ACA Basic High-Deductible Health Plan
Guidelines, Policies & Forms
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Active employees and official retirees can use this tool to compare medical benefits, as well as plan costs.
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The ACA Basic High-Deductible Health Plan works the same as the Healthcare + Savings plan, but has higher out-of-pocket costs.
This plan option meets the minimum essential coverage requirements under the federal health care reform, Affordable Care Act (ACA).
View 2022 plan information and resources for the ACA Basic High-Deductible Health Plan
| BASICS | |
|---|---|
|
Overview |
You may visit any doctor or hospital, but 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). You can set up an HSA with any financial institution that provides HSA services, or when you elect the ACA Basic HDHP during open enrollment, you can set up an account with Health Equity when you make your elections through My Benefits. Note that Stanford does not contribute to your HSA and you cannot make payroll contributions to the account, unlike those enrolled in the Healthcare + Savings plan |
|
Office copay |
Network: 60% after deductible Non-Network: 50% after deductible |
|
Deductible |
$3,250 per individual $6,500 per family for in-network services; $6,500 per individual $13,000 per family for out-of-network services. 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 me the individual deductible. |
|
Out-of-Pocket Maximum |
$6,500 per individual $13,000 per family for in-network services; $13,000 per individual $26,000 per family for out-of-network services. A single out-of-pocket maximum applies to all coverage under the plan, including medical and prescription drugs. (This plan will cover eligible prescriptions and medical expenses at 100% once the out-of-pocket maximum is met). |
| PREVENTATIVE CARE | |
|---|---|
|
Physical exams for adults |
Network: 100% Non-Network: Not covered |
|
Physical exams for children |
Network: 100% Non-Network: Not covered |
|
Pap smears |
Network: 100% if part of annual preventive Non-Network: Not covered |
|
Mammograms |
Network: 100% if part of annual preventive Non-Network: Not covered |
|
Immunizations |
Network: 100% Non-Network: Not covered; travel immunizations not covered. |
|
Prostate Specific Antigen test - PSA |
Network: 100% Non-Network: Not covered |
|
Well-woman visits |
Network: 100% Non-Network: Not covered |
| PRESCRIPTION DRUGS | |
|---|---|
|
Pharmacy (Retail) |
Network or Non-Network: 60% after deductible |
|
Mail order drug program |
60% after deductible Must use Blue Shield mail-order service |
|
Birth Control Pills |
Included in Prescription Drug benefit |
Traveling Outside the U.S.
Benefits will be provided for covered services you receive anywhere in the world. Blue Shield has network providers outside of California and the United States. We encourage you to see Blue Shield providers to help reduce your costs, but you still have the option to see any provider to get needed care.
You can access service outside of California through the BlueCard Worldwide® Network.
If you need care while out of the country, call the toll-free BlueCard Program Access number at 800-810-2583, or call collect at 804-673-1177, 24 hours a day, seven days a week.
Before traveling abroad, call Blue Shield Customer Service at 855-599-2657 to find out what you need to make your plan work for you when you travel. For more information, visit the Blue Shield website.
In an emergency, go directly to the nearest hospital. As soon as possible, you should call Blue Shield at 800-343-1691 or call collect at 804-673-1177, 24 hours a day, seven days a week.