Benefits: Health, Dental, Disability and Life Insurance
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Health, dental, disability and life insurance plans are briefly described below. These plans are subject to periodic review, including alteration or termination of benefits or change of carriers.
The Summary Plan Descriptions (SPD's), which will be distributed to you separately, and plan documents govern in the case of any inconsistency with the brief descriptions below.
Please contact the Office of Graduate Medical Education (650) 723-5948 or the Benefits Office (650) 723-5734 for additional information.
All house officers entering training at Stanford for the first time, regardless of the institution to which assigned, must complete an enrollment form for health, dental and life insurance at the time of registration.
See section "F" of the benefits section of this handout for coverage effective dates. If you do not enroll yourself, your spouse/domestic partner or dependents within 31 days of your first date of employment, the next opportunity to enroll will be during an open enrollment period or when you have a change of family status as described in section "G" of the benefits section of this handout.
Eligibility for Health and Dental Coverage
Your eligible dependents may include your:
- spouse or same sex domestic partner
- unmarried children under 19 years of age
- unmarried children under 23 years of age who are full-time students taking at least 12 credits per quarter/semester, dependent on you for more than half of their financial support. This means you or your spouse/domestic partner must be able to claim the child(ren) as dependents on your or your partner’s income tax return – unless you are covering the child under a QMCSO.
- unmarried children, of any age, who are incapable of self-support and principally dependent on you or your spouse because of physical or mental disabilities which began before the age 19
Children are:
- your birth or legally adopted children (or children for whom adoption proceedings have been initiated)
- your stepchildren
- your domestic partner’s children
- any children for whom you have legal guardianship.
You must have legal guardianship of any children related to you by blood or marriage that you wish to cover. If you have legal guardianship of children, those children must reside with you or be attending college full time as described above.
Domestic partner's children include any unmarried natural or adopted children or other children for whom you or your domestic partner have legal guardianship. They do not have to reside with you, but you and your domestic partner must provide principal maintenance and support.
If both parents of any dependent child are covered as employees under the Stanford Hospital and Clinics Plans, the child will be eligible to be covered as a dependent of one parent, except under the Dental Plan. If you are eligible for Stanford Hospital and Clinics coverage as an employee, you are not eligible for Stanford Hospital and Clinics coverage as a dependent under the medical and dental plans.
The term domestic partner refers to two individuals of the same sex who live together in a long term relationship of indefinite duration with an exclusive mutual commitment similar to that of marriage in which the partners agree to be financially responsible for each other's well being and each other's debts to third parties.
The domestic partners may not be related by blood or any other "family" relationships other than the partnership, and they must have been living together for at least six months to qualify for coverage.
You must file a certification of Domestic Partnership form with the Benefits Office before you enroll your domestic partner or any eligible children of your domestic partner in medical or dental coverage.
As with any other personnel document falsification of this document would be grounds for disciplinary action and loss of medical and dental coverage for your non-qualified partner and any children of your non-qualified partner.
Health
Your options include the CIGNA PPO, CIGNA HMO or Kaiser.
No monthly premium is required for you and your dependents. Premiums are paid by the institution to which you are assigned.
However, in accordance with IRS regulations, the cost of coverage for your domestic partner and/or domestic partner's children is considered taxable income and will be added to your earnings on the W-2 form.
CIGNA PPO
CIGNA’s Preferred Provider Organization (PPO) Plan is based on a network of doctors, hospitals and other health care professionals; however, you may go to any licensed health care provider you want. Using network providers saves you money because they offer medical services at pre-negotiated reduced rates to PPO members.
Under the PPO, you simply decide each time you need medical care whether to go to a CIGNA PPO network provider or another licensed health care provider. You do not select a Primary Care Physician (PCP), and you don’t need a referral to see a specialist in or out of the network.
When You Go to a PPO Network Provider
- You pay a $20 co-payment for a doctor’s office visit; $35 for a specialist visit
- The plan pays 80% of other eligible expenses, after you pay a $200 deductible
- The plan pays 100% of other eligible expenses, after you reach your out-of-pocket maximum
- There is an individual $2,000 (plus deductible) annual out-of-pocket maximum – a limit to the amount you must pay each year
- There are no forms
When You Go to an Out-of-Network Provider
- The plan pays 60% of eligible expenses, after you pay a $500 deductible
- The plan pays 100% of other eligible expenses, after you reach your out-of-pocket maximum
- There is an individual $5,000 (plus deductible) annual out-of-pocket maximum – a limit to the amount you must pay each year
- You are responsible for completing and submitting a claim form for reimbursement
- Pre-certification is required for inpatient hospital services or a penalty will apply.
CIGNA HMO
These plans offer you a choice of Primary Care Physicians (PCP’s) within their own networks. Each time you need care, you contact your PCP first. If your PCP determines that you need a specialist’s care or hospitalization, he or she will refer you and handle any pre-certification required.
In the HMO you:
- Must use CIGNA HMO doctors and facilities to receive benefits for non-emergency care
- Select a PCP to provide, coordinate and authorize all of your care
- Have no annual deductibles
- Are covered at 100% for most services or pay a co-payment, like $15 for a doctor office visit and $25 for a specialist office visit
- Have an annual out-of-pocket maximum – a limit to the amount you must pay each year. After that, the plan pays 100% with no co-payments
- Have no claim forms
Kaiser HMO
The Kaiser HMO also offers medical care at low out-of-pocket cost. Each time you need care, you go to any Kaiser doctor – you do not select a PCP.
In the Kaiser HMO you:
- Must use Kaiser doctors and facilities to receive benefits for non-emergency care
- Have no annual deductibles
- Are covered at 100% for most services or pay a small co-payment for services like doctor office visits of $15
- Have an annual out-of-pocket maximum – a limit to the amount you must pay each year. After that, the plan pays 100% with no co-payments
- Have no claim forms
- Identification for Hospital and Outpatient Care at Stanford Hospital & Clinics
If you or any of your covered dependents are hospitalized or require emergency care at Stanford University Medical Center, please identify yourself at the reception desk as a member of the house staff and complete the necessary insurance forms.
Mental Health
Participants in the CIGNA PPO and HMO are covered through the Merit Behavioral Health, which is described in the Summary Plan Description and Evidence of Coverage brochure.
To qualify maximum benefits, you must call 1-800-889-3992 for authorization prior to receiving treatment.
The Office of Graduate Medical Education can advise of other short-term mental health assistance available to you. Kaiser provides mental health within their program.
Vision Care
When you enroll in a health plan you automatically have vision coverage through the Vision Service Plan at no cost.
The plan provides for regular eye examinations and benefits toward vision care expenses, including glasses/contact lenses.
See your benefits handbook or enrollment guide for co-payments of in and out of network providers.
Dental
Stanford Hospital and Clinics pays the premium for dental coverage for you and your dependent children (including domestic partner's children) as defined above. Dental insurance for your spouse or domestic partner is available at your expense.
You may pay the spouse premium with pre tax dollars (domestic partners not eligible due to IRS regulations) by signing an enrollment form available in the Benefits Office.
Dental coverage is provided by the Stanford Hospital and Clinics Dental Plan regardless of which type of medical coverage you choose. There are two plans to choose from; both are administered by Delta Dental.
Delta Premier (Traditional Plan)
It covers a wide range of dental care from preventive, diagnostic and therapeutic services; restorative and replacement services; orthodontic care for children.
100% preventative, 80% basic and 50% major covered eligible expenses are paid for after the deductible.
Benefits are paid up to a calendar year maximum of $1,500 per person. You are responsible for a $25 deductible per person up to a $75 per family maximum.
Orthodontia expenses (for covered children only) are reimbursed at 50% of eligible expenses to a lifetime maximum of $1,000 per child to age 19 provided no appliance has been inserted into the child's mouth before coverage begins under this plan.
Please see handbook for complete details.
Delta Care (Prepaid Plan)
You choose a dentist from a panel of providers; not all dentists who participate in the Delta Premier network are also in the DeltaCare network. See the DeltaCare booklet for a list of dentists.
All enrolled family members must use the same dentist. You pay a co-payment for each procedure. Most preventive, diagnostic and basic services are covered in full. You pay a modest co-payment for all other services.
Orthodontia is provided for children and adults with a $1,600 co-payment to age 19; $1,800 co-payment age 19 and older and a $350 start up.
Enrollment in Health and Dental
Coverage under the Stanford Hospital & Clinics group plan begins on July 1st. If you cannot be at Stanford before July 7th, you are advised to extend your present health insurance for the month of July; in which case coverage begins on August 1st.
To enroll in the plans, you must complete your enrollment forms within 31 days of hire and supply the Benefits Office with copies of documentation of the dependents you are adding, i.e., marriage certificate, same-sex domestic partner certification or children's birth certificates.
If you do not enroll yourself and eligible dependents in a health plan by completing enrollment forms within the first 31 days of eligibility, you and your eligible dependent children will not be eligible for a Stanford Hospital & Clinics medical plan unless you enroll during the annual open enrollment period or you have a change of family status which makes you eligible to enroll at another time during the year.
Adding New Dependents
If you miss the 31-day deadline to enroll your spouse or newly eligible dependents, you must:
wait for an open period; or have a change in family status as described below.
If you have a change in family status, such as a birth, death, divorce, marriage,adoption, spouse's employment or termination of spouse's employment, be sure to contact the Benefits Office and submit completed enrollment forms, and documentation supporting the change, within 31 days.
Same sex domestic partners must have been living together for at least six months to qualify for coverage. Once the six-month qualification period has been fulfilled you must enroll your partner and children within 31 days. You must file a Certification of Domestic Partnership form with the Benefits Office at the time of enrollment.
Open Enrollment
You will be sent a communication announcing the date for health/dental open enrollment. During the open enrollment period, you may change health insurance plans. New coverage becomes effective January 1. The Benefits Office can supply you with materials on each of the health plan options and answer any questions concerning your coverage.
Claim Forms
CIGNA PPO out-of-network health and Delta Premier dental forms are available in the Department of Human Resources satellite office in Stanford Hospital & Clinics, Room H1108 across from the escalator on the 1st floor. You can also get information online at: http://www.benefitforms.stanfordhoslpital.com or http://www.benefitforms.lpch.org
Continuation of Group Coverage
If your employment ends or if you no longer meet the Plan's eligibility requirements as a result of a cutback in your working hours, you are entitled as a qualified beneficiary under the Consolidated Omnibus Budget Reconciliation Act (COBRA) to continue your health and/or dental coverage for up to 18 months (29 months if determined to be disabled for social security purposes), by paying the required premium.
Extended COBRA coverage may be available under CAL-COBRA in some circumstances. As part of your initial employment, you will receive a notice about continuation of coverage once your coverage ends.
Spouses and dependent children may continue in the Stanford Hospital and Clinics health/dental plans, by paying the required premium, for up to 18 months after their coverage would normally end. However if coverage ends due to a divorce or legal separation of you and your spouse; or, in the case of dependent children, after they no longer meet the Plan's eligibility requirements coverage can continue up to 36 months. In the event of your death, coverage for your dependents may also be continued for up to 36 months by paying the required premium.
However, continuation of coverage will end before the 18 (29 in case of disability for social security purposes) or 36 month period if: all Stanford Hospital and Clinics health care plans are discontinued;
you fail to pay the required premium; you become covered under another group health plan, unless there is an exclusion for a pre-existing condition; the covered person becomes eligible for Medicare benefits; also, you or your dependents may apply for individual conversion of coverage, following the 18 or 36 month continuation period.
Contact the Benefits Office for information regarding conversion coverage.
Disability Insurance
State Disability Insurance will provide up to 52 weeks of coverage after you have been in pay status for seven (7) months. The maximum coverage is $490 per week and there is a 7-day waiting period for all claims. Beginning July 1, 2004, State Disability Insurance also provides benefits for "Paid Family Leave" to eligible employees.
Long Term Disability Insurance
Stanford Hospital and Clinics Plan pays the premium for a long-term disability (LTD) plan designed to provide you with income protection during your tenure at Stanford Hospital and Clinics and to ensure that you have the ability to purchase specialty-specific LTD coverage when you leave Stanford Hospital & Clinics.
Group coverage while at Stanford Hospital & Clinics pays 60% of your salary to a maximum of $3,000 after a period of disability of 90 days. You will be enrolled in the plan automatically at time of hire. On leaving Stanford Hospital & Clinics, you may continue the group coverage by purchasing it at group rates, and you may also purchase an individual, specialty-specific policy.
Life Insurance
Stanford Hospital & Clinics provides one times your salary up to $50,000 of life insurance at no cost to you. Complete an enrollment form to designate a beneficiary.
In June 2004 House Staff become eligible to purchase supplemental life insurance. You can purchase coverage equal to one to four times your annual salary for yourself.
If you enroll in supplemental coverage, you may purchase coverage for your spouse or domestic partner in increments of $1,000 to the lower of $200,000 or 50% of your supplemental amount and/or $10,000 for each of your eligible children.
