2015 FACULTY BENEFITS SUMMARYEffective January 1, 2015

Fred Turner The Akiko Yamazaki and Jerry Yang University Fellow in Undergraduate Education and Associate Professor of Communication

Table of ContentsWho Is Eligible for Stanford Benefits? .............................. 4

What is My Contribution to My Health Plan? .................. 7

When Does Coverage Start? ............................................... 8

What Happens if I Don’t Enroll? ......................................... 9

Medical Plans ...................................................................... 10

Health Savings Account (HSA) ......................................... 12

Prescription Drugs .............................................................. 12

Mental Health and Substance Abuse ............................. 13

Dental Plans ........................................................................ 14

Vision Care ........................................................................... 15

Flexible Spending Accounts ............................................. 16

Life and Accident Insurance ............................................. 18

Disability (Wage Replacement) ........................................ 19

Retirement Savings Plan ................................................... 20

Commit to Your Health with BeWell@Stanford............ 21

Fitness and Healthy Living Classes with Health Improvement Program (HIP) ..................... 22

Tuition Grant Program (TGP) ........................................... 23

Stanford WorkLife Office ................................................... 24

Unemployment Insurance ................................................ 25

Workers’ Compensation ................................................... 25

Other Resources and Services ......................................... 26

Faculty Information Resources ........................................ 27

2015 Benefits Plan Comparison Charts ......................... 28

2015 Dental Plan Comparison Charts ............................ 34

Legal Notices ....................................................................... 36

Contact Information .......................................................... 44

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Dear Faculty Member,

Stanford University is committed to providing you a comprehensive benefits package from health, life and disability insurance to educational assistance and work-life integration resources.

We understand that selecting benefits is an important process. In addition to providing an overview of your benefits, this Faculty Benefits Summary includes health plan comparison charts and other information to assist you with selecting a plan that is the best fit for you and your family.

Whether you are new to Stanford or a current employee choosing to change benefits during Open Enrollment, this guide is intended to help you make educated choices so you get the most out of your Stanford experience.

For updates or additional information regarding your benefits, visit the Stanford Benefits website, http://benefits.stanford.edu.

In good health, Stanford Benefits

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Who Is Eligible for Stanford Benefits?

You Are Eligible for Stanford Benefits If You Are:

• Scheduled to work in a benefits-eligible position for at least six months; and

• A full-time employee working between 75 and 100 percent time; or

• A part-time employee working between 50 and 74 percent time.

Your Eligible Family Members Are Your:

• Spouse, same or opposite sex, if not legally separated

• Registered domestic partner

• Children to age 26

» Natural children

» Stepchildren

» Legally adopted children

» Children for whom you are the legal guardian

» Foster children

» Children placed with you for adoption

» Children of your registered domestic partner who depend on you for support and live with you in a regular parent/ child relationship

» Unmarried children for whom you are legally responsible to provide health coverage under the terms of a Qualified Medical Child Support Order (QMCSO)

• Unmarried children over the age limit if:

» Dependent on you for primary financial support and maintenance due to a physical or mental disability;* incapable of self-support; and

» The disability existed before reaching age 19.

* You may be asked to provide documentation or proof of disability to your medical plan provider for review and approval of continued coverage. In most cases, coverage for a disabled child can continue as long as the child is incapable of self-support, unmarried and fully dependent on you for support.

Dan Elison AzaguryAssistant Professor of Surgery (General Surgery),

Stanford University Medical Center, wife Tatiana Maratchi

along with son Leo and daughter Olivia

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Does Your Spouse/Registered Domestic Partner Work at Stanford?

You may not elect coverage as an employee and also receive coverage as the dependent of another Stanford employee or retiree. Only one university-employed parent may cover eligible dependent children.

YOUR SAME-SEX SPOUSEYou 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.

YOUR REGISTERED DOMESTIC PARTNERYou 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

• 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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WHO IS ELIGIBLE FOR STANFORD BENEFITS?

When May I Change My Benefits Elections? Changes to your benefits elections are allowed during the Open Enrollment period and when a Life Event occurs.

Open Enrollment

The annual Open Enrollment period is an opportunity for employees to change their health care elections, add or drop eligible dependents from coverage or re-elect flexible spending accounts.

Life Events

Certain events in your life allow you to make election changes without the need to wait for Open Enrollment. Examples of a life event include the following:

• Job status ( job change for you, your spouse/domestic partner)

• Family (marriage, divorce, birth/adoption of a baby)

Additional information regarding the types of Life Events and the changes you can make to your benefits is included in the Life Events section of the Benefits website, http://benefits.stanford.edu.

Adding Dependents to Your Benefits

Stanford University requires proof of dependent eligibility for the dependents you cover. For a list of acceptable documentation, view the Dependent Eligibility Documentation Requirements, available on the Stanford Benefits website at http://benefits.stanford.edu.

Why Must I Provide My Dependent’s Social Security Number?

When you add a new dependent, you will be prompted to include their social security number. Centers for Medicare and Medicaid Services (CMS), the agency that monitors the claims collections from employers for Medicare, requires all employers to provide the social security number of any employee and dependent covered through an employer-sponsored medical plan. CMS uses this to cross-reference any Medicare participant who also has coverage through an employer.

30 DAYSYou have 30 days from the date you added your dependent to fax the documentation to Stanford Benefits at 973-837-3330 or mail to:

Stanford Benefits P.O. Box 199747 Dallas, TX 75219-9747

Please include your Stanford University ID number on each document you submit.

Kathryn Ann Moler Professor of Applied Physicsand Ai Leen Koh, Research Scientist

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What Is My Contribution to My Health Plan?Stanford University pays for the majority of the cost of your health and wellness benefits. Your individual contribution

is the amount that the university does not cover.

Stanford-Provided Benefits— You Pay Nothing!

Stanford is one of the few employers in the Bay Area that still offer an employee health plan that is 100 percent employer-paid. Stanford covers the costs for the following benefits:

• Employee-only coverage under the lowest-cost medical plans (for full-time employees only)

• Delta Dental Basic PPO dental coverage for you and your eligible dependents (full-time employees only)

• Employee-only basic life insurance

• Employee-only long-term disability insurance

• Business Travel Accident (BTA) insurance

Employee Shared- and Full-Cost Benefits

If you do not select one of the lowest-cost medical plans, you pay the difference between what Stanford pays for the lowest-cost plan and the cost of the plan you select. You and Stanford also share the cost of covering your dependents in the medical plans.

There are other benefits for which Stanford pays the majority of the cost, and benefits for which you pay the full cost. These include:

• Dependent coverage in the lowest-cost plan

• Coverage in a medical plan that is not the lowest-cost plan (You pay the difference in the cost between the lowest-cost plan and the plan you select.)

• The Delta Dental Enhanced PPO dental plan (You pay the difference in cost between this plan and the Delta Dental Basic PPO plan.)

• Accidental Death & Dismemberment (AD&D) insurance for you and your eligible dependents

• Flexible Spending Accounts (FSAs) for health care and dependent day care (unless you receive a Child Care Subsidy Grant)

• Supplemental Life Insurance

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

• Long-Term Care Insurance for you, your spouse/registered domestic partner and certain other family members

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When Does Coverage Start?The date your coverage starts depends on the plan, when you enroll and, in some cases, the amount of coverage you select.

If you are an existing employee, changes you make during Open Enrollment take effect January 1, 2015.

If you are a new hire, coverage under most plans starts on your date of hire, with the exception of the following:

• If you elect more than three-times salary for Supplemental Life Insurance for yourself and more than $25,000 for your spouse/ partner for Supplemental Dependent Life Insurance, coverage starts after Evidence of Insurability (EOI) is submitted to, reviewed and approved by the insurance company. See page 18 for more information on life insurance and an explanation of EOI.

• Long-Term Care Insurance begins the date your application is approved by CNA.

• The medical, dental and vision plans have no pre-existing condition exclusions. This means you are covered for any eligible condition as soon as your coverage starts.

• Coverage for enrolled dependents begins on the date of the qualified Life Event ( job, family or personal change) if you provide the appropriate Dependent Eligibility Documentation within 30 days of the date you make your benefits elections. Generally, the date of the event is the date your coverage starts, with the exception of the following:

» Increases to your Flexible Spending Accounts election are not retroactive. An increase will cover claims you incur starting from the date of the change.

» Any increase in Supplemental Life Insurance and Supplemental Dependent Life Insurance will require you to submit EOI, and coverage starts after it is submitted to, and reviewed and approved by the insurance company.

NEED MEDICAL SERVICES BEFORE YOU RECEIVE YOUR ID CARD?If you made no changes to your medical plan election for Open Enrollment, simply use your current medical ID card.

If you changed elections for 2015 during Open Enrollment, your ID card should be sent to you by the end of the 2014 calendar year. If you have not received it and need medical care on or after January 1, 2015, print a copy of your Confirmation Statement as proof of coverage until you receive your new ID card.

Your doctor’s office or pharmacy may also verify coverage by calling us at 877-905-2985 or 650-736-2985 (Monday through Friday from 7 a.m. to 5 p.m. PST), and pressing option 9. If you need a prescription filled while waiting for your ID card, you might have to pay the full cost and then submit a claim to your medical plan for reimbursement.

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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.

Full-Time Employees

If you work 75 to 100 percent time and do not enroll within 31 days of your hire date, you receive the following default coverage:

• Blue Shield High-Deductible Health Plan (HDHP)

• Delta Dental Basic PPO

• Basic Life Insurance

• Long-Term Disability (LTD)

• Business Travel Accident (BTA) insurance

Part-Time Employees and VA Doctors

If you are a part-time employee working between 50 and 74 percent time, or are a VA doctor, you will be assigned:

• Basic Life Insurance

• Long-Term Disability (LTD)

• Business Travel Accident (BTA) insurance

You will not have medical or dental coverage. However, you will receive a $12.50 credit for waived medical in your paycheck. You will also not have the opportunity to change your assigned default coverage or enroll in any other health and life benefits until the next Open Enrollment period,

unless you have a Life Event change. Find more information on Life Event changes on the Benefits website at http://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, with the exception of the following:

• Health care and/or a dependent day care Flexible Spending Account.

• Child Care Subsidy Grant if one had been awarded to you.

• Health Savings Account (HSA). You must re-enroll in the HSA to contribute money and receive contributions from Stanford. If you do not re-enroll, your election will default to waive participation in the HSA. (Note: You may enroll in the HSA and elect $0.00 employee contributions to receive the employer contribution provided by the university.)

WAIVING MEDICAL COVERAGEIf you are a full-time employee and have medical or dental coverage elsewhere, you must log on to MyBenefits and actively waive coverage.

If you waive your medical coverage, you will receive a $25 credit (if you work in a full-time, benefits-eligible position) or a $12.50 credit (if you work in a part-time, benefits eligible position) provided as taxable income in each paycheck.

Medical PlansStanford offers a variety of medical insurance plans, all of which

provide coverage for pre-existing conditions, prescription drugs, and mental health and substance abuse. Choosing and personalizing your benefits depends on your specific health care needs, doctor preferences, budget

and the type of plan you prefer.

Stanford HealthCare Alliance (SHCA)

Stanford HealthCare Alliance (SHCA) is a select network health plan in which Stanford Health Care physicians and affiliated providers in multiple specialties take responsibility for working together to carefully coordinate and deliver your care. SHCA features an expanded network of primary and specialty care physicians who are affiliated with Stanford Health Care and Stanford Children’s Health to allow for seamless coordination of the high-quality care you expect from this world-class institution.

Your SHCA Member Care Services team provides personalized assistance to you in scheduling appointments, selecting physicians, navigating your care experience and answering all claims and billing issues. SHCA covers your expenses only if you go to an SHCA network doctor and/or facility except for an urgent or life-threatening emergency.

With Stanford HealthCare Alliance, you:

• Have no deductible

• Have no claims to file

• Pay a fixed copay for each office visit, emergency room visit and hospital stay

You are encouraged to select a primary care physician (PCP) to coordinate and provide all of your primary care. If you need to see a specialist, you should coordinate the referral with your Stanford HealthCare Alliance PCP.

To enroll in the Stanford HealthCare Alliance you must live within the service area (based on your home zip code).

Kaiser Permanente (HMO)

Kaiser Permanente is a Health Maintenance Organization (HMO) that provides patient services, hospitalization, supplies and prescription drugs through its own network of doctors, hospitals and other Kaiser-affiliated health care facilities. Kaiser covers your expenses only if you go to a Kaiser provider or facility. You are also covered if you have a life-threatening emergency when you are outside a Kaiser service area.

When you enroll in Kaiser, you may select a primary care physician (PCP) to manage your care using Kaiser’s network of physicians and facilities. Most likely, you’ll need approval from your PCP before seeing a specialist.

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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, unless you have a life-threatening emergency. When you see a provider in the EPO’s network, there are no deductibles or claims to file. You pay a fixed copayment for each office visit, emergency room visit and hospital stay. If you go to a doctor or hospital outside the EPO’s network, you pay the full cost for the care you receive. With the EPO, you do not need to select a primary care physician. You may go to any doctor, specialist or hospital within the network.

Blue Shield Preferred Provider Organization (PPO)

A PPO provides you with the flexibility to go to the provider or medical facility of your choice—even if your provider or the facility is not in the Blue Shield network. If you see providers and go to facilities within the Blue Shield network, however, your 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, as your provider will submit the claims to Blue Shield for you. Preventive care is provided at no charge.

• Out of network: Your annual deductible is the same as your in-network deductible. The plan pays 60 percent of covered costs (based on Blue Shield’s allowed amount), and you must file a claim for reimbursement of out-of-pocket costs. You are also responsible for any remaining amounts that Blue Shield does not pay. Remember: Preventive care is not covered if obtained out of network.

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MEDICAL PLANS

Health Savings Account (HSA)If you are interested in setting aside tax-deductible dollars for future health care expenses through a Health Savings Account (HSA) you must be enrolled in the Blue Shield High-Deductible Health Plan (HDHP). Note: If you have an HSA, you cannot also have a health care Flexible Spending Account.

In 2015, the HSA limit (the amount you contribute) is $3,350 for employee only, and $6,650 for employee + dependents.

Because of the tax savings and flexibility to reimburse yourself for medical expenses, an HSA is worth considering. You may even set up your HSA with Blue Shield’s financial partner, HealthEquity, at the same time you elect coverage in the HDHP. If you have questions about how HSAs work with your HDHP, visit http://www.healthequity.net/stanford, or call HealthEquity at 877-857-6810.

If you are enrolled in the HDHP, you may set up an HSA directly with HealthEquity or through a financial institution of your choice. There are two advantages in choosing HealthEquity:

• You may fund your HSA through payroll deductions.

• Stanford contributes to your HSA ($300 for employee only and $600 for employee + family). Note: These amounts are for employees who set up their account(s) with HealthEquity after electing the High-Deductible Health Plan through MyBenefits. If you enroll any time after January 1, the amount Stanford contributes will be prorated based on the number of pay periods remaining in the calendar year after you set up your account.

Prescription DrugsYour medical plan provides prescription drug coverage, so be sure to take your ID card when you have a prescription filled. In 2015, all five health plans will cover prescriptions at 100% once the out-of-pocket maximum is met. The High-Deductible Health Plan (HDHP) requires you to pay 20 percent of the cost for all prescription drugs after you have satisfied the deductible. If you fill your prescriptions at a Blue Shield network pharmacy, your costs are lower. You can find a list of these pharmacies on the Blue Shield website at https://www.blueshieldca.com.

For all other plans, the cost of your prescription depends on whether or not it can be dispensed in its generic form and if it is included in your plan’s list of approved drugs (known as a formulary).

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MEDICARE AND HSAWhen you reach age 65, you must defer coverage under Medicare Parts A and B to continue to contribute to the HSA. If you have enrolled in Medicare Parts A and B, you are no longer eligible to contribute to the HSA. However, you will still have access to any monies in your HSA account.

Once you become Medicare eligible, your HSA contributions will automatically stop. If you are not enrolled in the Medicare Parts A and B and want to continue the HSA, you will need to contact the Benefits Service Center to have them re-enroll you.

Mental Health and Substance AbuseMental health and substance abuse treatment are covered by your medical plan. For details, contact your plan or see

the comparison chart at the back of this booklet.

New Non-Network Mental Health Coverage for 2015

The allowed amount for non-network outpatient services (psychologists, therapists, counselors, etc.) has changed for employees who elect a Blue Shield EPO, PPO, High-Deductible Health Plan (HDHP) or Stanford HealthCare Alliance. Below are details on the non-network service changes:

PLAN 2014 NON-NETWORK COVERAGE

2015 NON-NETWORK COVERAGE

Blue Shield EPO Did not cover non-network services.

80% of up to $300 in allowed charges for professional services will be covered per visit, for a maximum benefit of $240.*

Blue Shield PPO 60% of non-network services were covered after deductible.

80% of up to $300 in allowed charges for professional services will be covered per visit, for a maximum benefit of $240*.

For all other services, 60% of allowed charges will be covered.

Blue Shield High Deductible Health Plan (HDHP)

60% of non-network services were covered after deductible.

80% of up to $300 in allowed charges for professional services will be covered per visit, for a maximum benefit of $240*.

For all other services, 60% of allowed charges will be covered.

Stanford HealthCare Alliance (SHCA)

Did not cover non-network services.

80% of up to $300 in allowed charges for professional services will be covered per visit, for a maximum benefit of $240*.

* Example, if bill charge is $350, 80% of $300 will be covered. 80% x $300 = $240.

Faculty Staff Help Center

Stanford’s Faculty Staff Help Center provides up to 10 sessions of professional, confidential, short-term counseling and consultation services free of charge to Stanford employees, retirees and their dependents.

You can learn more about the service at http://helpcenter.stanford.edu.

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FACULTY STAFF HELP CENTER HAS MOVED!The Faculty Staff Help Center’s main office has relocated from the Mariposa House to the Keck Science Building (380 Roth Way).

Dental PlansGood dental care can affect your overall health and wellness. In addition to coverage for basic and major services, Stanford’s coverage includes diagnostic and preventive checkups and cleanings.

Stanford offers comprehensive dental benefits through Delta Dental’s network of dentists with two plans:

Delta Dental Basic PPO

Stanford covers the entire cost of this plan for full-time employees. The Basic PPO plan does not include orthodontic treatment and coverage for implants.

Delta Dental Enhanced PPO

This plan requires an employee contribution but provides a higher level of coverage for some services when you use Delta Dental PPO providers. The Enhanced PPO plan includes orthodontic treatment and coverage for implants.

Note: If you waive dental coverage at any time, you will not be able to enroll in a dental plan for two years unless you have a Life Event change.

You may view more details about Stanford’s dental coverage in the comparison chart located at the back of this Faculty Benefits Summary or visit the Benefits website at http://benefits.stanford.edu.

Dr. Kari C. NadeauAssociate Professor of Pediatrics, Allergy & Immunology, School of Medicine

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Vision CareVision Service Provider (VSP) is an employee-based benefit that provides vision care through its Signature Choice network of providers. For a provider in your area, call VSP or go to the VSP website at http://vsp.com. You can find VSP contact information in the Contacts section of the Stanford Benefits website at http://benefits.stanford.edu.

VISION CARE

COVERAGE

COST WHEN USING A VSP PROVIDER

Eye Exam Once every calendar year $25 copay

Lenses Once every calendar year* (includes basic and bifocals)

Plan pays 100%

Frames Once every calendar yearPlan pays 100% up to $150 retail value

Contact Lenses

Once every calendar year in lieu of frames and lenses

• Medically necessary

• Elective (fitting and materials)

Plan pays 100%

Plan pays 100% up to $150

ExtrasIncluding scratch-resistant lenses, anti-reflective lenses, additional prescription glasses or sunglasses

Discount through your VSP provider

* $40 copay for progressive lenses

Abbas MilaniHoover Institute Research Fellow and The Hamid and Christina Moghadam Director of Iranian Studies Department

benefits.stanford.edu | 2015 Faculty Benefits Summary 15

Flexible Spending AccountsFlexible Spending Accounts (FSA) allow you to set aside before-tax money to pay for certain health care expenses including deductibles, copayments, certain services not covered by your health plan and dependent day care expenses.

Here’s how they work: you authorize contributions to be taken out of your paycheck before taxes are calculated. You pay your provider and file a claim for reimbursement. You then get reimbursed with the before-tax dollars in your spending account.

Note: Whether you are newly electing an FSA or if you had an FSA in 2014, Stanford’s vendor, Benesyst (a TASC Company), will send you a debit MasterCard for the 2015 year. The debit Visa card distributed in 2014 will not be accepted effective January 1, 2015. The debit MasterCard will have your 2015 FSA election loaded on it and may only be used in the plan year the expenses were incurred.

Two Types of Flexible Spending Accounts

Health Care FSAYou 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 2015 is $2,500. This spending account includes a debit card for your convenience.

When you use your FSA debit card for eligible expenses at a participating pharmacy or doctor, the provider is immediately reimbursed the full amount from your account. Please note that the IRS requires proof of payment on some claims. Be sure to save all itemized receipts when using your FSA debit card.

You may be asked for a copy of your receipts to prove your purchase (called substantiation).

You may also submit claims electronically, or by mail or fax. Please include an itemized receipt or Explanation of Benefits with the claim form. Some

Christian LinderAssistant Professor of Civil and Environmental Engineering

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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 FSAYou may use this account to pay non-medical day care expenses for your eligible dependent children up to age 13, elder dependents and disabled dependents. (You may only pay for your dependents’ health care expenses through a health care FSA.) The IRS limit for pre-tax contributions to your dependent care FSA in 2015 is $5,000 per household. If you received a CCSG grant, the amount will be included in your total dependent care FSA annual amount. The combined total cannot exceed the $5,000 annual limit. When you file a claim for reimbursement, you can only be reimbursed up to the amount that is in your account at the time you submit a claim.

For more information on how these plans work and which expenses are eligible, visit the Stanford Benefits website at http://benefits.stanford.edu, and click on the “Medical & Life” section and then the “Flexible Spending Accounts” section.

NEW IN 2015: $500 CARRYOVER FOR HEALTH CARE FSAAn Internal Revenue Service (IRS) change to the health care Flexible Spending Account (FSA) modifies the “use it or lose it” rule and allows participating active employees to carry over up to $500 in unused funds from one year to the next. Stanford University will be implementing the new carryover provision for 2015, which means you will be able to defer up to $500 of unused funds from your 2014 health care FSA into your 2015 health care FSA. (The $500 carryover is in addition to the $2,500 annual contribution limit for the 2015 year.) Any 2014 FSA monies over $500 will be forfeited. The carryover funds may be accessed starting May 1, 2015, once all 2014 FSA expenses have been reimbursed. For more information on the FSA carryover or for a list of FAQs, visit the Stanford Benefits website at http://benefits.stanford.edu.

Christian LinderAssistant Professor of Civil and Environmental Engineering

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FLEXIBLE SPENDING ACCOUNTS

Life and Accident InsuranceBasic Life Insurance

Stanford automatically provides insurance coverage in an amount equal to your annual appointment salary (up to a $50,000 maximum).

Supplemental Life Insurance for Yourself

You may purchase additional coverage from one to eight times your salary, up to a $1.5 million maximum.

Newly hired employees must complete an online Evidence of Insurability (EOI) form for coverage levels above three-times salary. For existing employees, any increase in your coverage amount requires EOI. You must be actively at work to apply for or increase coverage.

Supplemental Life Insurance for Your Spouse/Registered Domestic Partner

You may purchase coverage up to 50 percent of your total coverage (combined Basic and Supplemental) or $250,000, whichever is less.

For newly hired employees, coverage more than $25,000 requires your spouse or partner to complete EOI. For existing employees, any increase in this benefit requires EOI.

Supplemental Life Insurance for Your Dependent Child(ren)

You may purchase coverage for your dependent children in amounts of $5,000, $10,000 or $25,000 (up to 50 percent of your total coverage). One policy covers each of your dependent children for the same amount.

Accidental Death & Dismemberment Insurance (AD&D)

AD&D insurance provides protection to you or your beneficiaries if you die or are seriously injured in an accident. It does not cover a death resulting from illness or natural causes. See the AD&D Insurance Summary on the Stanford Benefits website at http://benefits.stanford.edu for information on how this plan works.

You may purchase AD&D insurance from one to eight times your salary, up to $1.5 million. You may also purchase AD&D insurance for your spouse/registered domestic partner and/or your dependent child(ren). The coverage levels are similar to the Supplemental Dependent Life Insurance plan. To enroll your dependents, you must have coverage for yourself equal to or greater than their coverage. You must be actively at work to apply for or increase coverage.

Business Travel Accident Insurance

Stanford provides you with Business Travel Accident Insurance in case you are accidentally injured or die during an official university business trip. Enrollment is automatic, and Stanford pays the full cost of coverage.

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EVIDENCE OF INSURABILITYDepending on the amount of supplemental life insurance you purchase, you may be required to provide Evidence of Insurability (EOI), also known as “proof of good health.” If the amount you request requires EOI, you will be prompted to complete an online EOI short form as part of the enrollment process.

Disability (Wage Replacement)Voluntary Short-Term (Non-Work Related) Disability Insurance

Stanford automatically enrolls you in a short-term disability plan, called Voluntary Disability Insurance (VDI). The plan pays 60 percent of your appointment salary, up to a certain maximum. Generally, coverage begins on the eighth day of your disability or on the first day of hospitalization. You pay the cost of this coverage. You may choose to reject automatic enrollment in Stanford’s VDI plan and instead enroll in California State Disability Insurance (SDI). You must complete a VDI Rejection Notice and submit it to the Payroll Department.

You may always return to the VDI plan as long as you complete an SDI Rejection Notice and submit it to the Payroll Department. For more information on SDI, visit California’s Employment Development Department website.

Long-Term Disability (LTD)

As part of your benefits, Stanford provides Long-Term Disability (LTD) coverage that pays you a monthly benefit if you meet the plan guidelines. Enrollment is automatic, and Stanford pays the full cost of coverage.

Once you qualify, the plan provides a benefit of 66 2/3 percent of your monthly appointment salary. This amount may be reduced by payments you receive from other sources, such as Workers’ Compensation or Voluntary Short-Term Disability Insurance.

Long-Term Care (LTC) Insurance

LTC insurance is an optional, after-tax benefit that helps pay many of the day-to-day expenses for nursing home and in-home care not generally covered by medical or disability plans. LTC insurance is provided through CNA.

LTC insurance is available to you, your spouse/registered domestic partner, parents, grandparents, and the parents and grandparents of your spouse/ registered domestic partner. You must be actively at work to apply for or increase coverage.

You can apply for coverage at any time, but if you apply for yourself within the 31-day new hire enrollment period, you do not have to complete Evidence of Insurability (EOI) and coverage is guaranteed. If you apply at a later time, you are required to complete EOI and coverage is not guaranteed.

Your eligible dependents or family members may also apply at any time, but must complete EOI and coverage is not guaranteed.

You may find more information about disability insurance and long-term care insurance on the Stanford Benefits website at http://benefits.stanford.edu under the “Medical & Life” section.

benefits.stanford.edu | 2015 Faculty Benefits Summary 19

NEW in 2015In addition to enrollment and customer service, CNA will take over direct billing for all long-term care insurance coverage, starting in 2015. Those that were enrolled in LTC insurance in 2014 will receive direct billing information from CNA in late October. Please note that Stanford’s last payroll deduction will be December 22; employees enrolled in LTC insurance coverage will receive a direct bill from CNA in late January.

Retirement Savings PlanParticipating in a retirement savings plan is one of the best things you can do to save for your future.

• Start immediately: Start saving for retirement after your first paycheck. You decide how much you want to contribute to the plan, and the deduction is automatically taken out of your paycheck.

• Maximize your dollars: Your contributions come out of your paycheck before federal and state taxes are taken out. This reduces your taxable income, and you pay less in taxes.

The Stanford Contributory Retirement Plan (SCRP) offers a variety of investment options and allows you to make before-tax contributions from your paycheck directly to a savings account. At the end of your first year of service, Stanford rewards you with a Basic Contribution to a retirement account based on your salary and years of service. You receive this money from Stanford even if you do not make contributions to the plan out of your own paycheck. If you do decide to contribute money toward your retirement out of your

paycheck, you become eligible for Stanford’s Match Contribution—up to an additional five percent of your earnings each pay period. Over time, your contributions and Stanford’s Basic and Match Contributions, may add up to significant retirement savings.

You are always fully vested in both the contributions you make and those you receive from Stanford.

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

• See the plan details in the Summary Plan Description (SPD).

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

• Schedule a free financial counseling appointment with a representative from Fidelity, Vanguard or TIAA-CREF.

Dr. Laurence C. BakerProfessor of Health Research and Policy; Stanford Health Policy Fellow

20 2015 Faculty Benefits Summary | benefits.stanford.edu

Commit to Your Health with BeWell@StanfordThe BeWell@Stanford employee incentive program encourages benefits-eligible employees and their spouses/registered domestic partners to adopt (or maintain) healthy lifestyle behaviors. By committing to health and wellness, employees not only feel better, but also earn rewards!

In 2015, benefits-eligible employees can earn up to $580 in a taxable incentive for completing The Stanford Health and Lifestyle Assessment (SHALA) and the following activities by November 30:

1. Wellness Profile ($480)* This includes health screenings, advising session, online plan and advisor-endorsed action.

2. Six BeWell Berries ($100) Berries are health-related activities that help employees put wellness goals into action. Choose from a variety of Berry options, including exercise classes, fitness assessments, stress workshops and self-reported activity.

* In addition to completing the steps above, BeWell participants must also be enrolled in a Stanford-sponsored medical plan in 2015 and agree to share their SHALA and health screening information in order to receive the maximum employee incentive. Participants who choose not to share information nor enroll in a Stanford-sponsored medical plan are still eligible to receive a $200 taxable incentive.

Your Spouse or Partner Can Benefit, Too!

A spouse or registered domestic partner of a BeWell participant may earn a $240 taxable incentive if he or she completes the SHALA and Wellness Profile, agrees to share the results of these screenings and is enrolled in a Stanford-sponsored medical plan. A spouse/registered domestic partner is only eligible to receive the incentive if the employee earns the incentive.

Other Rewards

In addition to monetary incentives, BeWell participants also receive other rewards, including access to free Stanford athletic and arts events throughout the year.

Learn how to get healthy and earn rewards with BeWell at http://bewell.stanford.edu.

WHY SHARE YOUR INFORMATION?Your SHALA and health screening information is used to help you identify ways to improve your health and/or manage any chronic conditions you may have.

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

Rest assured that BeWell and Stanford are committed to protecting the privacy and security of your health information.

benefits.stanford.edu | 2015 Faculty Benefits Summary 21

Fitness and Healthy Living Classes with Health Improvement Program (HIP)Did you know you have more than 250 fitness and health education classes available to you each quarter through the Health Improvement Program (HIP), part of the School of Medicine?

If you are a BeWell participant and have completed your SHALA, you are eligible for two discounted $30 group fitness classes per quarter. Some of the group fitness classes include cross-training, indoor cycling, yoga, Pilates, tai chi, swimming, dance and more.

In addition, many of the Healthy Living classes are eligible for STAP funds. You may find STAP-eligible HIP programs on the searchable HIP schedule. Examples include:

• 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, register for a class or listen to a pre-recorded webinar, visit http://hip.stanford.edu.

Physical Education, Recreation and Wellness

Through the Department of Athletics, Physical Education and Recreation, you have access to a variety of athletic, recreation and wellness facilities, including two 75,000-square-foot sports and recreation centers; a recreational pool; a driving range; tennis courts; indoor climbing walls; playing fields and a world-class aquatic center.

With all of these facilities at your disposal, you have lots of opportunity to find an activity that fits your needs and interests and to get fit.

Find a class or activity that interests you at http://recreation.stanford.edu.

Tara BryantHospital Technician, Clinical Decision Unit

22 2015 Faculty Benefits Summary | benefits.stanford.edu

Dan Elison AzaguryAssistant Professor of Surgery (General Surgery), Stanford University Medical Center, wife Tatiana Maratchi along with son Leo and daughter Olivia

Tuition Grant Program (TGP)Stanford will assist with up to four years of undergraduate college tuition costs at approved colleges and universities for eligible dependent children. Faculty in a university appointment for six months or longer are eligible for this benefit as soon as their appointment begins.

For the 2014–15 fiscal year, the maximum available amount is $22,092 depending on employment status, the amount of time worked (prorated if you work less than 100 percent time) and tuition cost.

For more information on the TGP, call 877-905-2985 or 650-736-2985 (press option 5) or visit TGP at http://hreap.stanford.edu.

benefits.stanford.edu | 2015 Faculty Benefits Summary 23

24 2015 Faculty Benefits Summary | benefits.stanford.edu

Stanford WorkLife OfficeStanford provides an array of programs and services to assist you with child care, elder care and living-well resources. Information about on-site child care and community resources is available. Financial assistance is available to eligible employees for child care expenses, adoption, and emergency and back-up child or elder care. Elder care resources are offered for both local and long-distance care giving.

Child Care Subsidy Grant Program (CCSG)

Stanford provides up to $5,000 per year in tax-free grants for eligible child care expenses. Grant amounts are based on the applicant’s (and their spouse/registered domestic partner’s) adjusted gross income and the number of eligible children age nine or younger.

Faculty Child Care Assistance Program (FCCAP)

Stanford provides a salary supplement to eligible faculty to offset qualified child care expenses. Award levels are based on an applicant’s (and their spouse/registered domestic partner’s) household adjusted gross family income. Awards range from $5,000 to $20,000.

Junior Faculty Dependent Care Travel Grant Program

Junior faculty can receive a taxable grant of up to $1,000 for qualified dependent care expenses incurred when traveling to attend professional meetings, conferences, workshops and professional development opportunities, or to conduct approved research or scholarship.

Adoption Assistance

Stanford reimburses eligible adoption expenses up to $10,000 per adoption, with a maximum lifetime benefit of $20,000 per family.

Emergency and Back-Up Dependent Care

Stanford offers help with child/elder care if a regular caregiver is ill or on vacation, or if a child/elder is mildly ill and is in need of temporary care. The Back-Up Care Advantage (BUCA) Program is for faculty and provides both in-home dependent care from credentialed in-home care agencies and trained caregivers as well as in-center care for a small copay.

Eldercare

The WorkLife Office supports family caregiving through a partnership with Avenidas to provide resources, referrals and monthly Caregivers’ Seminars. For Stanford faculty, Avenidas offers free and discounted consultations with a social worker.

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

benefits.stanford.edu | 2015 Faculty Benefits Summary 25

Unemployment InsuranceAll employees have unemployment insurance coverage for qualifying periods of unemployment. Stanford pays the full cost of coverage.

Workers’ CompensationWorkers’ 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 non-occupational illnesses and injuries;

• Prior to the injury, your doctor agrees to treat you for work injuries or illnesses;

• Prior to the injury, you provided your employer the following in writing:

1. Notice that you want your personal doctor to treat you for a work-related injury or illness, and

2. Your personal doctor’s name and business address.

Visit the Risk Management website at http://stanford.edu/dept/risk-management for more information.

26 2015 Faculty Benefits Summary | benefits.stanford.edu

Other Resources and ServicesStanford Coordinated Care

Stanford Coordinated Care (SCC) is a team of medical professionals and care coordinators who help people with chronic illnesses lead a healthy life and smoothly navigate their health care experiences. SCC can help you manage chronic health conditions, coordinate your medical care— no matter how many specialists you see— and provide you with care at our clinic or collaborate with your primary care provider. Visit http://stanfordhealthcare.org/medical-clinics/coordinated-care.html, or call 650-724-1800.

Direct Deposit/ Withholding Information

Learn how to sign up for direct deposit of your Stanford paycheck at the Axess website at http://axess.stanford.edu.

News and Information

The Stanford Report includes daily news and events at Stanford and is sent to all employees electronically. View past issues of The Stanford Report, at http://news.stanford.edu/sr/. Stanford employees also receive The Stanford Employee Insider, a quarterly digital newsletter featuring employment-related news and updates produced by University Human Resources. View past issues and subscribe to the newsletter at http://uhr.stanford.edu/stanford-insider. SLAC employees also receive SLAC Today via email.

Stanford Events

For information on lectures, concerts, athletic events, exhibits and much more, sign up for Stanford for You, a free monthly e-newsletter about fun, affordable events on campus. Register for Stanford for You at http://foryou.stanford.edu.

Parking & Transportation Services

Stanford supports many commuter programs including free transit on CalTrain and VTA. For information about the programs, mass transit, ride-sharing incentives and parking at Stanford, visit the Parking & Transportation Services website at http://transportation.stanford.edu, or call 650-723-9362.

Note: SLAC employees are not eligible for the commuter program.

Housing Program

The University has several financial programs designed to assist eligible faculty with the purchase of a home. The University also provides to eligible faculty long-term residential ground leases for 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 http://fsh.stanford.edu, or call 650-725-6893.

Faculty Information ResourcesThe University Faculty Handbook provides an overview of policies, procedures and other information related to faculty appointments at Stanford. To review the information or print a copy, go to http://facultyhandbook.stanford.edu.

• For faculty policies, procedures, forms and helpful links, go to http://facultyaffairs.stanford.edu. For questions, email facultyaffairs@stanford.edu or call 650-723-3622.

• For policies specific to your school, go to your school’s website or contact your dean’s office at http://facultyaffairs.stanford.edu/other_contacts.

• View the Research Policy Handbook at http://rph.stanford.edu to learn about the conduct of research at Stanford, including the Faculty Policy on Conflict of Commitment and Interest.

• The Global Operations Guide provides practical and logistical information for faculty and staff of regulatory issues that

are likely to be encountered by those working internationally. To view the guide, visit the Global Business Services website at http://stanford.edu/group/fms/globalops/guide.

• The Office of the Vice Provost for Faculty Development & Diversity supports the faculty through a variety of programs and resources for new and pre-tenured faculty in professional development, and for department chairs and deans in recruitment, retention and diversity. For more information, visit http://facultydevelopment.stanford.edu.

• The Office of Diversity & Access at http://stanford.edu/dept/diversityaccess may provide additional information.

benefits.stanford.edu | 2015 Faculty Benefits Summary 27

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Net

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Desc

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mitt

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$100

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itted

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0 co

pay

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Non

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100

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it

(cop

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itted

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Lab/

anci

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fess

iona

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t 80%

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or N

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Net

wor

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Non

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Lab/

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ork

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on-n

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$100

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itted

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Urge

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are

Offi

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Em

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cilit

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Offi

ce vi

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men

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Em

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copa

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pend

ing

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$50

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y; la

b/ot

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after

ded

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ork

or n

on-

netw

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Net

wor

k or

Non

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wor

k: 8

0%

after

ded

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0 co

pay

at K

aise

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man

ente

fa

cilit

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Hom

e H

ealth

Car

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0%10

0%N

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80%

afte

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Non

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wor

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0% a

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Net

wor

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Non

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100%

Up

to 1

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enda

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sits

per

day

max

]

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fits.

stan

ford

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| 2

015

Facu

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3

0

bene

fits.

stan

ford

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| 2

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umm

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3

1

Bene

fits P

lan

Com

paris

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hart

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Bene

fit

Desc

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Care

Alli

ance

AC

O P

lan

- Gro

up #

9762

48Bl

ue S

hiel

d EP

O P

lan

Gr

oup

#976

109

Blue

Shi

eld

PPO

Pla

n Gr

oup

#170

292

Blue

Shi

eld

Hig

h De

duct

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PP

O P

lan

- Gro

up #

1702

93Ka

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Per

man

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HM

O (C

A)

Grou

p #7

145

(Nor

ther

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178 (

Sout

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Hos

pita

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e-Ce

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you

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Pre-

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ficat

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ou

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our p

rovi

der.

$100

copa

y pe

r ad

mis

sion

Pre-

Certi

ficat

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requ

ired

by y

ou o

r yo

ur p

rovi

der.

Net

wor

k: 8

0% a

fter d

educ

tible

Non

-Net

wor

k: 6

0% a

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educ

tible

Pre-

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ficat

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requ

ired

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rovi

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Net

wor

k: 8

0% a

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educ

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Non

-Net

wor

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0% a

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educ

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$100

copa

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issi

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Infe

rtili

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Trea

tmen

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etw

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50%

of S

tanf

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Hea

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llian

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llow

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char

ges f

or p

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diag

nost

ic se

rvic

es; l

imite

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thre

e cy

cles

of i

ntra

uter

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inse

min

atio

n (IU

I).

In V

itro,

GIF

T, a

nd Z

IFT:

Not

cove

red

Ferti

lity

drug

s: se

e Ph

arm

acy

Net

wor

k: 5

0% o

f Blu

e Sh

ield

al

low

ed c

harg

es fo

r pro

fess

iona

l an

d di

agno

stic

serv

ices

; lim

ited

to th

ree

cycl

es o

f int

raut

erin

e in

sem

inat

ion

(IUI).

In V

itro,

GIF

T, a

nd Z

IFT:

Not

cove

red

Ferti

lity

drug

s: se

e Ph

arm

acy

Net

wor

k: 5

0% o

f Blu

e Sh

ield

al

low

ed c

harg

es a

fter d

educ

tible

fo

r pro

fess

iona

l and

lab

serv

ices

; lim

ited

to th

ree

cycl

es o

f in

traut

erin

e in

sem

inat

ion

(IUI).

Non

-Net

wor

k: N

ot co

vere

d

In V

itro,

GIF

T, a

nd Z

IFT:

Not

cove

red

Ferti

lity

drug

s: se

e Ph

arm

acy

Net

wor

k: 5

0% o

f Blu

e Sh

ield

al

low

ed c

harg

es a

fter d

educ

tible

fo

r pro

fess

iona

l and

lab

serv

ices

; lim

ited

to th

ree

cycl

es o

f in

traut

erin

e in

sem

inat

ion

(IUI).

Non

-Net

wor

k: N

ot co

vere

d

In V

itro,

GIF

T, a

nd Z

IFT:

Not

cove

red

Ferti

lity

drug

s are

cove

red

at 5

0%

after

ded

uctib

le, u

p to

$5,

000

lifet

ime

max

imum

50%

Ferti

lity

Drug

s: Co

vere

d un

der d

rug

bene

fits a

t 50%

; In

Vitro

, GIF

T, a

nd

ZIFT

: Not

cove

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Labo

rato

ry

Char

ges

100%

100%

Net

wor

k: 8

0% a

fter d

educ

tible

Non

-Net

wor

k: 6

0% a

fter d

educ

tible

Net

wor

k: 8

0% a

fter d

educ

tible

Non

-Net

wor

k: 6

0% a

fter d

educ

tible

100%

Offi

ce V

isits

$20

copa

y pr

imar

y/$5

0 co

pay

spec

ialis

t$2

0 co

pay

prim

ary/

$50

copa

y sp

ecia

list

Net

wor

k: $

20 co

pay

prim

ary/

$50

copa

y sp

ecia

list

Non

-Net

wor

k: 6

0% a

fter d

educ

tible

Net

wor

k: 8

0% a

fter d

educ

tible

Non

-Net

wor

k: 6

0% a

fter d

educ

tible

$20

copa

y pr

imar

y/$5

0 co

pay

spec

ialis

t

Visi

on C

are

$50

copa

y

Lim

ited

to sc

reen

and

refra

ctio

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nly

$50

copa

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Lim

ited

to sc

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and

refra

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Disc

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pro

gram

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r vi

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har

dwar

e

Net

wor

k: 1

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N

on-N

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ork:

Not

cove

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Lim

ited

to sc

reen

and

refra

ctio

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nly

Net

wor

k: 1

00%

N

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ork:

Not

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red

Lim

ited

to sc

reen

and

refra

ctio

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100%

Eye

exam

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isco

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am

for v

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X-ra

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0%

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Net

wor

k: 8

0% a

fter d

educ

tible

Non

-Net

wor

k: 6

0% a

fter d

educ

tible

Net

wor

k: 8

0% a

fter d

educ

tible

Non

-Net

wor

k: 6

0% a

fter d

educ

tible

100%

bene

fits.

stan

ford

.edu

| 2

015

Facu

lty B

enef

its S

umm

ary

3

2

Bene

fits P

lan

Com

paris

on C

hart

s

Bene

fits P

lan

Com

paris

on C

hart

s

Bene

fit

Desc

riptio

nSt

anfo

rd H

ealth

Care

Alli

ance

AC

O P

lan

- Gro

up #

9762

48Bl

ue S

hiel

d EP

O P

lan

Gr

oup

#976

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Blue

Shi

eld

PPO

Pla

n Gr

oup

#170

292

Blue

Shi

eld

Hig

h De

duct

ible

PP

O P

lan

- Gro

up #

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93Ka

iser

Per

man

ente

HM

O (C

A)

Grou

p #7

145

(Nor

ther

n CA

) Gr

oup

#230

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Sout

hern

CA)

Pres

crip

tion

Drug

s

Phar

mac

y (R

etai

l)St

anfo

rd H

ealth

Care

Allia

nce u

ses t

he

Blue

Shi

eld

Netw

ork p

harm

acy:

$10

gene

ric; $

30 b

rand

nam

e; $7

5 non

-fo

rmul

ary—

up to

a 30

-day

supp

ly

Non

-Net

wor

k ph

arm

acy:

Mem

ber

pays

copa

ymen

t plu

s 25%

of b

illed

ch

arge

s

Ferti

lity

drug

s cov

ered

at 5

0%

(ded

uctib

le d

oes n

ot a

pply

); m

ax

bene

fit o

f $5,

000

per l

ifetim

e

Blue

Shi

eld

Net

wor

k ph

arm

acy:

$1

0 ge

neric

; $30

bra

nd n

ame;

$75

no

n-fo

rmul

ary—

up to

a 3

0-da

y su

pply

Non

-Net

wor

k ph

arm

acy:

Mem

ber

pays

copa

ymen

t plu

s 25%

of b

illed

ch

arge

s

Ferti

lity

drug

s cov

ered

at 5

0%

(ded

uctib

le d

oes n

ot a

pply

); m

ax

bene

fit o

f $5,

000

per l

ifetim

e

Blue

Shi

eld

Net

wor

k ph

arm

acy:

$1

0 ge

neric

; $30

bra

nd n

ame;

$75

no

n-fo

rmul

ary

-- up

to a

30-

day

supp

ly

Non

-Net

wor

k ph

arm

acy:

Mem

ber

pays

copa

ymen

t plu

s 25%

of b

illed

ch

arge

s

Ferti

lity

drug

s cov

ered

at 5

0%

(ded

uctib

le d

oes n

ot a

pply

); m

ax

bene

fit o

f $5,

000

per l

ifetim

e

Net

wor

k or

Non

-Net

wor

k: 8

0%

after

ded

uctib

le

Ferti

lity

drug

s: se

e In

ferti

lity

Trea

tmen

t

KAIS

ER P

ERM

ANEN

TE P

HAR

MAC

Y Ge

neric

: $10

for u

p to

a 3

0-da

y su

pply

, $20

for a

31-

to 6

0-da

y su

pply

, or $

30 fo

r a 6

1- to

100

-day

su

pply

Bran

d: $

30 fo

r up

to a

30-

day

supp

ly, $

60 fo

r a 3

1- to

60-

day

supp

ly, o

r $90

for a

61-

to 1

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ay

supp

ly

Mai

l-Ord

er D

rug

Prog

ram

$20

gene

ric; $

60 b

rand

nam

e; $

150

non-

form

ular

y—up

to a

90-

day

supp

ly

Mus

t use

Blu

e Shi

eld

mai

l-ord

er se

rvice

$20

gene

ric; $

60 b

rand

nam

e; $

150

non-

form

ular

y—up

to a

90-

day

supp

ly

Mus

t use

Blu

e Shi

eld

mai

l-ord

er se

rvice

$20

gene

ric; $

60 b

rand

nam

e; $

150

non-

form

ular

y—up

to a

90-

day

supp

ly

Mus

t use

Blu

e Shi

eld

mai

l-ord

er se

rvice

80%

afte

r ded

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le

Mus

t use

Blu

e Shi

eld

mai

l-ord

er se

rvice

KAIS

ER P

ERM

ANEN

TE

MAI

L O

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PH

ARM

ACY

Gene

ric: $

10 u

p to

a 3

0-da

y su

pply

; $2

0 fo

r a 3

1-10

0 da

y su

pply

Bran

d: $

30 u

p to

a 3

0-da

y su

pply

; $6

0 fo

r a 3

1-10

0 da

y su

pply

Prev

entiv

e Ca

re

Pap

Smea

rs10

0%

(as p

art o

f the

offi

ce vi

sit)

100%

(a

s par

t of t

he o

ffice

visi

t)N

etw

ork:

100

% if

par

t of a

nnua

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even

tive

Non

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wor

k: N

ot co

vere

d

Net

wor

k: 1

00%

if p

art o

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ual

prev

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e N

on-N

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ork:

Not

cove

red

100%

Mam

mog

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s10

0%10

0%N

etw

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100

% if

par

t of a

nnua

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even

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Non

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wor

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Net

wor

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00%

if p

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ual

prev

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Imm

uniz

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mun

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vere

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100%

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d.

Net

wor

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N

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mun

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Net

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N

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f pr

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ce vi

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Wel

l-Wom

an V

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100%

100%

Net

wor

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N

on-N

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ork:

Not

cove

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Net

wor

k: 1

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N

on-N

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ork:

Not

cove

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100%

bene

fits.

stan

ford

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| 2

015

Facu

lty B

enef

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stan

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015

Facu

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3

Bene

fits P

lan

Com

paris

on C

hart

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Bene

fit D

escr

iptio

nDe

lta D

enta

l Enh

ance

d PP

O

Plan

#33

66De

lta D

enta

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ic P

PO

Plan

#336

5

Ove

rvie

wTh

is p

lan

pays

in-n

etw

ork

bene

fits w

hen

your

car

e is

eith

er p

rovi

ded

or a

utho

rized

by

your

Del

ta D

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net

wor

k de

ntis

t.

If yo

ur n

etw

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dent

ist d

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ot p

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de o

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horiz

e yo

ur c

are,

the

char

ges a

re

cons

ider

ed o

ut-o

f-net

wor

k.

You

are

enco

urag

ed to

obt

ain

a pr

edet

erm

inat

ion

of b

enef

its fr

om D

elta

for s

ervi

ces

grea

ter t

han

$300

, or f

or c

row

ns o

r brid

ges.

Delta

Den

tal P

PO is

the

dent

ist n

etw

ork

for t

his p

lan.

This

pla

n pa

ys m

ost b

enef

its a

t a p

erce

ntag

e.

The

bene

fit le

vel d

oes n

ot d

epen

d on

wha

t pro

vide

rs y

ou u

se.

You

are

enco

urag

ed to

obt

ain

a pr

edet

erm

inat

ion

of b

enef

its fr

om D

elta

for s

ervi

ces

grea

ter t

han

$300

, or f

or c

row

ns o

r brid

ges

Dedu

ctib

leN

etw

ork:

$0

per i

ndiv

idua

l/$0

per f

amily

Non

-net

wor

k: $

50 p

er in

divi

dual

/$15

0 fa

mily

$50

per i

ndiv

idua

l

$150

per

fam

ily

Coin

sura

nce

Net

wor

k:

- P

reve

ntiv

e an

d di

agno

stic

: 100

% o

f the

neg

otia

ted

rate

-

Bas

ic p

roce

dure

s: 80

% o

f the

neg

otia

ted

rate

-

Maj

or re

stor

ativ

e pr

oced

ures

: 50%

of t

he n

egot

iate

d ra

te

Non

-Net

wor

k:

- P

reve

ntiv

e an

d di

agno

stic

: 80%

of u

sual

& c

usto

mar

y ch

arge

s -

Bas

ic p

roce

dure

s: 60

% o

f usu

al &

cus

tom

ary

char

ges

- M

ajor

rest

orat

ive

proc

edur

es: 5

0% o

f usu

al &

cus

tom

ary

char

ges

- Pr

even

tive

and

diag

nost

ic: 1

00%

of u

sual

& c

usto

mar

y ch

arge

s -

Basi

c pr

oced

ures

: 80%

of u

sual

& c

usto

mar

y ch

arge

s -

Maj

or re

stor

ativ

e pr

oced

ures

: 50%

of u

sual

& c

usto

mar

y ch

arge

s

You

are

resp

onsi

ble

for a

mou

nts n

ot co

vere

d by

the

dent

al p

lan.

Annu

al M

axim

umN

etw

ork:

$3,

000

per i

ndiv

idua

l

Non

-Net

wor

k: $

1,50

0 pe

r ind

ivid

ual

$1,0

00 p

er in

divi

dual

Ort

hodo

ntia

Net

wor

k: 5

0% o

f Del

ta’s

appr

oved

fee

Non

-Net

wor

k: 5

0% o

f Del

ta’s

appr

oved

fee

Com

bine

d O

rthod

ontia

life

time

max

imum

ben

efit

of $

1,50

0

Not

cove

red

Prev

enta

tive

Type

of C

are

Clea

ning

sPr

even

tive

and

Diag

nost

ic se

rvic

e: N

etw

ork:

100

%

Non

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5

Legal NoticesHIPAA Privacy Notice

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires health plans to protect the confidentiality of your private health information. More detailed information is provided in the health plan’s notice of HIPAA privacy. You may request a copy of the notice by contacting the Stanford Benefits Office.

Women’s Health and Cancer Rights Act

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy- related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed;

• Surgery and reconstruction of the other breast to produce a symmetrical appearance;

• Prostheses; and

• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under our medical plans. If you have any questions concerning this provision, please contact your medical provider.

Important Notice about Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage available under the employee medical plans and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

• Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

• Stanford University has determined that the prescription drug coverage offered under the employee medical plans are, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

36 2015 Faculty Benefits Summary | benefits.stanford.edu

When can you join a Medicare drug plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What happens to your current coverage if you decide to join a Medicare drug plan?If you decide to join a Medicare drug plan, your current medical coverage will not be affected. Your current coverage pays for other health expenses in addition to prescription drugs. If you enroll in a Medicare prescription drug plan, you and your eligible dependents will still be eligible to receive all of your current health benefits. However, if you have chosen Medicare as your primary health plan, you will not be able to receive any benefits under your current coverage.

If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will not be able to get this coverage back until January 1 following the next annual Open Enrollment period.

When will you pay a higher premium (penalty) to join a Medicare drug plan?You should also know that if you drop or lose your current coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage.

For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For more information about this notice or your current prescription drug coverage, visit the website or call the number listed below. Note: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this employee coverage changes. You also may request a copy of this notice at any time.

More information about your options under Medicare prescription drug coverage and more detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

• Visit http://www.medicare.gov

• Call your State Health Insurance Assistance Program for personalized help

• Call (800) MEDICARE [(800) 633-4227]; TTY users should call (877) 486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit the Social Security website at http://www.socialsecurity.gov, or call them at (800) 772-1213 (TTY (800) 325-0778).

benefits.stanford.edu | 2015 Faculty Benefits Summary 37

TRAILING STORY LABELLEGAL NOTICES

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and therefore, whether or not you are required to pay a higher premium (a penalty).

Notice Date: October 15, 2014

Name of Entity/Sender: Benefits Office

Contact-Position/Office: Benefits Manager

Address: 3160 Porter Drive Suite 250 Palo Alto, CA 94304-8443

Phone Number: (650) 736-2985 (option 9)

Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, you can contact your state Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are not currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office or dial (877) KIDS-NOW (543-7669) or visit the website at http://www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the state if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at https://www.dol.gov or by calling toll-free at (866) 444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2013. You should contact your state for further information on eligibility. To see if any more states have added a premium assistance program since July 31, 2013, or for more information on special enrollment rights, you can contact either:

• U.S. Department of Labor Employee Benefits Security Administration http://www.dol.gov/ebsa (866) 444-EBSA (3272)

• U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services http://www.cms.gov (877) 267-2323, Menu Option 4, Ext. 61565

Eric L. Stein, Senior Associate Athletic Director and Pamela Mahlow, Associate Director for Recreation, Department of Athletics, Physical Education and Recreation

38 2015 Faculty Benefits Summary | benefits.stanford.edu

TRAILING STORY LABELLEGAL NOTICES

Alabama Medicaid http://www.medicaid.alabama.gov (855) 692-5447

Alaska Medicaid http://health.hss.state.ak.us/dpa/programs/medicaid (888) 318-8890 (Outside of Anchorage) (907) 269-6529 (Anchorage)

Arizona CHIP http://www.azahcccs.gov/applicants (877) 764-5437 (Outside of Maricopa County) (602) 417-5437 (Maricopa County)

Colorado Medicaid http://www.colorado.gov (In state): (800) 866-3513 (Out of state): (800) 221-3943

Florida Medicaid http://www.flmedicaidtplrecovery.com (877) 357-3268

Georgia Medicaid http://dch.georgia.gov Click on “Programs”, then “Medicaid”, then “Health Insurance Premium Payment (HIPP)” (800) 869-1150

Idaho Medicaid http://www.accesstohealthinsurance.idaho.gov (800) 926-2588

CHIP www.medicaid.idaho.gov (800) 926-2588

Indiana Medicaid http://www.in.gov/fssa (800) 889-9949

Iowa Medicaid http://www.dhs.state.ia.us/hipp (888) 346-9562

Kansas Medicaid http://www.kdheks.gov/hcf (800) 792-4884

Kentucky Medicaid http://chfs.ky.gov/dms/default.htm (800) 635-2570

Louisiana Medicaid http://www.lahipp.dhh.louisiana.gov (888) 695-2447

Maine Medicaid http://www.maine.gov/dhhs/ofi/public-assistance/index.html (800) 977-6740 TTY (800) 977-6741

Massachusetts Medicaid and CHIP http://www.mass.gov/MassHealth (800) 462-1120

Minnesota Medicaid http://www.dhs.state.mn.us Click “Health Care”, then “Medical Assistance” (800) 657-3629

Missouri Medicaid http://www.dss.mo.gov/mhd/participants/pages/hipp.htm (573) 751-2005

Montana Medicaid http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml (800) 694-3084

Nebraska Medicaid http://www.ACCESSNebraska.ne.gov (800) 383-4278

Nevada Medicaid http://dwss.nv.gov (800) 992-0900

benefits.stanford.edu | 2015 Faculty Benefits Summary 39

TRAILING STORY LABELLEGAL NOTICES

New Hampshire

Medicaid http://www.dhhs.nh.gov/oii/documents/hippapp.pdf (603) 271-5218

New Jersey Medicaid http://www.state.nj.us/humanservices/dmahs/clients/medicaid (609) 631-2392

CHIP http://www.njfamilycare.org/index.html (800) 701-0710

New York Medicaid http://www.nyhealth.gov/health_care/medicaid (800) 541-2831

North Carolina Medicaid http://www.ncdhhs.gov/dma (919) 855-4100

North Dakota Medicaid http://www.nd.gov/dhs/services/medicalserv/medicaid (800) 755-2604

Oklahoma Medicaid and CHIP http://www.insureoklahoma.org (888) 365-3742

Oregon Medicaid and CHIP http://www.oregonhealthykids.gov Spanish: http://www.hijossaludablesoregon.gov (800) 699-9075

Pennsylvania Medicaid http://www.dpw.state.pa.us/hipp (800) 692-7462

Rhode Island Medicaid http://www.ohhs.ri.gov (401) 462-5300

South Carolina Medicaid http://www.scdhhs.gov (888) 549-0820

South Dakota Medicaid http://dss.sd.gov (888) 828-0059

Texas Medicaid http://www.gethipptexas.com (800) 440-0493

Utah Medicaid http://health.utah.gov/upp (866) 435-7414

Vermont Medicaid http://www.greenmountaincare.org (800) 250-8427

Virginia Medicaid http://www.dmas.virginia.gov/rcp-hipp.htm (800) 432-5924

CHIP http://www.famis.org (866) 873-2647

Washington Medicaid http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm (800) 562-3022 ext. 15473

West Virginia Medicaid http://www.dhhr.wv.gov/bms (877) 598-5820, HMS Third Party Liability

Wisconsin Medicaid http://www.badgercareplus.org/pubs/p-10095.htm (800) 362-3002

Wyoming Medicaid http://www.health.wyo.gov/healthcarefin/index.html (307) 777-7531

40 2015 Faculty Benefits Summary | benefits.stanford.edu

TRAILING STORY LABELLEGAL NOTICES

Genetic Information Nondiscrimination Act

Congress passed the Genetic Information Nondiscrimination Act (GINA) establishing a national and uniform standard to protect workers from genetic discrimination. In addition to prohibitions on discrimination in employment practices, GINA prohibits group health insurers and group health plans from adjusting premiums or contributions based on genetic information. Also, GINA amended the HIPAA privacy rules to include genetic information in the definition of protected health information.

HIPAA Special Enrollment Rights

You have special enrollment rights if you acquire a new dependent, or if you decline coverage under the Stanford University employee health plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons.

Loss of Other Coverage (Excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse/registered domestic partner) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

Loss of Coverage for Medicaid or a State Children’s Health Insurance Program.If you decline enrollment for yourself or for an eligible dependent (including your spouse/registered domestic partner) while Medicaid

coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents’ coverage ends under Medicaid or a state children’s health insurance program.

New Dependent by Marriage, Birth, Adoption or Placement for Adoption. If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

Eligibility for Medicaid or a State Children’s Health Insurance Program.If you or your dependents (including your spouse/registered domestic partner) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance.

Summary of Benefits and Coverage

The Patient Protection and Affordable Care Act (also known as the Health Care Reform law) requires that you receive a Summary of Benefits and Coverage (SBC). The SBC is designed to help you understand and evaluate your health plan choices. To obtain copies of the SBC for each of the Stanford University sponsored medical plans, please visit the Benefits website at http://benefits.stanford.edu and search for “SBC” in the “Resource Library.” Paper copies are also available, free of charge, from the Benefits Office by calling (650) 736-2985 (option 9).

benefits.stanford.edu | 2015 Faculty Benefits Summary 41

TRAILING STORY LABELLEGAL NOTICES

Health Insurance Marketplace Notice

Effective January 1, 2014, the Affordable Care Act—also known as “health care reform”—requires most Americans to have health insurance. Individuals who don’t have coverage by January 1, 2014, will be required to pay a penalty.

The Health Insurance Marketplace (“health insurance exchange”) was created to ensure that everyone has access to affordable health insurance. The Marketplace is an option for someone who does not have employer-provided health coverage or for someone who chooses not to enroll in employer-provided health coverage. Because you have the option for employer-provided health coverage, it is unlikely that you will be eligible for federal subsidies.

Why am I receiving this notice?This notice provides you with information about the Health Insurance Marketplace and where you can access more information about health plans offered to you by either your state or the U.S. Department of Health and Human Services.

Stanford University is required to send the enclosed notice to every employee to comply with rules under the federal Affordable Care Act (ACA).

What do I need to do?You’re currently eligible to participate in a Stanford University sponsored medical plan. If you participate in the medical plan, you and the University share in the cost of your coverage. Your share of the cost is paid with after-tax dollars.

If you choose not to participate in a Stanford University plan and you buy insurance in the Marketplace, you will be responsible for paying the entire premium yourself with after-tax dollars.

What is the individual mandate tax?Under the ACA, most Americans are required to have health insurance or pay a penalty. If you elect coverage through Stanford University, you will satisfy this requirement. For more information about the individual mandate, please visit: http://www.irs.gov/uac/Newsroom/Affordable-Care-Act-Tax-Provisions-Questions-and-Answers.

Questions?

Call (800) 318-2596 TTY: (855) 889-4325

or visit https://www.healthcare.gov.

WHAT THIS MEANS FOR YOU• Stanford has you and your family covered.

As a benefits-eligible employee, you and your eligible dependents have access to health care coverage through Stanford University.

• Our plans are affordable. You’ll hear about new coverage options available in the Health Insurance Marketplace, but in most cases, Stanford’s coverage will continue to provide the greatest value. And because our plans exceed the federally required “minimum value standards,” it is unlikely that our employees will be eligible for federal subsidies.

• We’ll keep you updated. As we get updates, we’ll provide resources and support to help you understand the impact of health care reform and to feel confident about your personal coverage decisions.

42 2015 Faculty Benefits Summary | benefits.stanford.edu

TRAILING STORY LABELLEGAL NOTICES

Important Information about Medicare Prescription Drug Coverage

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a federal law gives you more choices about your prescription drug coverage.

This guide provides a brief summary of the benefit plans in effect on January 1, 2014, generally offered to employees of Stanford University. It is not a Summary Plan Description (SPD). However, this guide serves as the “Summary of Material Modification” to the employee benefit plans in accordance with the requirements of the Employee Retirement Income Security Act of 1974, as amended (ERISA). If there is a discrepancy between this guide and the applicable insurance contract, agreement, SPD, or plan document, the applicable insurance contract, agreement, SPD or plan document will prevail.

Every effort is made to ensure this guide contains the most current information available. Keep in mind a more current version may be available on the Benefits website at http://benefits.stanford.edu.

Stanford University reserves the right to change (including, but not limited to, the right to amend, suspend or terminate) or make exceptions to its policies, procedures and benefit plans, or to change contributions at its discretion at any time and without prior notice.

Benefits Office 3160 Porter Drive, Suite 250 Palo Alto, CA 94304-8443

Phone: (650) 736-2985 (option 9) Fax: (650) 723-7766 http://benefits.stanford.edu

benefits.stanford.edu | 2015 Faculty Benefits Summary 43

TRAILING STORY LABELLEGAL NOTICES

MedicalBlue Shield Plans (blueshieldca.com)

Medical Plans

Mail-Order Prescriptions

800-873-3605

866-346-7200

Stanford HealthCare Alliance (stanfordhealthcarealliance.org) Member Care Services 855-345-7422

Kaiser Permanente (kp.org)

HMO

Mail-Order Prescriptions

800-464-4000

800-464-4000

Health Savings Account: HealthEquity (healthequity.com/stanford) 877-857-6810

Vita Administration Company (vitacompanies.com) Direct Pay Administrator for Leave Billing & COBRA 800-424-3052

DentalDelta Dental (deltadentalca.org/stanford) 800-765-6003

Mental Health and Substance Abuse CounselingStanford Faculty & Staff Help Center (helpcenter.stanford.edu) 650-723-4577

VisionVision Service Provider (VSP) (vsp.com) 800-877-7195

Flexible Spending AccountsBenesyst (TASC) (partners.benesyst.net/Stanford) 855-842-4913

Life & DisabilityCNA Insurance Company (Long-Term Care) (ltcbenefits.com) Password: stanfordgltc 800-528-4582

Liberty Mutual (Short- and Long-Term Disability) (mylibertyconnection.com) Claimant Service ID: stanford 800-896-9375

Prudential Insurance Company of America (Life Insurance, AD&D) 800-524-0542

Retirement Savings PlansStanford Retirement Manager (netbenefits.com) 888-793-8733

TIAA-CREF (tiaa-cref.org) 800-842-2888

Staff Retirement Annuity Plan (SRAP) 650-736-2985 (press option 3)

Stanford Benefits Service Center: 877-905-2985 or 650-736-2985 (press option 9)