Stanford adds new low-cost medical plan to 2014 health care offerings

The benefits department in University Human Resources has prepared a variety of charts and publications designed to help employees and their families choose medical, dental and vision plans for 2014.

Stanford recently extended Open Enrollment to Nov. 19 to give employees a third weekend to review 2014 health care plan materials, including information on the new Stanford HealthCare Alliance (SHCA) and increased rates on the university's four existing plans.

Open Enrollment, which begins Oct. 28, is the once-a-year opportunity to change health care plans and to add or drop eligible dependents from coverage. (Benefits can only be changed during the year if there is a qualifying life event – the birth of a baby, an adoption, marriage or divorce – or a change in employment status.)

A variety of charts and publications designed to help employees and their families make the decision can be found in Open Enrollment materials, including Selecting Your Stanford Health Plan: A Quick Guide; Faculty Benefits Summary; Staff Benefits Summary; and the Employee Newsletter.

 In a recent interview with Stanford Report, Les Schlaegel, associate vice president for benefits, answered questions about the new SHCA plan and other changes the university is making to its medical care offerings in 2014.

What stays the same in 2014?

 Stanford will continue to offer the Kaiser Permanente HMO, the Blue Shield EPO and PPO and the High-Deductible Health Plan (HDHP).

Delta Dental remains our dental care provider with two plan options. Vision Service Plan (VSP), which will remain our vision plan provider, will add a new benefit: VSP members – and up to four dependents – will be offered a TruHearing discount program for hearing aids at a reduced cost.

Employees who complete four steps of the BeWell Employee Incentive Program – the Stanford Health and Lifestyle Assessment (SHALA), the Wellness Profile, enrollment  in a Stanford-sponsored medical plan in 2014, and agreement to share SHALA and health screening information – by Nov. 30, 2013 will be eligible for a $480 taxable incentive ($20 per pay period) on medical plan premiums in 2014. 

Employees participating in the BeWell Program for the first time in 2014 can earn a $200 taxable incentive by completing two steps – the SHALA and the Wellness Profile – by Nov. 30, 2013. This incentive also is available for returning participants who have elected not to share their information or are not enrolled in a Stanford medical plan.

Stanford also continues to offer discounts for fitness classes offered under the Stanford School of Medicine's Health Improvement Program.

What is the Stanford HealthCare Alliance?

 Stanford Hospital & Clinics created the Stanford HealthCare Alliance (SHCA) to offer another low-cost, high-quality health care plan to employees and postdoctoral scholars. The new plan is priced identically to Kaiser.

Stanford HealthCare Alliance is a select network health plan in which physicians at several Bay Area hospitals – including Stanford Hospital & Clinics and Lucile Packard Children's Hospital – and physicians' groups and affiliated doctors in multiple specialties work together to carefully coordinate and deliver care. So far, 300 primary care physicians and 2,300 specialists have joined the alliance, which is expected to grow.

For up-to-date information on the hospitals, clinics and doctors in the SHCA network, call a member care specialist at (855) 345-SHCA (7422) or visit the website. It's really important that employees call for information, because the alliance is adding doctors every week. The member care specialists are trained to help employees find primary care physicians tailored to their particular needs.

As an SHCA member, an employee must designate a primary care physician and use the physicians and facilities within the SHCA network. Your primary care physician will coordinate all of your care throughout the network.

Some Bay Area hospitals and physicians' groups are not part of the SHCA network: Palo Alto Medical Foundation, Washington Hospital (Fremont) and Valley Medical Center in San Jose.

We recognize that employees will be concerned when they see the increases in premiums and copayments in existing health care plans.  We hope they will consider the SHCA as a low-cost, high-quality alternative.

Are premiums increasing for Kaiser, Blue Shield and the HDHP plans?

While Kaiser remains free for an individual employee, premiums for all other Kaiser coverage categories – employee and spouse, employee and child, employee and family – are going up 13 percent.

Under the Blue Shield EPO, the premium for an individual is rising 20 percent; all other coverage categories are rising 17 percent.

Under the Blue Shield PPO, the premium for an individual is rising 24 percent; all other coverage categories are rising 20 percent.

Under the HDHP, the premium for an individual is rising 40 percent; all other coverage categories are rising 24 percent.

What about copayments?

Copayments to see a specialist will increase to $50, from $35, for the Blue Shield EPO and PPO plans, and a $50 copay will be added under the Kaiser plan to see a specialist.

Blue Shield EPO and Kaiser members will be charged copays of $100 for emergency room visits, but the fee will be waived if the individual is admitted to the hospital.

Detailed information about medical plan, dental and vision costs for full-time and part-time employees is available on the benefits website.

What factors are affecting the rise in health-related costs in general?

 There are many factors that drive health care costs, including the cost of developing new drugs and medical technologies and treatments, and inappropriate utilization of health care services – such as unnecessary trips to the emergency room for medical issues that could be handled in an urgent care center.

Obesity and other related diseases – including diabetes, hypertension, health disease and strokes – are on the rise. Because those conditions are so damaging to one's health and require ongoing care, they also become very expensive to treat. Those expenses are not simply passed along to the individuals affected by those conditions, but are distributed to everyone in the form of higher health costs. At Stanford, we are experiencing these same realities.

What factors are affecting the rise in health-related costs at Stanford?

The average age of a benefits-eligible employee at Stanford is 47, so we're seeing an increase in disease related to an aging population, such as cancer.

Advances in medicines to treat diseases like cancer are more effective than ever before, but they're also more expensive. In fact, Stanford's cost per participant for health care has increased between 9 and 13 percent per year on average between 2002 and 2012.

A significant jump in 2012 in the number of claims that cost more than $200,000 also contributed to the increase in health plan rates.

We want to ensure that our faculty and staff are as healthy as possible and continue to have access to world-class health care. At the same time, we're no different from other employers who are affected by rising costs of health care.

This year, Stanford is projected to spend $139 million for health care, compared with $71 million in 2007.

Three of Stanford's health care plans – Blue Shield EPO and PPO, and the HDHC – are self-funded. When claims are filed, Stanford writes checks to the providers.

Employees enrolled in Kaiser can take advantage of the Kaiser Mobile Health Vehicle, which makes regular visits to campus and to SLAC. Is there a similar option for members of the other Stanford-sponsored health plans?

 Stanford recently opened the Stanford Express Care clinic on the second floor of Hoover Pavilion. The clinic provides care to patients of all ages for non-emergency medical conditions that require timely treatment. Its staff can treat minor ailments, including respiratory illnesses, colds, flu, abdominal pain, fever, headaches and back pain, as well as minor injuries, such as cuts, sprains and fractures. The clinic, which is open weekdays from 10 am. to 7 p.m., takes same-day and next-day appointments.

Additionally, Stanford Coordinated Care, which is part of Stanford Hospital & Clinics, is a benefit available to active university and hospital employees and their adult dependents covered by Blue Shield. At its clinic, located in Hoover Pavilion, a team of medical experts helps people with chronic conditions lead a healthy life and smoothly navigate their health care experiences.

 Would some Stanford employees benefit by shopping for health care plans on the Covered California exchange, which was established under the Affordable Care Act?

Employees should consider all their options. However, since Stanford's plans meet all the criteria required by the federal government under the Affordable Care Act, employees generally will not be eligible for the tax breaks or federal subsidies offered under the legislation. When employees see the cost of plans on Covered California, they will realize that Stanford's plans are actually competitively priced.

Where can employees find out more about Stanford's 2014 health care plans?

In addition to visiting the Open Enrollment website, employees are encouraged to attend a Benefits and Retirement Savings Fair (four are scheduled) and any of the 15 Open Enrollment presentations (online or in person) to make well-informed decisions during Open Enrollment. The schedule can found on the 2014 Open Enrollment Meeting Calendar.