2015 retiree benefits summary

2015 RETIREE BENEFITS SUMMARYEffective January 1, 2015

Pan A. Yotopoulos Professor Emeritus, Food Research Institute

ContentsDo you Qualify for Retirement? .......................................... 4

Preparing for Retirement? .................................................. 5

Who Is Eligible for Stanford Benefits? .............................. 6

Participation: Your Options at Retirement ..................... 8

If you are Rehired or Recalled to Work ........................... 10

When Does Coverage Start? ............................................. 11

Paying for Benefits ............................................................. 12

Health Plans ........................................................................ 13

Health Plans if you are Not Enrolled in Medicare ........ 14

Health Plans If You Are Enrolled in Medicare ................ 17

Health Plans If You Are in a “Split Family” ..................... 19

Prescription Drugs .............................................................. 20

Mental Health and Substance Abuse ............................. 21

Dental Plans ........................................................................ 22

Long-Term Care (LTC) Insurance ..................................... 23

Tuition Grant Program (TGP) ........................................... 24

Commit to Your Health with BeWell .............................. 25

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

2015 Benefits Plan Comparison Charts for Retirees Not Enrolled in Medicare ............................. 27

2015 Benefits Plan Comparison Charts for Retirees Enrolled in Medicare .................................... 33

Delta Dental PPO ................................................................ 39

Legal Notices ....................................................................... 40

Contact Information .......................................................... 48

2 2015 Retiree Benefits Summary | benefits.stanford.edu

http://benefits.stanford.edu/

Dear Retiree,

Stanford University is committed to providing you a comprehensive benefits package from health and dental insurance to educational assistance and wellness resources.

We understand that selecting benefits is an important process. In addition to providing an overview of your benefits, this Retiree 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 planning to retire or are currently retired and making benefits elections during Open Enrollment, this guide is intended to help you make educated choices.

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

In good health, Stanford Benefits

benefits.stanford.edu | 2015 Retiree Benefits Summary 3

http://benefits.stanford.edu


Do You Qualify for Retirement?To qualify to become an official retiree of Stanford University, you must be a benefits-eligible employee in good standing and have not been terminated for misconduct.

In addition, to qualify for retiree medical benefits, you must meet one of the following requirements:

• Hired before January 1, 1992

» You are at least age 55, and

» You have at least 10 years of benefits-eligible service , or

• Rule of 75 (for anyone)

» Your age + years of benefits eligible-service equals at least 75, and

» You complete at least 10 years of benefits-eligible service

For each month you work at least one day in a benefits-eligible position at Stanford, that month counts toward a year of service. Each 12-month period is counted as a year of service.



Preparing for Retirement?When you’re ready to retire, you’ll have to make some important decisions about your financial and health benefits. It pays to be prepared.

Choosing and personalizing your benefits depends on your specific needs, preferences and budget. We’ve made it easier for you to do your homework, research plans and get your questions answered.

The following Retirement Checklist was created to help you prepare for this important milestone.

❏ Read When Employment Ends – Retirement, which may be downloaded from the Stanford Benefits website at http://benefits.stanford.edu.

❏ Request a Retirement Calculation from Stanford Benefits at 877-905-2985 or 650-736-2985 (press option 9). Results may take up to 4–6 weeks.

❏ Attend a Health Care in Retirement workshop or view the workshop online.

❏ Review your retiree medical plan options before you make your medical and dental elections.

❏ Enroll in your Stanford health plan by contacting Stanford Benefits at 877-905-2985 or 650-736-2985 (press option 9).

❏ If you are over age 65 and enrolled in a Medicare Advantage Plan, be sure to complete the documentation.

❏ Look for your new medical plan ID card in the mail.

❏ Talk to your accountant or tax advisor about your accounts in SCRP and/or SRAP funds. Or, make an appointment with a financial counselor available on campus.

❏ Determine how you want to take a distribution from SCRP and/or SRAP.




Who Is Eligible for Stanford Benefits?

All official retirees are eligible for Stanford benefits. See “Do you Qualify for Retirement?” on page 4 for details on criteria for retirement.

A retiree’s dependents may also be eligible for coverage. Eligible dependents include 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.

Pan A. Yotopoulos Professor Emeritus

with grandson Mattias and daughter-in-law Amy Yotopoulos,

‘93, Program Manager, WorkLife Office



Adding Dependents to Your Benefits

We require 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 retiree 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.

Is Your Spouse/Domestic Partner a Stanford Employee or Retiree?

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

Continued Coverage for Your Dependents

If you die while eligible for the retiree health care program, your eligible dependents may still receive coverage. Your surviving spouse/registered domestic partner must notify Stanford of your death and request to enroll (if not already enrolled) to postpone or continue coverage.

If your eligible surviving spouse/registered domestic partner dies, then coverage continues for the remaining eligible children. Although Stanford provides access to these health care benefits for your eligible dependents, the surviving dependents must pay their portion of the cost of the plan.

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.

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


WHO IS ELIGIBLE FOR STANFORD BENEFITS?

https://benefits.stanford.edu


http://www.ss.ca.gov/dpregistry


Participation: Your Options at Retirement When you become eligible for retiree health care and are ready to retire, you have three options: enroll for coverage to start at retirement, postpone coverage until a later date or waive coverage completely. Your decision is very important, and you should carefully consider these choices.

Enroll for Coverage to Start at Retirement.

• You may elect coverage before you leave Stanford so benefits begin the first day of the month after your retirement date. This coverage stays in effect until the end of the calendar year in which you enroll, unless you have a Life Event change (job, family, personal) or fail to pay your contributions on time. Failure to pay your monthly contributions will result in your benefits being waived and losing future eligibility in Stanford retiree health care benefits.

• During each annual Open Enrollment period, you’ll receive information that allows you to change your current benefit elections for the following calendar year. If you do not change your benefits during the Open Enrollment period, your elections will continue through the following year as long as the plan is still available and you remain eligible for that plan. In addition, you must pay the new costs. You cannot make any changes until the next Open Enrollment period, unless you have a Life Event change.

Option

1



Postpone Coverage Until a Later Date.

• You may choose not to enroll at retirement but reserve the right to enroll in your retiree benefits during any future Open Enrollment period or if you have a Life Event change. You may postpone only once when you first retire.

• After you have enrolled in a Stanford retiree health plan, you no longer have the option to stop coverage and start again at a later date.

• If you die while eligible for the retiree health care program, your eligible surviving dependents have a one-time option to postpone coverage. If your eligible surviving spouse/registered domestic partner then dies, your surviving children likewise have a one-time option to postpone coverage. If you do not enroll or apply to postpone coverage within 31 days of your retirement, you will be automatically placed in postpone status indefinitely until you contact Stanford Benefits.

Waive Coverage and Permanently Lose Future Eligibility and Access to Coverage through Stanford’s Program.

• You may decline or drop retiree health care coverage at retirement, or at any time, and permanently waive your right to retiree health care. If you wish to waive coverage, Stanford Benefits will ask you to confirm your decision.

To learn more about Life Event changes and other conditions of participation, visit the Stanford Benefits website at http://benefits.stanford.edu or call 877-905-2985 or 650-736-2985 (press option 9) to speak with a Benefits representative.

Remember: If you enroll for coverage and then terminate coverage for any reason, you cannot re-enroll. You and your eligible dependents lose all future eligibility for Stanford retiree health care.

Option

2

Option

3





If You Are Rehired or Recalled to WorkIf you return to Stanford University and work fewer than 20 hours a week, you remain covered under your retiree health care plan.

If you return to work at Stanford University in a benefits-eligible position and work at least 20 hours per week, the following will apply, depending on your situation.

If you are:

• Rehired or recalled within the same calendar year you retired, you will receive the health and life plans you had as an active employee.

• Recalled or rehired after a year, you will be asked to enroll in one of the active employee medical plans offered at that time, as well as all other active benefits.

• Enrolled in Medicare, your Stanford active health care benefits become your primary health plan, and Medicare becomes your secondary health plan. You may want to contact Social Security to discuss dropping Medicare Part B. You may re-enroll in Medicare Part B at the time you lose active coverage in the future.

• Enrolled in a Medicare Advantage health plan and return to Stanford, contact us to help you disenroll from the plan during your period of employment.

• In “postpone” status when you are recalled or rehired, you return to postpone status when you terminate employment again.

• Enrolled in a Stanford retiree health care plan when you are recalled or rehired, you may either re-enroll in retiree health care or waive coverage when you terminate employment and return to retiree status. If you waive coverage, you lose all future eligibility for retiree health care.


When Does Coverage Start?Your active medical and dental benefits stop on the last day of the month in which you retire. In order for your retiree benefits to begin on the first day of the following month, you must make your elections by the 15th of the month.

For example: If your retirement date is May 21, your active benefits continue through May 31. If you elected your new benefits by May 15, your retiree benefits will begin on June 1.

If you miss your election deadline (the 15th of the month) your retiree health benefits are delayed and you must find other coverage until your retiree health coverage begins. A Benefits representative can give you more information if you miss your election deadline.

University Contributions

The amount Stanford contributes toward the cost of your medical benefits depends on when you were originally hired and the length of your benefits-eligible employment before retirement. These conditions determine if you receive a contribution under the Grandfathered Contribution or Non-Grandfathered Contribution (also called “Defined Contribution”) method.

Determine Your Monthly Premium

Grandfathered RetireesReview the Enrollment Worksheet in your initial or open enrollment packet for monthly contribution and rate amounts.

Non-Grandfathered RetireesPlease call us at 877-905-2985 or 650-736-2985 (press option 9). A Benefits representative will help you determine your plan costs.

Split Family Worksheet for Grandfathered RetireesThe “Calculate Costs for a Split Family” worksheet on page 19 will help you calculate your monthly costs. The Enrollment Worksheet in your Open Enrollment packet shows you the amounts to use when calculating your monthly costs.

For more information on Defined Contribution, read the Retiree Medical Plan FAQs on the Stanford Benefits website at http://benefits.stanford.edu.


http://benefits.stanford.edu/resources/contribution-rates-2015-retiree





Paying for BenefitsWhen you retire, you’ll be sent information by Vita Administration Company on the cost of coverage and how to pay. Vita is Stanford University’s billing administrator. You have the option of mailing your payments each month using payment coupons, or using the SurePay program, which automatically debits your bank account. SurePay is easy to set up. Simply complete the SurePay Enrollment Form which is located on the Benefits website at http://benefits.stanford.edu.

Each year before Open Enrollment begins, Stanford will send you contribution information for the following year. Remember to make your payments in order to remain eligible for retiree health care benefits. If you have questions about your contributions, please contact Stanford Benefits for this information.

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 the three-week Open Enrollment period, your ID card will 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. PT), 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.


http://benefits.stanford.edu/sites/default/files/benefits/resource_library/2603_surepay_generic_fm10-v2.03_12_2012.pdf


Health PlansTypes of Plans

Your health plan options depend on your and your dependents’ Medicare eligibility.

Non-Medicare Plans: If you and your covered dependents are under age 65 and are not enrolled in Medicare, read about the non-Medicare Plans starting on page 14.

Medicare Plans: If you and all of your covered dependents are enrolled in Medicare, read about the Medicare Plans starting on page 17.

Non-Medicare + Medicare = Split Family: If your family includes both non-Medicare eligible and Medicare eligible members, read both the Non-Medicare and Medicare Plans sections, as well as the Split Family section on page 19.


WHAT HAPPENS IF I DON’T RE-ENROLL? If you do not elect a new medical plan for coverage during the Open Enrollment period, your benefit elections from 2014 will roll over automatically. However, the cost will reflect the 2015 contribution amounts.


Health Plans If You Are Not Enrolled in MedicareThese plans are only available if you and all of your enrolled dependents are not eligible for Medicare, or if you are in a “Split Family” (see page 19).

Stanford offers a variety of health plans that include coverage for prescription drugs, 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 providers affiliated with Stanford Health Care and Stanford Children’s Health 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 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 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 a SHCA network doctor and/or facility except for an urgent or life-threatening emergency if you are outside the SHCA service area.

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 will need approval and referral from your Stanford HealthCare Alliance PCP.

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.

Kaiser offers cost-effective managed care and places a strong emphasis on wellness and preventive care. With Kaiser, you:



• 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. Pre-authorization may be required on certain services.

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.


HEALTH PLANS IF YOU ARE NOT ENROLLED IN MEDICARE


Health Savings Account (HSA)

Available only if you are not enrolled in Medicare

If you are interested in setting aside tax-deductible funds for future health care expenses through a Health Savings Account (HSA), you must be enrolled in the Blue Shield High-Deductible Health Plan (HDHP). In 2015, the HSA limit (the amount you contribute) is $3,350 for retiree only, and $6,650 for retiree + dependents.

Because of the tax savings and flexibility to reimburse yourself for medical expenses, an HSA is worth considering.

If you are enrolled in the HDHP, you may set up an HSA directly with HealthEquity, Blue Shield’s financial partner, or with a financial institution of your choice by making contributions on a post-tax basis.

If you have questions about how HSAs work with your HDHP, visit http://healthequity.com/stanford, or call HealthEquity at 877-857-6810. You may also find more information about HSAs in the “Medical & Life” section of the Stanford Benefits website at http://benefits.stanford.edu.

Medicare and HSA

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

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


HEALTH PLANS IF YOU ARE NOT ENROLLED IN MEDICARE

http://healthequity.com/stanford

http://healthequity.com/stanford



Health Plans If You Are Enrolled in MedicareOnce you become eligible for Medicare, you must be enrolled in Medicare Parts A and B to participate in any of Stanford’s retiree health plans. Any covered eligible dependents who are 65 or older, or who receive Social Security Disability Insurance (SSDI), must also be enrolled in Medicare Parts A and B.

Prescription drug coverage is included in Stanford’s retiree health plans, so do not enroll in Medicare Part D prescription drug plan. If you have questions about enrolling in Medicare, contact the Social Security Administration at 800-772-1213 or visit the website at http://socialsecurity.gov.

Stanford offers a variety of health plans that work with your Medicare coverage. You may choose from Medicare Advantage or Medicare Supplement plans.

Medicare Advantage Plans

Medicare Advantage plans require you to enroll in an HMO and then assign your Medicare benefits to that HMO. An HMO is a managed care group that provides services and supplies through its own network of doctors, hospitals and other health care facilities. It covers your expenses only if you go to a health care provider within its network of providers (unless it’s a life threatening emergency).

When you enroll in an HMO plan, you may be required to select a primary care physician (PCP) who manages your care using the HMO network’s physicians and facilities. You will likely need approval from your PCP before seeing a specialist.

HMOs offer cost-effective managed care and place a strong emphasis on wellness and preventive care.

With an HMO, you:



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

• Pay a fixed copay for prescriptions

How to Enroll in a Medicare Advantage Plan

To enroll in a Medicare Advantage plan, you must live in one of the HMO’s service areas (based on your home zip code). Stanford offers these Medicare Advantage HMO plans:

• Health Net Seniority Plus

• Kaiser Permanente Senior Advantage

• United Healthcare Group Medicare Advantage

You must complete a Medicare Advantage Enrollment Form to assign your Medicare benefits to the HMO you elect whether you enroll for the first time or change from one Medicare Advantage plan to another.

A Medicare Advantage Enrollment Form will be sent to you if needed. You and your spouse must each complete a separate form when enrolling. In the event you change to a Medicare Supplement Plan, you must disenroll. For additional assistance, you may call Stanford Benefits at 877-905-2985 or 650-736-2985 (press option 9) to speak to a Benefits representative.

Medicare Advantage Enrollment and Disenrollment Forms are available on the Stanford Benefits website at http://benefits.stanford.edu in the “Resource Library.”


http://socialsecurity.gov

http://benefits.stanford.edu/sites/default/files/benefits/resource_library/2757_medicare_advantage_enrollment_form_2.14.13.02_15_2013.pdf

http://benefits.stanford.edu/sites/default/files/benefits/resource_library/2757_medicare_advantage_enrollment_form_2.14.13.02_15_2013.pdf

http://benefits.stanford.edu/sites/default/files/benefits/resource_library/2591_103_Medicare_disenroll_form.09_18_2013.pdf

http://benefits.stanford.edu/sites/default/files/benefits/resource_library/2591_103_Medicare_disenroll_form.09_18_2013.pdf



Medicare Supplement Plans

Under a Medicare Supplement plan, Medicare is the primary medical plan for you and your dependents. They allow you to seek services from any doctor who accepts Medicare, but your costs will be lower if you see a provider who is in the plan’s network. Medicare Supplement Plans pay benefits for services after you receive payment from Medicare.

Stanford offers the following Medicare Supplement plans:

• Blue Shield Retiree Medical Plan: Available anywhere in the United States and internationally if you keep your Medicare coverage.

• United Healthcare Senior Supplement: Available in most U.S. locations.

• Health Net COB Plan: Available only in certain California HMO service areas. You must receive care from a Health Net HMO provider. If you choose to go out of network, your care will be limited to services covered under Medicare and must be provided by a doctor who accepts Medicare.

Medicare Crossover Billing

You might be able to have Medicare and your Medicare Supplement health plan automatically work together to process your claims. This is called “crossover billing.” If your doctor accepts Medicare, your physician automatically sends claims to Medicare for you. If you set up Medicare crossover billing, after Medicare pays its portion of the claim, they notify your health plan of any outstanding balance, so there is less claims work for you to manage.

How to Set Up Medicare Crossover Billing

After you receive your new medical plan ID card, call your health plan’s member care services number on the back of your medical ID card. To set up crossover billing, you must provide your health plan with the following information:

Medicare Claim Number (usually your

Social Security Number, followed by a letter)

—and—

The effective date of your Medicare Part A and Part B coverage, as found on

your Medicare card.

For additional information on how to set up crossover billing, call your health plan’s member services number on your medical ID card.


HEALTH PLANS IF YOU ARE ENROLLED IN MEDICARE


Health Plans If You Are in a “Split Family”“Split family” describes a family where some members are Medicare eligible and some are not Medicare eligible. If you’re in a split family, you and your dependents must enroll in medical plans offered by the same insurance company, if available. The retiree’s medical plan election determines the plan choice for other family members.

For example, if you are eligible for Medicare and elect coverage with the Kaiser Permanente Senior Advantage plan, your non-Medicare-eligible dependents must enroll in the Kaiser Permanente HMO.

If you are in one of the Health Net or United Healthcare Medicare plans, your non-Medicare eligible dependents may enroll in one of the Blue Shield plans.

Rules for a Split Family

1. Any family member who is in Medicare must be enrolled in Medicare Parts A and B.

2. Any family member who is in Medicare may need to complete special paperwork. (See the Medicare plans section on page 17 for information on the need to complete the Medicare Advantage Form or Disenrollment Form.)

Calculate Costs for a Split Family

Use this worksheet to help you calculate your monthly costs. The Enrollment Worksheet in your Open Enrollment packet shows you the amounts to use when calculating your monthly costs.

NAME OF PLAN YOU ELECTED

COST OF PLAN FOR YOU AND/OR

YOUR ELIGIBLE DEPENDENTS

MEDICARE PLAN: $

NON-MEDICARE PLAN: + $

TOTAL MONTHLY COST: = $




Prescription DrugsYour medical plan provides prescription drug coverage, so be sure to take your ID card when you have a prescription filled. New in 2015, all five non-Medicare health plans will cover prescriptions at 100% once the out-of-pocket maximum is met.

The Blue Shield High-Deductible Health Plan (HDHP) requires you to pay 20 percent of the cost of all prescription drugs after you have satisfied the deductible. If you fill your prescriptions at a Blue Shield network pharmacy, your costs are lower.

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).

SMART DECISIONS CAN ADD UP TO SAVINGS

No matter which plan you’re in, you can save money by:

Switching to Generic Drugs: They are chemically equivalent to brand-name drugs but sold under their generic names, usually at a significantly lower price. If your medication does not have a generic equivalent on the market yet, ask your doctor if there is a similar generic drug for your condition.

Using Mail-Order Prescription Services: Each medical plan offers a home delivery prescription drug program through its mail-order prescription benefit. If appropriate to your situation, ask your doctor to write you a prescription that specifies up to a 90-day quantity (100-day for Kaiser Permanente) and includes three refills. Then, mail your prescription and order form to your plan’s mail-order service.

Checking the Preferred Drug List: Each medical plan has a list of approved drugs, known as a formulary. If your prescription is not included in your plan’s formulary, you’ll probably end up paying a higher copay. Talk with your doctor about whether a formulary alternative is appropriate. Each medical plan’s formulary is updated throughout the year, so call your medical plan’s Member Services number listed on your medical plan ID card or visit your plan’s website if you want information on a specific prescription drug.



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).

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 or a High-Deductible Health Plan (HDHP) and 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.


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

Stanford HealthCare Alliance (SHCA)

Did not cover non-network services.


* 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.


http://campus-map.stanford.edu/?id=07-220&lat=37.4316904627&lng=-122.171700225&zoom=17&srch=Keck%20Bldg

http://helpcenter.stanford.edu


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.

Delta Dental PPO Group 1149

Stanford retirees have a separate PPO dental plan. This plan gives you the freedom to choose your own dentist, though out-of-pocket costs will be lower if you see a dentist in Delta’s PPO network. Delta’s website can help you find a dentist in your area.

Compare network and non-network dental costs at the end of this booklet or see the “Medical & Life” section of the Stanford Benefits website, http://benefits.stanford.edu.

For 2015 rates, see your Enrollment Worksheet in your Open Enrollment packet or call Stanford Benefits at 877-905-2985 or 650-736-2985 (press option 9).





Long-Term Care (LTC) InsuranceLong-Term Care (LTC) insurance is an optional 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, Medicare or Medicaid.

LTC insurance is available to Stanford retirees, covered spouses/registered domestic partners and enrolled dependents.

LTC insurance is provided through CNA. In addition to enrollment and customer service, CNA manages all direct billing for all Long-Term Care insurance coverage.

You may apply for LTC insurance at any time. Applicants must complete an Evidence of Insurability (EOI) long form application, and coverage is not guaranteed. If the application is approved, CNA will begin billing you directly.

If you were enrolled in LTC as an active employee, you and any enrolled dependents can continue participating in the program. Contact CNA within 31 days after you retire to request continuation of coverage. Your cost will remain the same but you will be billed directly by CNA.

Program details can be found on the Stanford Benefits website at http://benefits.stanford.edu under the “Medical & Life” section. Call CNA to request an application packet (see the contact information on page 48).

IS EVERYTHING CORRECT?

If you think you made an error during your enrollment process, call us to make corrections at 877-905-2985 or 650-736-2985 (Monday through Friday from 7 a.m. to 5 p.m. PT).

For Open Enrollment, all corrections must be made by 5 p.m. PT on November 14, 2014.

When you receive your first bill from Vita Administration Company with your new payment amounts, compare it to your Confirmation Statement. If the amount is not correct, call Vita at 800-424-3052 by the end of December 2014.




Tuition Grant Program (TGP)Stanford will assist retirees who have fulfilled their qualifying service requirement prior to retirement with up to four years of undergraduate college tuition costs at approved colleges and universities for eligible dependent children.

If prior to retirement, an employee is at less than 100% full time employment (FTE) at Stanford, the grant amount may be prorated depending on FTE history.

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.


http://hreap.stanford.edu


Commit to Your Health with BeWellThe BeWell program was established in 2008 to encourage benefits-eligible employees and their spouses or registered domestic partners to adopt behaviors that can improve their health, well-being and quality of life.

New this year: As an official Stanford retiree, you will be eligible to participate in limited BeWell@Stanford programs, at a reduced cost.

Starting January 5, 2015, eligible retirees may take advantage of the following programs:

BEWELL PROGRAM COST

The Stanford Health and Lifestyle Assessment (SHALA)*—an online health risk assessment.

FREE

The Wellness Profile: health screening* and advising session.

$35.00

Up to two (2) fitness classes per quarter on a space available basis.

$30.00 per class (discount price after completing the SHALA)

Healthy Living classes. Cost varies (scholarships available for one class per quarter)

Learn more about BeWell@Stanford at http://bewell.stanford.edu.

Find a class or activity that interests you.

• Health Improvement Program, http://hip.stanford.edu

• Cardinal Recreation, http://recreation.stanford.edu

Physical Education and Recreation Facilities

Through the Department of Athletics, Physical Education and Recreation, you have access to a variety of athletic, recreation and wellness facilities on campus using your Stanford ID card, 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 will have lots of opportunity to find an activity that meets your needs and interests and to stay fit.

To access fitness classes and recreational facilities, you must present your official Stanford Retiree ID card. If you need a card, visit the Stanford ID Card Office located at George Forsythe Hall, 275 Panama Street, Room 90.

* By participating in the SHALA and biometric screening, you will be asked to share your assessment results. BeWell advisors will review the information with you and may use your results to suggest appropriate health promotion resources, both on campus and 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.


https://bewell.stanford.edu

http://hip.stanford.edu

http://recreation.stanford.edu


Other Retiree Resources and ServicesAs a Stanford retiree, you have access to various benefits, services, resources and amenities on campus, such as:

• Use of athletic and recreational facilities and access to exercise classes and health seminars through the Health Improvement Program (see”Commit to Your Health with BeWell” on page 25 for details)

• Access to Stanford’s libraries, lectures, plays, concerts, films and exhibits— often at no cost or at special rates

• Access to Faculty Staff Help Center mental health services for you and your family

• Membership in the Stanford Federal Credit Union

• Membership in Stanford Staffers

News and Information

Stay connected to Stanford as an official retiree by signing up for the Stanford Retiree Insider, a digital newsletter delivered quarterly by email and designed especially for Stanford retirees. The Retiree Insider provides news and information about staying connected to the university, and highlights a variety of benefits, perks and services available to retirees. View past issues of the retiree newsletter and sign up to receive future issues by visiting http://uhr.stanford.edu/stanford-insider.

You may also get the latest news from Stanford from the Stanford Report, which is delivered daily to your email address. Simply sign up at http://news.stanford.edu/subscribe.

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.

Your Stanford Identification Card

A Retiree ID card, offered at no cost to retirees, may be secured through the Stanford ID Card Office. The Retiree ID card provides retirees access to recreational facilities, libraries and other university resources including the golf course, special offers and discounts to many ticketed events.

The Stanford ID Card office also issues courtesy cards to retirees’ spouses or domestic partners.

ID and courtesy cards are only issued in person at the ID Card Office. Card eligibility is determined by Information Technology Services. For more information, visit the Card Center website, https://itservices.stanford.edu/service/campuscard.

Location: George Forsythe Hall, 275 Panama Street, Room 90

Hours: Open 8 a.m. to 5 p.m., Monday through Friday. Closed daily between 12:30 and 1 p.m.

Phone: 650-498-2273


http://uhr.stanford.edu/stanford-insider

http://news.stanford.edu/subscribe

http://foryou.stanford.edu

https://itservices.stanford.edu/service/campuscard


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non-

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day

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Mus

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150

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to a

90-

day

supp

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Mus

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non-

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d: $

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Desc

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Blue

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Med

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you

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sign

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plan

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pla

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aim

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Appr

oved

: De

duct

ible

s Wai

ved

Non

-Med

icar

e Ap

prov

ed:

$100

per

indi

vidu

al/$

300

fam

ily

No

dedu

ctib

leN

o de

duct

ible

No

dedu

ctib

leN

o de

duct

ible

No

dedu

ctib

le



Bene

fits P

lan

Com

paris

on C

hart

sbe

nefit

s.st

anfo

rd.e

du |

201

5 Re

tiree

Ben

efits

Sum

mar

y

34

Bene

fit

Desc

ript

ion

Blue

Shi

eld

Retir

ee

Med

ical

Pla

n

Grou

p #9

7571

9

Heal

th N

et S

enio

rity

Plus

Gr

oup

#580

0SP

Heal

th N

et M

edic

are

COB

Grou

p #5

8004

BKa

iser P

erm

anen

te

Seni

or A

dvan

tage

Gr

oup

#714

5 (No

rthe

rn C

A)

Grou

p #23

0178

(Sou

ther

n CA)

Unite

d He

alth

care

Gro

up

Med

icar

e Ad

vant

age

Gr

oup

#240

689

Unite

d He

alth

care

Sen

ior

Supp

lem

ent

Grou

p #0

0014

837-

SN01

Coin

sura

nce

100%

for M

edic

are

Appr

oved

se

rvic

es; 1

00%

for P

reve

ntiv

e Se

rvic

es; 8

0% a

fter

dedu

ctib

le fo

r Non

-Med

icar

e Ap

prov

ed o

r oth

er se

rvic

es

100%

afte

r app

licab

le co

pays

, un

less

oth

erw

ise

note

d10

0% a

fter a

pplic

able

copa

ys,

unle

ss o

ther

wis

e no

ted

100%

afte

r app

licab

le co

pays

.10

0% a

fter a

pplic

able

copa

ys.

100%

for M

edic

are

Appr

oved

an

d so

me

othe

r ser

vice

s.

Out

-of-P

ocke

t M

axim

umM

edic

are-

Appr

oved

or N

on-

Med

icar

e Ap

prov

ed: $

1,00

0 pe

r ind

ivid

ual

$3,4

00 p

er in

divi

dual

$1,5

00 p

er in

divi

dual

/$4,

500

fam

ily$1

,500

per

indi

vidu

al

$3,0

00 fa

mily

$3,4

00 p

er in

divi

dual

No

out o

f poc

ket m

axim

um

Mat

erni

ty

Pren

atal

Vis

itsM

edic

are

Appr

oved

: 100

%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

$25

copa

y10

0%10

0%$2

5 co

pay

Firs

t vis

it on

ly

Not

cove

red

Men

tal H

ealt

h/Su

bsta

nce

Abus

e

Men

tal H

ealth

INPA

TIEN

T CA

RE

Pre-

Certi

ficat

ion

is re

quire

d by

you

or y

our p

rovi

der.

Med

icar

e Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

60%

afte

r ded

uctib

le

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

Med

icar

e Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

MH

N m

ust a

ppro

ve m

enta

l he

alth

car

e.

INPA

TIEN

T CA

RE

100%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it

MH

N m

ust a

ppro

ve m

enta

l he

alth

car

e.

INPA

TIEN

T CA

RE

100%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it

Kais

er P

erm

anen

te m

ust

appr

ove

men

tal h

ealth

car

e.

INPA

TIEN

T CA

RE

100%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it, in

divi

dual

$1

2 co

pay

per v

isit,

gro

up

INPA

TIEN

T CA

RE

100%

U

p to

190

day

s per

life

time

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it

INPA

TIEN

T CA

RE

Med

icar

e Ap

prov

ed: 1

00%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

Med

icar

e Ap

prov

ed: 1

00%


Bene

fits P

lan

Com

paris

on C

hart

s

Bene

fits P

lan

Com

paris

on C

hart

s

bene

fits.

stan

ford

.edu

| 2

015

Retir

ee B

enef

its S

umm

ary

3

4

bene

fits.

stan

ford

.edu

| 2

015

Retir

ee B

enef

its S

umm

ary

3

5

Bene

fit

Desc

ript

ion

Blue

Shi

eld

Retir

ee

Med

ical

Pla

n

Grou

p #9

7571

9

Heal

th N

et S

enio

rity

Plus

Gr

oup

#580

0SP

Heal

th N

et M

edic

are

COB

Grou

p #5

8004

BKa

iser P

erm

anen

te

Seni

or A

dvan

tage

Gr

oup

#714

5 (No

rthe

rn C

A)

Grou

p #23

0178

(Sou

ther

n CA)

Unite

d He

alth

care

Gro

up

Med

icar

e Ad

vant

age

Gr

oup

#240

689

Unite

d He

alth

care

Sen

ior

Supp

lem

ent

Grou

p #0

0014

837-

SN01

Subs

tanc

e Ab

use

INPA

TIEN

T CA

RE

Pre-

Certi

ficat

ion

is re

quire

d by

you

or y

our p

rovi

der.

Med

icar

e Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

60%

afte

r ded

uctib

le

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

Med

icar

e Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

MH

N m

ust a

ppro

ve

subs

tanc

e ab

use

care

.

INPA

TIEN

T CA

RE

100%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it

MH

N m

ust a

ppro

ve

subs

tanc

e ab

use

care

.

INPA

TIEN

T CA

RE

100%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it

INPA

TIEN

T DE

TOXI

FICA

TIO

N

100%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it, in

divi

dual

$5 co

pay

per v

isit,

gro

up

INPA

TIEN

T CA

RE

100%

Up

to 1

90 d

ays p

er li

fetim

e

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

$25

copa

y pe

r vis

it

INPA

TIEN

T CA

RE

Med

icar

e Ap

prov

ed: 1

00%

OU

TPAT

IEN

T CA

RE

[no

visi

t lim

it]

Med

icar

e Ap

prov

ed: 1

00%

Oth

er S

ervi

ces

Acup

unct

ure

Med

icar

e-Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

Up

to 2

0 vi

sits

per

yea

r M

edic

are-

Appr

oved

and

N

on-M

edic

are

Appr

oved

co

mbi

ned.

$15

copa

y, li

mite

d to

20

visi

ts

Mus

t use

Am

eric

an S

peci

alty

H

ealth

(ASH

) pro

vide

rs

$15

Copa

y, li

mite

d to

20

visi

ts

(com

bine

d w

ith c

hiro

prac

tic)

Mus

t use

Am

eric

an S

peci

alty

H

ealth

(ASH

) pro

vide

rs

$15

copa

y

Up

to 4

0 co

mbi

ned

chiro

prac

tic a

nd a

cupu

nctu

re

visi

ts p

er y

ear

Amer

ican

Spe

cial

ty H

ealth

(A

SH) P

lans

Par

ticip

atin

g

Acup

unct

uris

ts

$25

copa

y up

to 2

0 vi

sits

$25

copa

y up

to 2

0 vi

sits

/yea

r

Alle

rgy

Test

sM

edic

are-

Appr

oved

: 100

%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

100%

Offi

ce co

pay

may

app

ly

100%

Offi

ce co

pay

may

app

ly

$25

copa

y$2

5 co

pay

Med

icar

e-Ap

prov

ed: 1

00%

Alle

rgy

Trea

tmen

tM

edic

are-

Appr

oved

: 100

%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

100%

Offi

ce co

pay

may

app

ly

100%

Offi

ce co

pay

may

app

ly

$3 co

pay

for i

njec

tions

$25

copa

yM

edic

are-

Appr

oved

: 100

%

Alte

rnat

ive

Med

icin

eN

ot co

vere

dN

ot co

vere

dN

ot co

vere

dN

ot co

vere

dN

ot co

vere

dN

ot co

vere

d

Ambu

lanc

e Ch

arge

sM

edic

are-

Appr

oved

: 100

%

after

$50

copa

y

Non

-Med

icar

e Ap

prov

ed:

80%

of t

he a

llow

ed a

mou

nt

after

$50

copa

y

$50

copa

y$5

0 co

pay

$50

copa

y$5

0 co

pay

Med

icar

e-Ap

prov

ed: 1

00%



Bene

fits P

lan

Com

paris

on C

hart

sbe

nefit

s.st

anfo

rd.e

du |

201

5 Re

tiree

Ben

efits

Sum

mar

y

36

Bene

fit

Desc

ript

ion

Blue

Shi

eld

Retir

ee

Med

ical

Pla

n

Grou

p #9

7571

9

Heal

th N

et S

enio

rity

Plus

Gr

oup

#580

0SP

Heal

th N

et M

edic

are

COB

Grou

p #5

8004

BKa

iser P

erm

anen

te

Seni

or A

dvan

tage

Gr

oup

#714

5 (No

rthe

rn C

A)

Grou

p #23

0178

(Sou

ther

n CA)

Unite

d He

alth

care

Gro

up

Med

icar

e Ad

vant

age

Gr

oup

#240

689

Unite

d He

alth

care

Sen

ior

Supp

lem

ent

Grou

p #0

0014

837-

SN01

Chiro

prac

tors

Up

to $

1,50

0 m

ax b

enef

it pe

r ca

lend

ar y

ear

Med

icar

e-Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

$20

copa

y

Cove

rage

is li

mite

d to

man

ual

man

ipul

atio

n of

the

spin

e to

corre

ct su

blux

atio

n. Yo

u pa

y th

e fu

ll co

st o

f rou

tine

care

. Lim

ited

to M

edic

are

allo

wab

le co

vera

ge.

Disc

ount

pro

gram

ava

ilabl

e.

$15

copa

y. L

imite

d to

20

visi

ts (c

ombi

ned

with

ac

upun

ctur

e)

Mus

t use

Am

eric

an S

peci

alty

H

ealth

(ASH

) pro

vide

rs

Disc

ount

pro

gram

ava

ilabl

e

$15

copa

y

Up

to 4

0 co

mbi

ned

chiro

prac

tic a

nd a

cupu

nctu

re

visi

ts p

er y

ear

Amer

ican

Spe

cial

ty H

ealth

(A

SH) P

lans

Par

ticip

atin

g

Chiro

prac

tors

$10

copa

y; 1

2 vi

sit m

axim

um$1

0 co

pay;

12

visi

t max

imum

Emer

genc

y Ro

omIn

clud

ing

emer

genc

y ro

om

prof

essi

onal

and

lab/

anci

llary

cha

rges

Med

icar

e-Ap

prov

ed: 1

00%

aft

er $

50 fa

cilit

y co

pay

per v

isit

(cop

ay w

aive

d if

adm

itted

)

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r $50

faci

lity

copa

y pe

r vis

it (c

opay

wai

ved

if ad

mitt

ed)

$65

copa

y (w

aive

d if

adm

itted

)$1

00 co

pay

(wai

ved

if ad

mitt

ed)

$65

copa

y (w

aive

d if

adm

itted

)$6

5 co

pay

(wai

ved

if ad

mitt

ed)

Med

icar

e-Ap

prov

ed: 1

00%

Urge

nt C

are

Serv

ices

Med

icar

e-Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

$25

copa

y$2

5 co

pay

$25

copa

y$2

0 co

pay

$20

copa

y if

outs

ide

Secu

re

Hor

izons

Ser

vice

Are

a

Med

icar

e-Ap

prov

ed: 1

00%

Hom

e H

ealth

Ca

reM

edic

are-

Appr

oved

: 100

%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

100%

100%

100%

100%

Med

icar

e-Ap

prov

ed: 1

00%

Hos

pita

l Sta

yM

edic

are

Appr

oved

: 100

%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

100%

100%

100%

100%

Plan

pay

s 100

% o

f Med

icar

e Ap

prov

ed se

rvic

es u

p to

a

lifet

ime

max

imum

of 3

65

days

.

Infe

rtili

ty

Trea

tmen

tN

ot co

vere

dN

ot co

vere

d50

%

Ferti

lity

Drug

s: Co

vere

d un

der d

rug

bene

fits;

In V

itro

Ferti

lizat

ion

(IVF)

, GIF

T an

d ZI

FT: N

ot co

vere

d

$25

copa

y

Ferti

lity

Drug

s: Co

vere

d un

der

drug

ben

efits

; In

Vitro

, GIF

T,

and

ZIFT

: Not

cove

red.

Not

cove

red

Not

cove

red


Bene

fits P

lan

Com

paris

on C

hart

s

Bene

fits P

lan

Com

paris

on C

hart

s

bene

fits.

stan

ford

.edu

| 2

015

Retir

ee B

enef

its S

umm

ary

3

6

bene

fits.

stan

ford

.edu

| 2

015

Retir

ee B

enef

its S

umm

ary

3

7

Bene

fit

Desc

ript

ion

Blue

Shi

eld

Retir

ee

Med

ical

Pla

n

Grou

p #9

7571

9

Heal

th N

et S

enio

rity

Plus

Gr

oup

#580

0SP

Heal

th N

et M

edic

are

COB

Grou

p #5

8004

BKa

iser P

erm

anen

te

Seni

or A

dvan

tage

Gr

oup

#714

5 (No

rthe

rn C

A)

Grou

p #23

0178

(Sou

ther

n CA)

Unite

d He

alth

care

Gro

up

Med

icar

e Ad

vant

age

Gr

oup

#240

689

Unite

d He

alth

care

Sen

ior

Supp

lem

ent

Grou

p #0

0014

837-

SN01

Labo

rato

ry

Char

ges

Med

icar

e-Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

100%

100%

100%

100%

Med

icar

e-Ap

prov

ed: 1

00%

Offi

ce V

isits

Med

icar

e-Ap

prov

ed: 1

00%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

$25

copa

y$2

5 co

pay

$25

copa

y$2

5 co

pay

100%

if m

edic

ally

nec

essa

ry

X-ra

ysM

edic

are-

Appr

oved

: 100

%

Non

-Med

icar

e Ap

prov

ed:

80%

afte

r ded

uctib

le

100%

100%

100%

100%

Med

icar

e-Ap

prov

ed: 1

00%

Pres

crip

tion

Drug

s

Phar

mac

y (R

etai

l)Bl

ue S

hiel

d N

etw

ork

phar

mac

y: $

10 g

ener

ic; $

30

bran

d na

me;

$75

non

-fo

rmul

ary—

up to

a 3

0-da

y su

pply

.

Non

-Net

wor

k Ph

arm

acy:

80

%, n

o de

duct

ible

In-N

etw

ork

only

: Inf

ertil

ity

Drug

s cov

ered

at 5

0% o

f ch

arge

s, up

to a

$5,

000

lifet

ime

max

imum

.

Dru

gs fo

r int

raut

erin

e in

sem

inat

ion

(IUI)

are

limite

d to

thre

e cy

cles

Pres

crip

tion

drug

cove

rage

is

prov

ided

by

Hea

lth N

et.

$10

Tier

I; $

30 T

ier I

I (fo

rmul

ary

bran

d); $

75 T

ier I

II

Up

to a

30-

day

supp

ly

Pres

crip

tion

drug

cove

rage

is

prov

ided

by

Hea

lth N

et.

$10

Tier

I; $

30 T

ier I

I (fo

rmul

ary

bran

d); $

75 T

ier I

II

Up

to a

30-

day

supp

ly

KAIS

ER P

ERM

ANEN

TE

PHAR

MAC

Y

Gene

ric: $

10 fo

r up

to a

30-

day

supp

ly, $

20 fo

r a 3

1- to

60

-day

supp

ly, o

r $30

for a

61

- to

100-

day

supp

ly

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

00-

day

supp

ly

$10

gene

ric; $

30 b

rand

pr

efer

red;

$75

non

-form

ular

y no

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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 retiree 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 retiree 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.



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 retiree 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


LEGAL NOTICES

http://www.medicare.gov


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).

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


LEGAL NOTICES

http://www.socialsecurity.gov

http://www.socialsecurity.gov

http://www.insurekidsnow.gov

http://www.insurekidsnow.gov

https://www.dol.gov

http://www.dol.gov/ebsa

http://www.cms.gov


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


LEGAL NOTICES

http://www.medicaid.alabama.gov

http://www.medicaid.alabama.gov

http://health.hss.state.ak.us/dpa/programs/medicaid



http://www.azahcccs.gov/applicants

http://www.azahcccs.gov/applicants

http://www.colorado.gov

http://www.flmedicaidtplrecovery.com

http://www.flmedicaidtplrecovery.com

http://dch.georgia.gov

http://www.accesstohealthinsurance.idaho.gov



http://www.medicaid.idaho.gov

http://www.in.gov/fssa

http://www.dhs.state.ia.us/hipp

http://www.dhs.state.ia.us/hipp

http://www.kdheks.gov/hcf

http://chfs.ky.gov/dms/default.htm

http://chfs.ky.gov/dms/default.htm

http://www.lahipp.dhh.louisiana.gov

http://www.lahipp.dhh.louisiana.gov

http://www.maine.gov/dhhs/ofi/public-assistance/index.html



http://www.mass.gov/MassHealth

http://www.mass.gov/MassHealth

http://www.dhs.state.mn.us

http://www.dss.mo.gov/mhd/participants/pages/hipp.htm



http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml



http://www.ACCESSNebraska.ne.gov

http://www.ACCESSNebraska.ne.gov

http://dwss.nv.gov


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


LEGAL NOTICES

http://www.dhhs.nh.gov/oii/documents/hippapp.pdf

http://www.dhhs.nh.gov/oii/documents/hippapp.pdf

http://www.state.nj.us/humanservices/dmahs/clients/medicaid



http://www.njfamilycare.org/index.html

http://www.njfamilycare.org/index.html

http://www.nyhealth.gov/health_care/medicaid

http://www.nyhealth.gov/health_care/medicaid

http://www.ncdhhs.gov/dma

http://www.nd.gov/dhs/services/medicalserv/medicaid



http://www.insureoklahoma.org

http://www.insureoklahoma.org

http://www.oregonhealthykids.gov

http://www.oregonhealthykids.gov

http://www.hijossaludablesoregon.gov

http://www.hijossaludablesoregon.gov

http://www.dpw.state.pa.us/hipp

http://www.dpw.state.pa.us/hipp

http://www.ohhs.ri.gov

http://www.scdhhs.gov

http://dss.sd.gov

http://www.gethipptexas.com

http://health.utah.gov/upp

http://www.greenmountaincare.org

http://www.greenmountaincare.org

http://www.dmas.virginia.gov/rcp-hipp.htm

http://www.dmas.virginia.gov/rcp-hipp.htm

http://www.famis.org

http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm

http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm

http://www.dhhr.wv.gov/bms

http://www.badgercareplus.org/pubs/p-10095.htm

http://www.badgercareplus.org/pubs/p-10095.htm

http://www.health.wyo.gov/healthcarefin/index.html

http://www.health.wyo.gov/healthcarefin/index.html


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 retiree 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).


LEGAL 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 retiree 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 retiree, 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 retirees 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.


LEGAL NOTICES

http://www.irs.gov/uac/Newsroom/Affordable-Care-Act-Tax-Provisions-Questions-and-Answers



https://www.healthcare.gov


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 retirees of Stanford University. It is not a Summary Plan Description (SPD). However, this guide serves as the “Summary of Material Modification” to the retiree benefit plans in accordance with the requirements of the Retiree 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


LEGAL NOTICES



Medical

Blue Shield Plans (blueshieldca.com/stanford)

Medical Plans

Mail-Order Prescriptions

800-873-3605

866-346-7200

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

Health Net HMO (healthnet.com)

Medical Plans


800-522-0088

888-624-1139

Kaiser Permanente (kp.org)

HMO


800-464-4000

800-464-4000

United Healthcare (uhcwest.com)

Medical Plans


800-624-8822

800-562-6223

Vita Administration Company (vitacompanies.com) Direct Pay Administrator for Retiree Health Care 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

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)

Long Term CareCNA Insurance Company (ltcbenefits.com) 800-528-4582

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

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

http://blueshieldca.com/stanford

http://stanfordhealthcarealliance.org

http://healthnet.com

http://kp.org

http://uhcwest.com

http://vitacompanies.com

http://deltadentalca.org/stanford

http://helpcenter.stanford.edu

http://netbenefits.com

http://tiaa-cref.org

http://ltcbenefits.com

http://mylibertyconnection.com

2015 retiree benefits summary

Documents

benefits elections

retiree medical benefits

stanford benefits website

health plans

benefitseligible employee

comprehensive benefits

good health

retiree resources