2016 retiree benefits summary

2016 RETIREE BENEFITS SUMMARYEffective January 1, 2016

Myra Strober Professor of Education, Emerita Graduate School of Education and husband, Jay Jackman

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 & Vision 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

2016 Benefits Plan Comparison Charts for Retirees Not Enrolled in Medicare ............................. 27

2016 Benefits Plan Comparison Charts for Retirees Enrolled in Medicare .................................... 33

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

Contacts ............................................................................... 48

2 2016 Retiree Benefits Summary | cardinalatwork.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 tuition and training programs 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 Cardinal at Work website, http://cardinalatwork.stanford.edu.

In good health, Stanford Benefits

cardinalatwork.stanford.edu | 2016 Retiree Benefits Summary 3

http://cardinalatwork.stanford.edu


Do You Qualify for Retirement?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

In addition, you must be a benefits-eligible employee in good standing and have not been terminated for misconduct.



Preparing for RetirementWhen 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.

R Request a Retirement Calculation by contacting the University HR Service Team at 877-905-2985 or 650-736-2985. Results may take up to 4–6 weeks.

R Read When Employment Ends – Retirement, which may be downloaded from the Cardinal at Work website at http://caw.stanford.edu/employmentends.

R Review your retiree medical plan and dental plan options on the Cardinal at Work website at http://caw.stanford.edu/retireehealthplans.

R Attend a Health Care Benefits In Retirement workshop. See the Cardinal at Work Calendar for scheduled dates. If you are unable to attend, listen to the audio presentation Your Health Care Benefits in Retirement in the Resource Library on the Cardinal at Work website at http://caw.stanford.edu/retireehealthbenefits.

R Determine your termination date and notify your manager.

R Ask your Human Resources Manager if you are eligible for terminal vacation. If you are eligible, then your last day on terminal vacation is your termination date. (see Administrative Guide 2.1.6)

R Enroll in Medicare Parts A & B if age 65 or over within 3 months prior to your retirement date.

R Enroll in your Stanford health plan by contacting the University HR Service Team at 877-905-2985 or 650-736-2985.

R If you are over age 65 and enrolling in a Medicare Advantage Plan, be sure to submit your Advantage forms by the 15th of the month prior to your retirement date.

R Look for your new medical plan ID card in the mail 3–4 weeks after your retirement date.

R Set up crossover billing if you are in a retiree supplement plan. (See page 18.)

R If interested, request life insurance conversion and/or portability forms within 30 days of your termination date.

R Review the Retirement Savings Checklist.

R You will receive a COBRA and a retiree billing packet from The Vita Companies at the end of your first month on the retiree medical plan.


https://caw.stanford.edu/employmentends

https://caw.stanford.edu/employmentends

https://caw.stanford.edu/retireehealthplans

https://caw.stanford.edu/retireehealthplans

https://caw.stanford.edu/retireehealthbenefits

https://caw.stanford.edu/retireehealthbenefits

http://caw.stanford.edu/admin-guide

https://caw.stanford.edu/retireesavingschecklist

https://caw.stanford.edu/retireesavingschecklist


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.



Adding Dependents to Your Benefits

We require proof of dependent eligibility for the dependents you cover. For a list of acceptable documentation, view the Eligibility & Enrollment page, available on the Cardinal at Work website at http://caw.stanford.edu/eligibility-enrollment.

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. Please make sure to submit the required dependent certification documentation if enrolling your spouse (such as a marriage certificate) within 30 days of completing your enrollment by logging into My Benefits at http://caw.stanford.edu/my-benefits.

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

• For opposite-sex domestic partnerships, one or both persons must be over 62 years of age, and one or both must meet the eligibility criteria under Title II of the Social Security Act.


WHO IS ELIGIBLE FOR STANFORD BENEFITS?

http://caw.stanford.edu/eligibility-enrollment

http://www.medicare.gov


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

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 the University HR Service Team.

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, the University HR Service Team will ask you to confirm your decision.

To learn more about Life Event changes and other conditions of participation, visit the Cardinal at Work website at http://caw.stanford.edu/change-your-benefits or call the University HR Service Team at 877-905-2985 or 650-736-2985 to speak with a specialist.

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


http://caw.stanford.edu/change-your-benefits



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 prior 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 University HR Service Team specialist 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 mailed in your initial or open enrollment packet for monthly contribution and rate amounts.

Non-Grandfathered Retirees (Defined Contribution)Please call the University HR Service Team at 877-905-2985 or 650-736-2985. A service team specialist will help you determine your plan costs.

Split Family WorksheetThe “Calculate Costs for a Split Family” 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 Cardinal at Work website at http://cardinalatwork.stanford.edu.


http://caw.stanford.edu/splitfamilyworksheet

http://cardinalatwork.stanford.edu/




Paying for BenefitsWhen you retire, you’ll be sent information by The Vita Companies 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 & Rewards section of the Cardinal at Work website at http://cardinalatwork.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 the University HR Service Team 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 2016 during the three-week Open Enrollment period, your ID card will be sent to you by the end of the 2015 calendar year. If you have not received it and need medical care on or after January 1, 2016, 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 the University HR Service Team at 877-905-2985 or 650-736-2985 (Monday through Friday from 8 a.m. to 5 p.m. PT). 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.






Health PlansTypes of Plans

Your health plan options depend on whether you and your dependents are or are not Medicare eligible.

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 2015 will roll over automatically (as long as the plan is still available and you remain eligible for that plan). However, the cost will reflect the 2016 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 (under 65), 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 Health Care Alliance (SHCA)

Stanford Health Care 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 Health Care Alliance, you:

• Have no deductible

• Have no claims to file

• Pay a fixed co-pay 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 Health Care 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 co-pay for each office visit, emergency room visit and hospital stay

To enroll in Kaiser, you must live within a Kaiser service area. Medical benefit plans are all home ZIP code driven.



Blue Shield Healthcare + Savings Plan

The Healthcare + Savings plan is a high deductible plan that works like a PPO plan, but there are no fixed co-pays with this plan. Instead, all benefits—including prescription drugs—are covered after you meet your deductible. Up to $2,600 of an individual’s claims will apply toward the family deductible, and once that threshold is met the plan will begin sharing the costs for that individual. You may enroll in a Health Savings Account (HSA) to set aside money to cover eligible out-of-pocket expenses with this plan.

• 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.

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 co-payment 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.


HEALTH PLANS IF YOU ARE NOT ENROLLED IN MEDICARE


Health Savings Account (HSA)

Available only if you are not enrolled in Medicare Part A and Part B

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 Healthcare + Savings Plan. In 2015, the HSA limit (the amount you may contribute) is $3,350 for retiree only, and $6,750 for retiree + dependents. Employees age 55 or older may also contribute up to $1,000 in catch-up contributions to their HSA.

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

If you are enrolled in the Healthcare + Savings Plan, 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 Healthcare + Savings Plan, visit http://healthequity.com/stanford, or call HealthEquity at 877-857-6810. You may also find more information about HSAs on the Cardinal at Work website at http://caw.stanford.edu/hsa.

Medicare and HSA

When you reach age 65, you must defer coverage under Medicare Parts A and B and be enrolled in a high deductible medical plan 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 University HR Service Team to have them re-enroll you.


HEALTH PLANS IF YOU ARE NOT ENROLLED IN MEDICARE

http://healthequity.com/stanford

http://caw.stanford.edu/hsa


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 co-pay for each office visit, emergency room visit, hospital stay and other services

• Pay a fixed co-pay 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, and any Medicare-eligible dependents, 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 The University HR Service Team at 877-905-2985 or 650-736-2985 to speak with a specialist.

Medicare Advantage Enrollment and Disenrollment Forms are available on the Cardinal at Work website at http://cardinalatwork.stanford.edu.


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://cardinalatwork.stanford.edu


Medicare Supplement Plans

Under a Medicare Supplement plan, Medicare is the primary medical plan for you and/or 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: 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 the SHCA plan or 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 Enrollment 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: = $


http://benefits.stanford.edu/resources/contribution-rates-2014-retiree


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

The Blue Shield Healthcare + Savings Plan 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 co-pay. 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.



Mental Health and Substance AbuseMental health and substance abuse treatment are both covered

by your medical plan. For details, contact your plan or see the comparison chart at the back of this booklet.

Non-Network Mental Health Coverage

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

PLAN NON-NETWORK COVERAGE

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

Healthcare + Savings Plan

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 Health Care Alliance (SHCA)

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.

Visit the Faculty Staff Help Center at the Keck Science Building located at 380 Roth Way or online at http://caw.stanford.edu/help-center.


http://caw.stanford.edu/help-center


Dental & Vision 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 1149-0001

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 view Retiree Dental Plan on the Cardinal at Work website, http://caw.stanford.edu/dental-retiree.

For 2016 rates, see your Enrollment Worksheet in your Open Enrollment packet or call the University HR Team at 877-905-2985 or 650-736-2985.

NEW: VSP Vision CareRetirees now have access to vision care which includes annual eye exams, contact lenses and/or frames.

VSP PLAN COVERAGE COST

Eye Exam Once every calendar year $25 co-pay

LensesOnce every calendar year (includes basic, bifocals, trifocals and lenticular)

Plan pays 100%

Frames Once every calendar year Plan pays up to $150

Contact Lenses Once every calendar year in lieu of frames and lenses

Plan pays 100% if medically necessary

Plan pays up to $150 if elective

ExtrasIncluding scratch-resistant coating, anti-reflective coating, progressives and sunglasses

Discounted through your VSP provider


http://caw.stanford.edu/dental-retiree

http://caw.stanford.edu/dental-retiree



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.

Starting October 1, 2015, CNA Insurance Company discontinued LTC coverage and is no longer our LTC insurance provider. Stanford’s new LTC insurance provider, Genworth, is not making LTC available to retirees.

If you elected LTC coverage as a retiree prior to October 1, 2015, you will continue coverage with CNA. CNA will continue to manage all LTC direct billing and customer service.

If you were enrolled in LTC as an active employee, you and any enrolled family members can continue participating in the program. Contact CNA to continue coverage.

IS EVERYTHING CORRECT?

If you think you made an error during your enrollment process, call the University HR Service Team to make corrections at 877-905-2985 or 650-736-2985 (Monday through Friday from 8 a.m. to 5 p.m. PT).

For Open Enrollment, all corrections must be made by 5 p.m. PT on November 13, 2015.

When you receive your first bill from The Vita Companies with your new payment amounts, compare it to your Enrollment Confirmation Statement. If the amount is not correct, call Vita at 800-424-3052 by the end of December 2015.


https://www.cna.com/portal/site/groupLTC/?companyLogin=stanfordgltc

https://www.genworth.com/


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 or visit the Cardinal at Work website, http://caw.stanford.edu/tgp.


http://caw.stanford.edu/tgp


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.

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

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 coaching session.

$35.00

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

$30.00 per class**

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.

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 staff 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.

**Discount price after completing the SHALA Healthy Living Classes. Cost varies. Scholarships available for one class per quarter.


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”Health Improvement Program” 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 the Cardinal at Work website, http://caw.stanford.edu/connect.

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.

Note: You cannot access athletic facilities until you receive a Retiree ID card.

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, http://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://caw.stanford.edu/connect

http://caw.stanford.edu/connect

http://news.stanford.edu/subscribe

http://foryou.stanford.edu

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


Benefits Plan Comparison Charts

Benefit Description

Stanford Health Care Alliance Plan – Group #868025

Blue Shield EPO Plan – Group #PPOX0006

Blue Shield Healthcare + Savings Plan – Group #PPOX0004

Blue Shield ACA Basic High Deductible Plan – Group #PPOX0007

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

BASICS

Overview The Stanford Health Care Alliance ACO plan requires you designate a primary care provider to coordinate all of your care. You may visit any Stanford Health Care Alliance network doctor or hospital. Some services require prior authorization from your primary care physician.

There is no benefit if you see a non-network provider, except for emergency care or when clinically appropriate and prior authorized by Stanford Health Care Alliance.

You may visit any Blue Shield PPO network doctor or hospital.

For certain services or procedures Blue Shield may require use of certain providers within their network.

There is no benefit if you see a non-network provider, except for emergency or urgent care.

You may visit any doctor or hospital. You receive a higher level of benefits when you use Blue Shield PPO providers. You are responsible for ensuring all providers are in the network.

When you see a non-network provider you are responsible for the balance of your bill that is not covered by Blue Shield. The Out-of-Pocket Maximum does not apply to the balance of the bill not covered by Blue Shield.

This plan is compatible with an individual Health Savings Account (HSA), that you establish at a financial institution of your choice.

You may visit any doctor or hospital. You receive a higher level of benefits when you use Blue Shield PPO providers. You are responsible for ensuring all providers are in the network.

When you see a non-network provider you are responsible for the balance of your bill that is not covered by Blue Shield. The Out-of-Pocket Maximum does not apply to the balance of the bill not covered by Blue Shield.

This plan is compatible with an individual Health Savings Account (HSA), that you establish at a financial institution of your choice.

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

Pre-Authorization Requirement

Pre-authorization from your primary care provider is required for the following services: Advanced Imaging (CT, MRI, MRA and PET); all electively scheduled inpatient admissions; all elective outpatient procedures (example- endoscopic procedures, arthroscopic procedures, epidural steroid injections, etc.); physical therapy; durable medical equipment; speech therapy.

PENALTY for not pre-authorizing: the services will be considered not covered by the plan and the member is responsible for the full amount of the service.

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

PENALTY for not pre-authorizing: benefit reduced to 50% of Blue Shield Allowed Amount. You pay balance of all charges not covered by Blue Shield. Out-of-Pocket Maximum does not apply.

Pre-authorization required for all hospital stays and certain outpatient procedures.

PENALTY for not pre-authorizing: benefit reduced to 50% of Blue Shield Allowed Amount. Maximum reduction of $1,000. You pay balance of all charges not covered by Blue Shield. Out-of-Pocket Maximum does not apply. Certain may be denied in full for failure to pre-authorize.

Pre-authorization required for all hospital stays and certain outpatient procedures.

PENALTY for not pre-authorizing: benefit reduced to 50% of Blue Shield Allowed Amount. Maximum reduction of $1,000. You pay balance of all charges not covered by Blue Shield. Out-of-Pocket Maximum does not apply. Certain benefits may be denied in full for failure to pre-authorize.

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

PENALTY for not pre-authorizing: not covered.

Office Co-Pay $30 co-pay primary/$75 co-pay specialist

$30 co-pay primary/$75 co-pay specialist

Network: 80% after deductible

Non-Network: 60% after deductible




2016 Benefits Plan Comparison Charts for Retirees Not Enrolled in Medicare




Benefit Description






Deductible No deductible No deductible $1,750 per individual coverage/$3,500 per family coverage Combined Network or Non-Network. Up to $2,600 of an individual’s claims will apply toward the family deductible, and once that threshold is met the plan will begin sharing the costs for that individual.

In-Network: $3,250 per individual coverage/$6,500 per family coverage

Out-of-Network: $6,500 per individual coverage/$13,000 per family coverage.

The individual deductible will apply to each covered family member’s claims. If met, the plan would begin sharing costs for the family member that met the individual deductible.

No deductible

Coinsurance 100% after applicable co-pays 100% after applicable co-pays Network: 100% for preventive care; 80% after deductible for all other services, including prescriptions

Non-Network: 60% of allowed charges after deductible, including prescriptions

Network: 100% for preventive care; 60% after deductible for all other services, including prescriptions

Non-Network: 50% of allowed charges after deductible, including prescriptions

100% after applicable co-pays

Out-of-Pocket Maximum

$3,500 per individual/$7,000 family

A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.)

$3,500 per individual/$7,000 family

Combined Network or Non-Network:. A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.)

$3,750 per individual/$7,500 per family

Combined Network or Non-Network: A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This will cover prescriptions and medical expenses at 100% once the out-of-pocket maximum is met.)

In-Network: $6,500 per individual/$13,000 per family

Out-of-Network: $13,000 per individual/$26,000 per family


$3,500 per individual $7,000 family


MATERNITY

Prenatal Visits 100% 100% Network: 80% after deductible




100%




Benefit Description






MENTAL HEALTH/AUTISM/SUBSTANCE ABUSE

Mental Health Stanford HealthCare Alliance must approve mental health care.

INPATIENT CARE$150 co-pay per admission

OUTPATIENT CARE[no visit limit]

Network: $30 co-pay per visit

Non-Network: 80% of billed charges (up to $300 maximum allowed charges) for professional services only.

*The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.

Blue Shield must approve mental health care.






INPATIENT CAREPre-Certification is required by you or your provider.


Non-Network: 60% of billed charges


Network: 80% after deductible.



INPATIENT CAREPre-Certification is required by you or your provider.


Non-Network: 50% of the allowed amount after deductible


Network: 60% after deductible.


Kaiser Permanente must approve mental health care.


OUTPATIENT CARE[no visit limit] $30 co-pay per visit, individual $15 co-pay per visit, group

Substance Abuse Pre-certification is required by you or your provider.





The maximum allowed amount will not exceed $300 for each office visit. For example, if the billed charge is $350, the plan will pay 80% of {the lesser of $300 or the billed charge} = 80% x $300 = $240.

Pre-certification is required by you or your provider.







INPATIENT CARENetwork: 80% after deductible







INPATIENT CARENetwork: 60% after deductible





INPATIENT DETOXIFICATION$150 co-pay per admission

OUTPATIENT CARE[no visit limit] $30 co-pay per visit, individual $5 co-pay per visit, group

Transitional Residential Recovery Services$150 co-pay per admission





Benefit Description






OTHER SERVICES

Emergency Room $200 co-pay (waived if admitted) $200 co-pay (waived if admitted) Network: 80% after deductible


Lab/ancillary/professional charges paid at 80% after deductible for Network or Non-Network



Lab/ancillary/professional charges paid at 60% after deductible for Network or Non-Network

$200 co-pay (waived if admitted)

Urgent Care Office visit co-payment, specialist visit co-payment, or Emergency Room co-payment, depending on the facility.

Office visit co-payment, specialist visit co-payment, or Emergency Room co-payment, depending on the facility.

Network or Non-Network: 80% after deductible


$30 co-pay at Kaiser Permanente facility

Ambulance Charges

100% after $50 co-pay 100% after $50 co-pay Network or Non-Network: 80% after deductible (if medically approved)

Network or Non-Network: 60% after deductible (if medically approved)

100% after $50 co-pay

Hospital Stay Pre-Certification required by you or your provider. $150 co-pay per admission

Pre-Certification required by you or your provider. $150 co-pay per admission

Pre-Certification required by you or your provider.



Pre-Certification required by you or your provider.



$150 co-pay per admission

Home Health Care 100% 100% Network: 80% after deductible




100%

Up to 100 two-hour visits/calendar year [3 visits per day max]

Acupuncture $30 co-pay

Up to 20 visits per year

In-Network providers only

$30 co-pay





Up to 20 combined Network and Non-Network visits per year




$20 co-pay

Up to 40 combined chiropractic and acupuncture visits per year

American Specialty Health (ASH) Plans Participating Acupuncturists

Allergy Tests 100%

Office co-pay may apply.

100%

Office co-pay may apply.





$30 co-pay

Chiropractors $30 co-pay



$30 co-pay









$20 co-pay


American Specialty Health (ASH) Plans Participating Chiropractors




Benefit Description






Infertility Treatment

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

In Vitro, GIFT, and ZIFT: Not covered

Fertility drugs: see Pharmacy

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


Fertility drugs: see Pharmacy

Network: 50% of Blue Shield allowed charges after deductible for professional and lab services; limited to three cycles of intrauterine insemination (IUI).

Non-Network: Not covered


Fertility drugs are covered at 50% after deductible, up to $5,000 lifetime maximum

Network: 50% of Blue Shield allowed charges after deductible for professional and lab services; limited to three cycles of intrauterine insemination (IUI).



Fertility drugs are covered at 50% after deductible, up to $5,000 lifetime maximum

50%

Fertility Drugs: Covered under drug benefits at 50%; In Vitro, GIFT, and ZIFT: Not covered.

Laboratory Charges

100% 100% Network: 80% after deductible




100%

Office Visits $30 co-pay primary/$75 co-pay specialist







Physical Therapy $75 co-pay **Pre-authorization requirement

$75 co-pay Network: 80% after deductible




$30 co-pay

Hearing Care $75 co-pay

Hearing aids not covered

$75 co-pay


Network: 100% as part of preventive care



Network: 100% as part of preventive care



100%


Vision Care $75 co-pay

Limited to screen and refraction exams only

$75 co-pay


Discount program available for vision hardware

Network: 100%



Network: 100%



100%

Eye exams only. Discount program for vision hardware.

X-Rays 100% 100% Network: 80% after deductible




100%





Benefit Description






PRESCRIPTION DRUGS

Pharmacy (Retail) Stanford Health Care Alliance uses the Aetna Network pharmacies: $10 generic; $40 brand name; $100 non-formulary — up to a 30-day supply

Non-Network pharmacy: Member pays co-payment plus 25% of billed charges

Fertility drugs covered at 50% (deductible does not apply); max benefit of $5,000 per lifetime

Blue Shield Network pharmacy: $10 generic; $40 brand name; $100 non-formulary — up to a 30-day supply

Non-Network pharmacy: Member pays co-payment plus 25% of billed charges

Fertility drugs covered at 50% (deductible does not apply); max benefit of $5,000 per lifetime


Fertility drugs: see Infertility Treatment


Fertility drugs: see Infertility Treatment

KAISER PERMANENTE PHARMACYGeneric: $10 for up to a 30-day supply, $20 for a 31- to 60-day supply, or $30 for a 61- to 100-day supply

Brand: $40 for up to a 30-day supply, $80 for a 31- to 60-day supply, or $120 for a 61- to 100-day supply

Mail-Order Drug Program

$20 generic; $80 brand name; $200 non-formulary — up to a 90-day supply

Must use Aetna mail-order service


Must use Blue Shield mail-order service

80% after deductible


60% after deductible


KAISER PERMANENTE MAIL ORDER PHARMACYGeneric: $10 up to a 30-day supply; $20 for a 31-100 day supply

Brand: $40 up to a 30-day supply; $80 for a 31-100 day supply

Birth Control Pills Included in Prescription Drug benefit

Included in Prescription Drug benefit



Included in Prescription Drug benefit, covered at 100%

PREVENTIVE CARE

Pap Smears 100%

[as part of the office visit]

100%

[as part of the office visit]

Network: 100% if part of annual preventive




100%

Mammograms 100% 100% Network: 100% if part of annual preventive




100%

Immunizations 100%

Travel immunizations not covered.

100%

Travel immunizations not covered.

Network: 100%

Non-Network: Not covered; travel immunizations not covered.

Network: 100%

Non-Network: Not covered; travel immunizations not covered.

100%

Office visit co-pay applies if provided during doctor office visit

Prostate Specific Antigen Test - PSA

100% 100% Network: 100%


Network: 100%


100%

Well-Woman Visits 100% 100% Network: 100%


Network: 100%


100%




2016 Benefits Plan Comparison Charts for Retirees Enrolled in Medicare


Benefit Description

Blue Shield Retiree Medical Plan Group # #975719

Health Net Seniority Plus Group #5800SP

Health Net Medicare COB Group #58004B

Kaiser Permanente Senior Advantage Group #7145 (Northern CA) Group #230178 (Southern CA)

United Healthcare Group Medicare Advantage Group #240689

United Healthcare Senior Supplement Group #00014837-SN01

BASICS

Overview This plan provides coverage from any licensed physician anywhere in the world, and pays Medicare Part A and Part B deductibles and co-insurance for all Medicare-approved services. This plan covers some services not covered by Medicare.

You will have lower costs if you use a provider who accepts Medicare assignment and is a Blue Shield PPO network provider.

As a Medicare Supplement plan, this plan coordinates with Medicare. Many of the expenses that are covered by Medicare are paid at 100% of the Medicare Allowable Amount. Many of the non-Medicare approved services are first subject to the deductible and are covered at 80%.

This plan pays benefits when you get care from your Seniority Plus network doctor and when your doctor refers you to a hospital or specialist in the network. Most covered expenses are paid at 100%. You must choose a Primary Care Physician (PCP) from the network to coordinate all your services.

You will pay a co-pay for certain services.

You do not get benefits from this plan or from Medicare if you receive non-emergency care outside the network. When you enroll in this plan, you assign your Medicare benefits to the plan.

This plan pays benefits when you get care from your Health Net network doctor and when your doctor refers you to a hospital or specialist in the network. Most covered expenses are paid at 100%. You must choose a Primary Care Physician (PCP) from the network to coordinate all your services.


You do not get benefits from this plan if you receive non-emergency care outside the network. If you obtain care outside the network, your benefits are limited to services covered by Medicare, and services must be provided by a doctor that accepts Medicare assignment. If your doctor does not accept Medicare assignment you may be billed for the balance.

This plan pays benefits when you get care from your Kaiser Permanente doctor and when your doctor refers you to a hospital or specialist in the network. Most covered expenses are paid at 100%.



This plan pays benefits when you get care from your Group Medicare Advantage network doctor and when your doctor refers you to a hospital or specialist in the network. Most covered expenses are paid at 100%. You must choose a Primary Care Physician (PCP) from the network to coordinate all your services.



This plan provides coverage from any licensed physician anywhere in the US, and pays Medicare Part A and Part B deductibles for all Medicare-approved services. This plan covers some services not covered by Medicare.

You will have lower costs if you use a provider who accepts Medicare assignment.

As a Medicare Supplement plan, this plan coordinates with Medicare. All claims must be submitted to Medicare first. Many of the expenses that are covered by Medicare are paid at 100% of the Medicare Allowable Amount.

Coinsurance 100% for Medicare-Approved services; 100% for Preventive Services; 80% after deductible for Non-Medicare-Approved or other services

100% after applicable co-pays, unless otherwise noted

100% after applicable co-pays, unless otherwise noted



100% for Medicare-Approved and some other services.

Office Co-Pay Medicare-Approved: 100%

Non-Medicare-Approved: 80% after deductible

$25 co-pay $25 co-pay $25 co-pay $25 co-pay 100%



Benefits Plan Comparison Charts cardinalatwork.stanford.edu | 2016 Retiree Benefits Summary 34

Benefit Description







Deductible Medicare-Approved: Deductibles Waived

Non-Medicare-Approved: $100 per individual/$300 family

No deductible No deductible No deductible No deductible No deductible

Out-of-Pocket Maximum

Medicare-Approved or Non-Medicare-Approved: $1,000 per individual

$3,400 per individual $1,500 per individual; $4,500 family

$1,500 per individual; $3,000 family

$3,400 per individual No out-of-pocket maximum

MATERNITY

Prenatal Visits Medicare-Approved: 100%


$25 co-pay 100% 100% $25 co-pay First visit only Not covered

MENTAL HEALTH/SUBSTANCE ABUSE

Mental Health INPATIENT CAREPre-Certification is required by you or your provider.

Medicare-Approved: 100%





MHN must approve mental health care.

INPATIENT CARE100%


$25 co-pay per visit

MHN must approve mental health care.

INPATIENT CARE100%



Kaiser Permanente must approve mental health care.

INPATIENT CARE100%


$25 co-pay per visit, individual

$12 co-pay per visit, group

INPATIENT CARE100%

Up to 190 days per lifetime



INPATIENT CAREMedicare-Approved: 100%



Substance Abuse INPATIENT CAREPre-Certification is required by you or your provider.






MHN must approve substance abuse care.

INPATIENT CARE100%



MHN must approve substance abuse care.

INPATIENT CARE100%



INPATIENT DETOXIFICATION

100%


$25 co-pay per visit, individual

$5 co-pay per visit, group

INPATIENT CARE100%

Up to 190 days per lifetime



INPATIENT CAREMedicare-Approved: 100%





Benefit Description







OTHER SERVICES

Acupuncture Medicare-Approved: 100%


Up to 20 visits per year Medicare-Approved and Non-Medicare-Approved combined.

$15 co-pay, limited to 20 visits

Must use American Specialty Health (ASH) providers

$15 co-pay, limited to 20 visits (combined with chiropractic)


$15 co-pay


American Specialty Health (ASH) Plans Participating Acupuncturists

$25 co-pay up to 20 visits $25 co-pay up to 20 visits/year

Allergy Tests Medicare-Approved: 100%


100%

Office co-pay may apply

100%

Office co-pay may apply

$25 co-pay $25 co-pay Medicare-Approved: 100%

Ambulance Charges

Medicare-Approved: 100% after $50 co-pay

Non-Medicare-Approved: 80% of the allowed amount after $50 co-pay

$50 co-pay $50 co-pay $50 co-pay $50 co-pay Medicare-Approved: 100%

Chiropractors Up to $1,500 max benefit per calendar year



$20 co-pay

Coverage is limited to manual manipulation of the spine to correct subluxation. You pay the full cost of routine care. Limited to Medicare allowable coverage. Discount program available.

$15 co-pay. Limited to 20 visits (combined with acupuncture)


Discount program available

$15 co-pay


American Specialty Health (ASH) Plans Participating Chiropractors

$10 co-pay; 12-visit maximum

$10 co-pay; 30 visit maximum with up to $50 benefit per visit

Emergency Room Including emergency room professional and lab/ancillary charges

Medicare-Approved: 100% after $50 facility co-pay per visit (co-pay waived if admitted)

Non-Medicare-Approved: 80% after $50 facility co-pay per visit (co-pay waived if admitted)

$65 co-pay

(co-pay waived if admitted)

$100 co-pay


$65 co-pay


$65 co-pay



Urgent Care Services



$25 co-pay $25 co-pay $25 co-pay $20 co-pay

$20 co-pay if outside Secure Horizons Service Area





Benefit Description







Hearing Care Medicare-Approved: 100% for annual exams

Non-Medicare-Approved: 100% for annual exams


$25 co-pay for exams

Two standard hearing aids are covered every 12 months, up to a max benefit of $1,000.

Discount program available.


Hearing aids not covered. Discount program available.

100%

Annual benefit allowance of $1,000 for hearing aids.

100%

Hearing screenings only

$300 hearing aid allowance every two years

$10 co-pay

One exam/year

Max benefit of $80

Hearing aid allowance of $250 every three years

Home Health Care Medicare-Approved: 100%


100% 100% 100% 100% Medicare-Approved: 100%

Hospital Stay Medicare-Approved: 100%


100% 100% 100% 100% Plan pays 100% of Medicare-Approved services up to a lifetime maximum of 365 days.

Laboratory Charges




Office Visits Medicare-Approved: 100%


$25 co-pay $25 co-pay $25 co-pay $25 co-pay 100% if medically-necessary

Physical Therapy Medicare-Approved: 100%


100% $25 co-pay $25 co-pay 100% Medicare-Approved: 100%

Vasectomy Medicare-Approved: 100%


100% $20 co-pay $25 co-pay per procedure 100% Not covered unless state-mandated or medically necessary. Contact United Healthcare for more information.

Vision Care (Annual Eye Exams/Eyewear)

100% no deductible

Limited to screen and refraction exams only; eyewear not covered


One pair glasses/contacts every 24 months. Discount program available for vision hardware.


Eyewear not covered.

Discount program available for vision hardware.

100%

$150 eyewear allowance every 24 months. Contact Kaiser Permanente for other vision benefit information.

$25 co-pay

$75 eyewear allowance every 24 months; contacts not covered. Contact United Healthcare for other vision benefit information.

$10 co-pay up to $80 maximum per year; one exam/year

Eyewear not covered

X-Rays Medicare-Approved: 100%





Benefit Description







PRESCRIPTION DRUGS

Pharmacy (Retail) Blue Shield Network pharmacy: $10 generic; $30 brand name; $75 non-formulary — up to a 30-day supply.

Non-Network Pharmacy: 80%, no deductible

Prescription drug coverage is provided by Health Net.

$10 Tier I $30 Tier II (formulary brand) $75 Tier III

Up to a 30-day supply




KAISER PERMANENTE PHARMACY

Generic: $10 for up to a 30-day supply, $20 for a 31- to 60-day supply, or $30 for a 61- to 100-day supply

Brand: $30 for up to a 30-day supply, $60 for a 31- to 60-day supply, or $90 for a 61- to 100-day supply

$10 generic; $30 brand preferred; $75 non-formulary non-preferred

Up to 30 day supply

$10 generic; $30 brand preferred; $75 non-formulary non-preferred

Up to 30 day supply

Mail-Order Drug Program

Must use Blue Shield Mail Order Service








KAISER PERMANENTE MAIL ORDER PHARMACY

Generic: $10 up to a 30-day supply; $20 for a 31-100 day supply

Brand: $30 up to a 30-day supply; $60 for a 31–100 day supply

$20 generic; $60 formulary brand/preferred; $150 non-formulary/non-preferred


$20 generic; $60 formulary brand/preferred; $150 non-formulary/non-preferred


PREVENTIVE CARE

Pap Smears Medicare-Approved: 100%

Non-Medicare-Approved: 100%

100% 100% 100% 100% Included as part of $250 annual allowance

Mammograms Medicare-Approved: 100%



Immunizations Medicare-Approved: 100%


Travel immunizations not covered

100%

When office visit not required; foreign travel/occupational services: 80%

100%

When office visit not required; foreign travel/occupational services: 80%

100%

When office visit not required

100%

Travel immunizations not covered

100%

When office visit not required; travel immunizations not covered

Prostate Specific Antigen Test – PSA




Well-Woman Visits







2016 Retiree Dental PlanBenefit Description Delta Dental PPO Plan #1149

BASICS

Overview This plan pays in-Network benefits when your care is either provided or authorized by your Delta Dental PPO Network dentist.

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

You are encouraged to obtain a predetermination of benefits from Delta for services greater than $300, or for crowns or bridges.

Coinsurance Network:

• Preventive and diagnostic: 100% of the negotiated rate

• Basic procedures: 80% of the negotiated rate

• Major restorative procedures: 50% of the negotiated rate

Non-Network:

• All services: 50% of usual & customary charges

Deductible Network: $0 per individual/$0 per family

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

Annual maximum Network & Non-Network Combined: $1,000 per individual

Benefit Description Delta Dental PPO Plan #1149

OTHER SERVICES

Anesthesia Basic procedures service: Network: 80% Non-Network: 50% after deductible

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

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

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

Extractions Basic procedures service: Network: 80% Non-Network: 50% after deductible

Fillings Basic procedures service: Network: 80% Non-Network: 50% after deductible

Gingivectomy Basic procedures service: Network: 80% Non-Network: 50% after deductible

Gold Restorations (Inlays & Onlays only) Major Restorative procedures service: Network: 50% Non-Network: 50% after deductible

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

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

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

Benefit Description Delta Dental PPO Plan #1149

Oral surgery Basic procedures service: Network: 80% Non-Network: 50% after deductible

Periodontal Surgery

Basic procedures service: Network: 80% Non-Network: 50% after deductible

Prescription Drugs Not covered

Root Canals Basic procedures service: Network: 80% Non-Network: 50% after deductible

Space Maintainers Preventive and Diagnostic service: Network: 100% Non-Network: 50% (deductible waived)

Splinting Not covered

TMJ (Temporomandibular Joint Syndrome)

Not covered

PREVENTIVE TYPE OF CARE

Cleanings Preventive and Diagnostic service: Network: 100% Non-Network: 50% (deductible waived)

Fluoride Treatments

Preventive and Diagnostic service: Network: 100% Non-Network: 50% (deductible waived)

Routine Exams Preventive and Diagnostic service: Network: 100% Non-Network: 50% (deductible waived)

Sealants Basic procedures service: Network: 80% Non-Network: 50% after deductible

X-Rays Preventive and Diagnostic service: Network: 100% Non-Network: 50% (deductible waived)




2016 Retiree Vision PlanBenefit Description VSP Choice Plan®

Plan Co-Pay $25 Exam Co-pay / $0 Materials Co-pay

EXAM COVERAGE

Vision Exam Covered in full once every calendar year

Routine Retinal Screenings (Covered after no more than a $39 co-pay) Covered

EXAM COVERAGE

Basic Prescription Lenses (glass or plastic, single vision, lined bifocal, lined trifocal, or lenticular)

Covered in full once every calendar year

Lens Enhancements Most popular are covered with a co-pay, saving an average of 20-25%

PATIENT COSTProgressives: $40

Anti-reflective: $41 Photochromics: $70 Scratch coating: $17 Polycarbonate: $31

Valid only through VSP doctors, Costco® Optical prices already include savings

Dependent children are eligible for covered polycarbonate prescription lenses

FRAME COVERAGE

Frame (Costco® Optical allowance may differ but is of equivalent value; 20% off not available at Costco as price already includes savings.)

Covered in full once every calendar year $150 retail allowance,

plus 20% off any amount above the allowance $80 allowance at Costco® Optical

Wholesale Guarantee (Frame Allowance backed by a wholesale guarantee, meaning VSP fully covers more frames than retail allowance plans)

Covered

Extra $20 Allowance (On featured brands like bebe®, Calvin Klein, Flexon, Lacoste, Nike, Nine West and more. Featured frame brands and promotion subject to change, promotion doesn’t apply to Costco® Optical.)

Covered

Benefit Description VSP Choice Plan®

Additional Pairs of Glasses or Sunglasses (All members receive 20% off unlimited additional pairs of glasses from any VSP doctor within 12 months of last eye exam. 20% off not available at Costco® Optical as price already includes savings.)

20% off

CONTACT LENS COVERAGE

Elective Contact Lenses (Prescription contact lenses, in lieu of glasses) 15% off not available at Costco® Optical as price already includes savings.

Fitting & Evaluation: Standard and premium fit: covered in full after

co-pay (15% off contact lens exam services; co-pay will never exceed $60)

Contact Lenses: Materials covered in full up to $150

Elective Contact Lenses (Prescription contact lenses, in lieu of glasses) 15% off not available at Costco® Optical as price already includes savings.

Contact lens materials are covered up to $150

15% off contact lens exam service

Contact Lens Rebates (Exclusive mail-in rebates, savings, and coupons on eligible contact lenses. Subject to change.)

Available

Necessary Contact Lenses (Covered for members with specific conditions that contacts would provide better visual correction. Not available at participating retail chains.)

Covered

PLAN ENHANCEMENTS

VSP Primary EyeCare PlanSM (Supplemental coverage for medical eye conditions, such as pink eye, by a VSP doctor)

$5 Co-pay

PLAN ENHANCEMENTS

VSP Laser VisionCareSM Program (Discounts on LASIK, Custom LASIK, and PRK, plus patient education. Wavefront technology with the microkeratome surgical device only. Other LASIK procedures performed at additional cost. Discounts only available from VSP- contracted facilities.)

Average 15% off or 5% off promotional offer



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



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, 2015

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

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


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://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

New Hampshire

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


LEGAL NOTICES

http://www.ncdhhs.gov/dma

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

http://netbenefits.com


http://ltcbenefits.com



http://tiaa-cref.org




New Jersey Medicaid http://www.state.nj.us/humanservices/dmahs/clients/medicaid (609) 631-2392CHIP 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://www2.ncdhhs.gov (919) 855-4100

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

Oklahoma Medicaid and CHIP http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/oklahoma.html (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.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/rhode-island.html (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 https://www.virginiamedicaid.dmas.virginia.gov/wps/portal (800) 432-5924

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

Washington Medicaid http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/washington.html (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





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

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

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


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.


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, 2016, 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 Cardinal at Work website at http://caw.stanford.edu/benefits-rewards.

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


LEGAL NOTICES

http://caw.stanford.edu/benefits-rewards

http://caw.stanford.edu/benefits-rewards


Medical

Blue Shield Plans (blueshieldca.com/stanford)

Medical Plans

Mail-Order Prescriptions

800-873-3605

866-346-7200

Stanford Health Care 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

The Vita Companies (vitacompanies.com) Direct Pay Administrator for Retiree Health Care 800-424-3052

Dental

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

Vision

VSP Vision Care (www.vsp.com) 800-877-7195

Mental Health and Substance Abuse Counseling

Stanford Faculty & Staff Help Center (helpcenter.stanford.edu) 650-723-4577

Long-Term Care

CNA (if retired before Oct. 1, 2015) (ltcbenefits.com) 800-528-4582

Genworth (www.genworth.com/groupltc) Stanford Code: groupltc 800-416-3624

Disability

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

Retirement Savings Plans

Stanford Retirement Manager (netbenefits.com) 888-793-8733

TIAA (tiaa.org) 800-842-2888

Staff Retirement Annuity Plan (SRAP) 650-736-2985

University HR Service Team: 877-905-2985 or 650-736-2985

http://blueshieldca.com/stanford

http://stanfordhealthcarealliance.org

http://healthnet.com

http://kp.org

http://uhcwest.com

http://vitacompanies.com

http://www.deltadentalca.org/stanford

http://helpcenter.stanford.edu




http://caw.stanford.edu/UHR-service-team

2016 retiree benefits summary

Documents