benefits elections during Open Enrollment, this guide will help you make educated choices and get the most out of your Stanford benefits. In good health, Stanford Benefits


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 (four months or more for bargaining unit employees); 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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»» 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 for its review and approval of continued coverage. In most cases, coverage for a disabled child can continue for as long as the child is incapable of self support, unmarried and fully dependent on you for support.


Your Same-Sex Spouse

If You Add a Dependent to Coverage

You may cover your same-sex 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.

We require proof of dependent eligibility for the dependents you cover. A document that lists acceptable forms of proof, titled “Dependent Eligibility Documentation Requirements,” is available on the Stanford Benefits website at benefits.stanford.edu .

Your Registered Domestic Partner You may cover your registered domestic partner if your partnership is registered with the State of California. You do not have to live in 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

Does Your Spouse 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 parent may cover eligible dependent children.

Waiving Medical Coverage If you have medical coverage elsewhere, you may choose to waive coverage through Stanford. 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, benefitseligible position) provided as taxable income in your paycheck.

• 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

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Contributing to Your Plans Stanford University pays for the majority of the cost of your health- and wellness-related benefits. Your individual contribution is the amount that the university does not cover.

University-Provided Benefits Stanford contributes 100 percent of the costs for the following benefits; you pay nothing!

• Employee coverage under the lowest-cost medical plan (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

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

• Your Supplemental Life Insurance • Dependent Life Insurance for your spouse/ registered domestic partner and children

Shared-Cost and Full-Cost Benefits If you do not select the lowest-cost medical plan, 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 for dependent coverage in the medical plans. There are other benefits for which Stanford pays the majority cost, and benefits for which you pay the full cost.

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• Long-Term Care Insurance for you, your

spouse/registered domestic partner and certain other family members.


Want More Money in Your Pocket and Better Health? BeWell@Stanford Would you like to put extra money in your pocket each year just for taking steps to enhance your health? One of the easiest ways to make a commitment to your health in 2014 is to participate in BeWell@Stanford. This employee incentive program encourages Stanford employees and their spouses or registered domestic partners to adopt healthy behaviors that can improve their health, wellbeing and quality of life. Benefits-eligible employees (and their spouses/ registered domestic partners) can earn a $480 taxable incentive in the coming year ($20 in each paycheck) for completing these four steps by November 30: 1. Complete the Stanford Health and Lifestyle Assessment (SHALA)—an online health risk assessment. 2. Complete the Profile, which includes a health screening, advising session and online plan.

outreach. Rest assured that BeWell and Stanford are committed to protecting the security of your health information.) Your spouse can benefit, too! Spouses of benefits-eligible university employees will receive a $240 taxable wellness incentive if they meet the same criteria (listed above). This will be added to the employee’s paycheck, with the amount increasing from $20 (employee only) to $30 (employee + spouse). Note: Spouses/registered domestic partners are only eligible to receive the incentive if the employee is also eligible for the incentive.

Other Ways to Participate You can earn additional money by completing five “Berries”—health-related activities offered by BeWell—before the November 30 deadline. Participants can focus on the areas that are of the most interest to their wellbeing. Here are some of the Berries available to you:

3. Be enrolled in a Stanford-sponsored medical plan in 2014.

• Fitness Assessment, Personal Training,

4. Agree to share your SHALA and health screening information.

• Nutrition Workshop and Healthy

(BeWell advisors will review the information with you and may use your results to suggest appropriate health promotion resources. Your medical plan may also use your information for the purpose of health promotion and/or disease management

Physical Activity and BeWell Walkers Living Workshop

• Stress Workshop, Wellness Advocate and Well Visit

Learn how to get healthy and earn money with BeWell at bewell.stanford.edu .

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Fitness and Healthy Living Classes with the Health Improvement Program (HIP) Did you know you have more than 150 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 $20 classes per quarter. You may choose from:

• Group Fitness: Cross training, indoor

cycling, yoga, Pilates, tai chi, swimming, dance and more.

• 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.

To find a class or listen to a pre-recorded webinar, visit hip.stanford.edu .

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. With all of these facilities at your disposal, you have every opportunity to find an activity that fits your needs and interests, and get fit. Find a class or activity that interests you at stanford.edu/dept/pe . 

Why Does BeWell Ask You to Share Your Information? To receive the employee incentive, BeWell asks you to share your Stanford Health and Lifestyle Assessment (SHALA) and health screening information with us. Why? We use your information to help you identify ways to improve your health and/or manage any chronic conditions you may have. How? 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 may also use your information for the purpose of health promotion and/or disease management outreach. Rest assured that BeWell and

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Stanford are committed to protecting the security of your health information and may use your results to suggest appropriate health promotion resources, both on campus or with your medical plan. Your medical plan may also 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 security of your health information.


When Coverage Starts 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, 2014. If you are a new hire, coverage under most plans starts on your date of hire with the following exceptions:

• Your Flexible Spending Accounts begins the date you elect coverage.

• 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, reviewed and approved by the insurance company. See page 16 for more information on life insurance and page 17 for an explanation of EOI.

• Long-Term Care Insurance begins the

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 (new hire, marriage, birth, etc.) 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 following exceptions:

• 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, reviewed and approved by the insurance company.

date your application is approved by CNA.

Need Medical Services Before You Receive Your ID Card?

If you remain in the same medical plan: Simply use your current medical ID card. If you change medical plans for 2014 by the end of Open Enrollment (November 19, 2013) your ID card should be sent to you by the end of 2013. If you have not received it and need medical care on or after January 1, 2014, 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.

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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. If you are a full-time employee and do not want medical or dental coverage through Stanford, you must log on to MyBenefits and actively waive coverage.

Full-Time Employees If you work 75 to 100 percent time and do not enroll within 31 days of your hire date, you will be assigned:

• Blue Shield High-Deductible Health Plan • Delta Dental Basic PPO • Basic Life Insurance • Long-Term Disability (LTD)

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)

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You will not have medical or dental coverage. 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, unless you have a Life Event change. Find more information on Life Event changes on the Benefits website at benefits.stanford.edu .

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, except for the benefits specified below. Note: The cost will reflect the contribution amounts for the 2014 plan year.

• You will not have a health care and/or a

dependent day care Flexible Spending Account.

• You will not receive your Child Care Subsidy Grant if one had been awarded to you.

• You will not have a 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.)


Medical Plans Stanford offers a variety of medical insurance plans, all of which provide coverage for preexisting 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 an Accountable Care Organization (ACO). A new health plan offering in 2014, Stanford HealthCare Alliance is a select network health plan in which Stanford Hospital & Clinics 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 Hospital & Clinics (SHC) and Lucile Packard Children’s Hospital (LPCH) to allow for seamless coordination of the high-quality care you expect from this world-class institution. As a SHCA member, your SHCA Member Care Services team provides personalized assistance to you in scheduling appointments, selecting physicians and navigating your care experience, and answering all claims and billing issues. Stanford HealthCare Alliance covers your expenses only if you go to an SHC 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

Like an HMO, you select a primary care physician (PCP) to coordinate and provide all of your primary care. If you need to see a specialist, you will need approval and referral from 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.

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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. 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.

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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 out-of-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; 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.

Health Savings Account (HSA) (*Only available if you enroll in the Blue Shield High-Deductible Health Plan) The Blue Shield High-Deductible Health Plan (HDHP) meets federal guidelines for a Health Savings Account, allowing you to set aside tax-deductible funds for future health care expenses. In 2014, the HSA limit—the amount you contribute in 2014—is $3,300 (for employees only) and $6,550 (for employees + 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 healthequity.com/stanford , or call HealthEquity at 877-857-6810. Note: If you have an HSA, you cannot also have a health care Flexible Spending Account.

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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).

*These amounts are for employees who set up their account(s) with HealthEquity during Open Enrollment. If you enroll any time after January 1,

the amount Stanford contributes will be prorated based on the number of pay periods remaining after you set up your account. ** Note: When you reach age 65, you must defer coverage under Medicare Parts A and B to continue the HSA benefit. If you have enrolled in Medicare Parts A and B, you are no longer eligible for the HSA benefit. Once you become Medicare eligible, your HSA benefit will be automatically waived. If you are not enrolled in the Medicare Parts A and B and want to continue the HSA benefit, you will need to contact the service center to have them re-enroll you.

Prescription Drugs

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Your medical plan provides prescription drug coverage, so be sure to take your medical plan’s ID card when you have a prescription filled.

a Blue Shield network pharmacy, your costs are lower. You can find a list of these pharmacies on the Blue Shield website at blueshieldca.com .

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

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).

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Mental Health & 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.

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 helpcenter.stanford.edu .

Dental Plans 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 the option of two plans: Delta Dental Basic PPO plan and Delta Dental Enhanced PPO plan. The Delta Dental Enhanced PPO plan requires a contribution but provides a higher level of coverage for some services when you use Delta Dental PPO providers. This plan

includes orthodontic treatment and coverage for implants. The Delta Dental Basic PPO plan is free for full-time employees, but it does not include orthodontic treatment and coverage for implants. You may view more details about Stanford’s dental coverage on the benefits.stanford.edu website. Remember: 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.

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Vision Care 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 vsp.com . You can find VSP contact information in the Contacts section of the Stanford Benefits website at benefits.stanford.edu .

VISION CARE

COST WHEN USING A VSP PROVIDER

Eye exam once every calendar year

$25 copay

Lenses once every calendar year (includes basic, bifocals, or progressive)

Plan pays 100%

Frames once every calendar year

Plan pays 100% up to $150 retail value

Contact lenses once every calendar year in lieu of frames and lenses • Medically necessary

Plan pays 100%

• Elective (fitting and materials)

Plan pays 100% up to $150

Extras, including scratch-resistant lenses, antireflective lenses, additional prescription glasses or sunglasses * $40 copay for progressive lenses

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Discount through your VSP provider


Flexible Spending Accounts Flexible Spending Accounts 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. Important: These accounts have some restrictions on allowable expenses, and any money left in your account at the end of the year will be forfeited; it cannot be rolled over to the next year or paid out. If you elect an FSA, Stanford’s vendor, Benesyst, will send you a welcome kit and new debit cards for 2014.

Two Types of Flexible Spending Accounts Health Care FSA

You may use this account to pay for medical and dental copayments, deductibles, prescription 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 2014 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. However, 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 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 2014 is $5,000 per household. 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 benefits.stanford.edu , and click on the Medical & Life section and then the Flexible Spending Accounts section.

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Life and Accident Insurance Basic Life Insurance Stanford automatically provides insurance coverage in an amount equal to your annual 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 will be prompted to complete an online EOI short form directly with the insurance company. If approved, your coverage is not automatically updated and will be pending until the insurance company administers the approval. A confirmation of your approval will be sent separately. However, you will have the option to print the approval from the insurance company’s website or have it mailed to your by the insurance company. If you complete the EOI short form and are not approved, you will be automatically taken to the online EOI long form to complete.

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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. You will be prompted to complete an online EOI short form directly with the insurance company. If approved, your coverage is not automatically updated and will be pending until the insurance company administers the approval. A confirmation of your approval will be sent separately. However, you will have the option to print the approval from the insurance company’s website or have it mailed to your by the insurance company. If you complete the EOI short form and are not approved, you will need to print and complete the EOI long form and mail or fax it back to the insurance company.

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.


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 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.

Business Travel Accident Insurance Stanford provides you with Business Travel Accident Insurance if 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 asked to complete a form as part of the enrollment process. Coverage

begins after the form is reviewed and approved by the insurance company. While your application is processed, you will be insured for the highest amount that does not require EOI.

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Disability (Wage Replacement) Voluntary Short-Term ( Non-Work Related) Disability Insurance Stanford automatically enrolls you in a short-term disability plan, called Voluntary Disability Insurance (VDI). The plan pays 60 percent of your basic earnings, 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 your Payroll Department. You may always return to the VDI plan as long as you complete a SDI Rejection Notice. For more information on SDI, visit California’s Employment Development Department website.

Long-Term Disability (LTD) As part of your benefits, Stanford provides LTD coverage that pays you a monthly benefit if you become completely disabled or are unable to work after 90 days of continuous disability. 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 earnings. This amount may be reduced by payments you receive from other sources, such as Workers’ Compensation or Voluntary Short-Term Disability Insurance.

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2014 Faculty Benefits Summary | benefits.stanford.edu

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. Enrollment and all customer service issues are handled directly through CNA. LTC 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 benefits.stanford.edu under the Medical & Life section.


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 board-certified 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 doctors 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 stanford.edu/dept/risk-management for more information.

benefits.stanford.edu | 2014 Faculty Benefits Summary

19


Retirement Savings Plans 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.

Visit the Stanford Benefits website at benefits. stanford.edu to learn more about Stanford’s retirement savings plan and to:

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.

• See the plan details in the Summary Plan

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.

• Schedule a free financial counseling

If you do decide to contribute money toward your retirement out of your paycheck,

20

you become eligible for Stanford’s Match Contribution—up to an additional 5 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.

2014 Faculty Benefits Summary | benefits.stanford.edu

Description (SPD).

• Use the Before-Tax Calculator to help you determine your maximum contribution.

appointment with a representative from Fidelity, Vanguard or TIAA-CREF.


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.

For the 2013-2014 fiscal year, the maximum available amount is $21,345, 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 hreap.stanford.edu .

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. Additional information on these programs and others is available on the WorkLife website at worklife.stanford.edu , or by calling 650-723-2660.

partner’s) federal taxable gross income and number of eligible children age 9 or younger. To learn more about CCSG, go to the WorkLife Office website at worklife.stanford.edu .

Child Care Subsidy Grant (CCSG) Program

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. Dependents include infants through school age children, and elders in ones immediate family. Get more information on the WorkLife website at worklife.stanford.edu .

Stanford provides up to $5,000 per year in tax-free grants for eligible child care expenses. Grant amounts are based on your the applicant’s (including spouse’s/registered domestic

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

benefits.stanford.edu | 2014 Faculty Benefits Summary

21


Other Resources and Services Stanford Coordinated Care

News and Information

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 stanfordhospital.org/coordinatedcare , or call 650-724-1800.

The Stanford Report includes daily news and events at Stanford and is sent to all employees electronically. Stanford employees also receive The Stanford Employee Insider, a quarterly digital employee newsletter produced by University Human Resources. SLAC employees also receive SLAC Today via email.

Use of Facilities For information on lectures, concerts, athletic events, exhibits, libraries, gyms, pools and much more, visit Stanford’s New Hire website at newhire.stanford.edu/benefits . For access to athletic facilities on campus, call 650-723-1949.

Direct Deposit/Withholding Information Learn how to sign up for direct deposit of your Stanford paycheck at the Axess website at axess.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 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 on-campus 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 fsh.stanford.edu , or call 650-725-6893.

22

2014 Faculty Benefits Summary | benefits.stanford.edu


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 facultyhandbook.stanford.edu .

• For faculty policies, procedures, forms and

• View the Research Policy Handbook at

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 engaged in international work. Find the guide at stanford.edu/group/fms/globalops/guide .

helpful links, go to facultyaffairs.stanford.edu. For questions, email facultyaffairs@stanford.edu • The Faculty Development & Diversity Office at facultydevelopment.stanford.edu or call 650-723-3622. and the Office of Diversity & Access at • For policies specific to your school, go to your stanford.edu/dept/diversityaccess may school’s website or contact your dean’s office provide additional information. at facultyaffairs.stanford.edu/other_contacts.

benefits.stanford.edu | 2014 Faculty Benefits Summary

23


$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.

Benefits Plan Comparison Charts

Office copay

Pre-Authorization Requirement

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.

Overview

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.

Stanford HealthCare Alliance ACO Plan - Group #976248

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.

$20 copay primary/$50 copay specialist

PENALTY for not pre-authorizing: not covered.

Pre-authorization required for all elective inpatient and outpatient procedures.

You may use only Kaiser doctors and facilities except in emergencies.

Kaiser Permanente HMO (CA) Group #7145 (Northern CA) Group #230178 (Southern CA)

benefits.stanford.edu | 2014 Faculty Benefits Summary

Network: 80% after deductible 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 may be denied in full for failure to pre-authorize.

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

2014 Benefits Plan Comparison Charts

24


100% after applicable copays

$3,000 per individual/$6,000 family

Coinsurance

Out-of-Pocket Maximum

Blue Shield must approve mental health care. INPATIENT CARE $100 copay per admission OUTPATIENT CARE [no visit limit] $20 copay per visit

INPATIENT CARE $100 copay per admission

OUTPATIENT CARE [no visit limit] $20 copay per visit

100%

$3,000 per individual/$6,000 family

100% after applicable copays

No deductible

Blue Shield EPO Plan Group #976109

Stanford HealthCare Alliance must approve mental health care.

Benefits Plan Comparison Charts

Mental Health

Mental Health/Autism/Substance Abuse

Prenatal Visits

100%

No deductible

Deductible

Maternity

Stanford HealthCare Alliance ACO Plan - Group #976248

Benefit Description

OUTPATIENT CARE [no visit limit] Network: 80% after deductible Non-Network: 60% after deductible

OUTPATIENT CARE [no visit limit] Network: $20 copay per visit Non-Network: 60% after deductible

OUTPATIENT CARE [no visit limit] $20 copay per visit, individual $10 copay per visit, group

INPATIENT CARE $100 copay per admission

25

Kaiser must approve mental health care.

100%

$3,000 family

$1,500 per individual

100% after applicable copays

No deductible

Kaiser Permanente HMO (CA) Group #7145 (Northern CA) Group #230178 (Southern CA)

benefits.stanford.edu | 2014 Faculty Benefits Summary

Non-Network: 60% after deductible

Network: 80% after deductible

Network: 100% after deductible Non-Network: 60% after deductible

INPATIENT CARE Pre-Certification is required by you or your provider. INPATIENT CARE Pre-Certification is required by you or your provider.

Network: 80% after deductible Non-Network: 60% after deductible

Combined network or non-network

Non-Network: $7,500 per individual/$15,000 family

Network: $20 copay (first visit) Non-Network: 60% after deductible

$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 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


Benefits Plan Comparison Charts

Office visit copayment, or Emergency Room copayment, depending on the facility.

Urgent Care

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

Office copay may apply.

Office copay may apply.

100% after $50 copay

100%

In-network providers only

In-network providers only

100%

Up to 20 visits per year

Up to 20 visits per year

Ambulance Charges

Allergy Tests

Acupuncture $20 copay

OUTPATIENT CARE [no visit limit] $20 copay per visit

OUTPATIENT CARE [no visit limit] $20 copay per visit

$20 copay

INPATIENT CARE $100 copay per admission

INPATIENT CARE $100 copay per admission

Other Services

Blue Shield must approve substance abuse care.

Stanford HealthCare Alliance must approve substance abuse care.

Substance Abuse

Blue Shield EPO Plan Group #976109

Stanford HealthCare Alliance ACO Plan - Group #976248

Benefit Description

$50 copay; lab/other services 80% after deductible, network or nonnetwork

Lab/ancillary/professional charges paid at 80% after deductible, network or non-network

100% after $100 copay per visit (copay waived if admitted)

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 visits per year

Non-Network: 60% after deductible

$20 copay at Kaiser facility

$100 copay (waived if admitted)

Kaiser providers only

Up to 40 combined chiropractic and acupuncture visits per year

$15 copay

100% after $50 copay

$20 copay

Kaiser providers only

Up to 40 combined chiropractic and acupuncture visits per year

$15 copay

benefits.stanford.edu | 2014 Faculty Benefits Summary

Network or Non-Network: 80% after deductible

Lab/ancillary/professional charges paid at 80% after deductible, network or non-network

Non-Network: 80% 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

Network or Non-Network: 80% after deductible (if medically approved)

Non-Network: 60% after deductible

Network: 80% after deductible

Up to 20 visits per year

Non-Network: 60% after deductible

Network: 80% after deductible

Network: 80% after deductible Non-Network: 60% after deductible

Network: $20 copay primary / $35 copay specialist Non-Network: 60% after deductible

Network: 80% after deductible

OUTPATIENT CARE [no visit limit]

OUTPATIENT CARE [no visit limit]

26

Transitional Residential Recovery Services $100 copay per admission

OUTPATIENT CARE [no visit limit] $20 copay per visit, individual $5 copay per visit, group

INPATIENT CARE Network: 80% after deductible Non-Network: 60% after deductible

INPATIENT CARE Network: 100% after deductible Non-Network: 60% after deductible

Kaiser Permanente HMO (CA) Group #7145 (Northern CA) Group #230178 (Southern CA) INPATIENT DETOXIFICATION $100 copay per admission

Blue Shield High Deductible PPO Plan - Group #170293 Pre-certification is required by you or your provider.

Pre-certification is required by you or your provider.

Blue Shield PPO Plan Group #170292


Limited to screen and refraction exams only

Network: 50% of Stanford HealthCare Alliance allowed charges for professional and diagnostic services; limited to three cycles of intrauterine insemination (IUI).

100%

$20 copay primary/$50 copay specialist

$50 copay

Limited to screen and refraction exams only

Infertility Treatment

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).

$100 copay per admission

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.

Non-Network: 60% after deductible

Non-Network: 60% after deductible

Pre-Certification required by you or your provider.

Network: 80% after deductible

Blue Shield High Deductible PPO Plan - Group #170293

Network: 80% after deductible

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

100%

27

Eye exams only. Discount program available 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

[3 visits per day max]

Up to 100 two-hour visits/calendar year

100%

Kaiser Permanente HMO (CA) Group #7145 (Northern CA) Group #230178 (Southern CA)

benefits.stanford.edu | 2014 Faculty Benefits Summary

Network: 80% after deductible Non-Network: 60% 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

Non-Network: Not covered In Vitro, GIFT, and ZIFT: 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

$100 copay per admission

Hospital Stay

100%

100%

Home Health Care

Blue Shield EPO Plan Group #976109

Stanford HealthCare Alliance ACO Plan - Group #976248

Benefit Description


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)

Must use Blue Shield mail-order service

Must use Blue Shield mail-order service

100%

28

Office visit copay applies if provided during doctor office visit

100%

100%

100%

KAISER MAIL ORDER PHARMACY Generic: $10 up to a 30-day supply; $20 for a 31-100 day supply Brand: $30 up to a 30-day supply; $60 for a 31-100 day supply

KAISER PHARMACY $10 generic; $30 brand name; up to a 30-day supply

Kaiser Permanente HMO (CA) Group #7145 (Northern CA) Group #230178 (Southern CA)

benefits.stanford.edu | 2014 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

$20 generic; $60 brand name; $150 non-formulary—up to a 90-day supply

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


Preventive and Diagnostic service: Network: 100% Non-Network: 80% (deductible waived)

Preventive and Diagnostic service: Network: 100% Non-Network: 80% (deductible waived)

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 | 2014 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

$150 per family

Non-network: $50 per individual/$150 family

Network:

$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.

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.

This plan pays most benefits at a percentage.

If your network dentist does not provide or authorize your care, the charges are considered out-of-network.

Delta Dental Basic PPO Plan#3365 The dentist network for this plan includes the Delta Dental PPO, plus additional Delta dentists.

Delta Dental Enhanced PPO Plan #3366

This plan pays in-network benefits when your care is either provided or authorized by your network dentist.

Benefits Plan Comparison Charts

Routine Exams

Fluoride Treatments

Cleanings

Preventative Type of Care

Orthodontia

Annual Maximum

Coinsurance

Deductible

Overview

Benefit Description

2014 Dental Plan Comparison Charts

29


Delta Dental Enhanced PPO Plan #3366

Not covered

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

Major Restorative procedures service: Network: 50% Non-Network: 50% after deductible

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

Basic procedures service: Network: 80% Non-Network: 60% after deductible

Basic procedures service: Network: 80% Non-Network: 60% after deductible

Preventive and Diagnostic service: Network: 100% Non-Network: 80% (deductible waived)

Benefits Plan Comparison Charts

Splinting

Onlays

Implants

Dentures

Crown

Bridges

Major Procedures

Sealants

Root Canals

Fillings

Extractions

Anesthesia

Basic Procedures

X-rays

Benefit Description

Not covered

benefits.stanford.edu | 2014 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: 80% after deductible

Preventive and diagnostic service: 100% (deductible waived) Balance billing by your dentist may apply. You are responsible for these charges.

Delta Dental Basic PPO Plan#3365

30


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) (benesyst.net )

FSA vendor beginning January 1, 2014

855-842-4913

CNA Insurance Company (Long-Term Care) (ltcbenefits.com )

Password: stanfordgltc

800-528-4582

Liberty Mutual (Short- and Long-Term Disability)

Claimant Service ID: stanford

800-896-9375

Life & Disability

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)


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Faculty Benefits Summary