Health Insurance

Your 2012 Benefits Choices: A brief overview

Updated choices and programs to stay healthy.

  • A new wellness incentive program, to reward employees who take an active role in improving or maintaining their good health.
  • A revised free Preferred Provider Organization (PPO) plan, which includes a portable Health Savings Account (HSA).
  • A new health care option, the Exclusive Provider Organization (EPO), allows you to see any participating provider without a referral from a primary care physician.
  • UMR, a division of UnitedHealthcare, will replace Anthem as the medical plan administrator, effective January 1, 2012. In-network medical benefits will be provided by UnitedHealthcare Options PPO network providers. Go to www.umr.com, “Find a Provider,” and click “Medical” and the “UnitedHealthcare Options PPO” for a list of providers. Please note that all Stanford Medical Group (SMG), Menlo Medical Clinics (MMC) and Palo Alto Medical Foundation (PAMF) doctors are in the network so there is no need to look them up in the provider database. Click here for more local medical groups which are in the network.
  • There are no changes to prescription drug plan administration (Express Scripts) or mental health administration (OptumHealth).
  • The Kaiser HMO plan will be the only HMO offered in 2012.

Your 2012 Benefits Choices: Medical

Use the Medical Plan Cost Calculator to compare your options.

Preferred Provider Organization (PPO) with Health Savings Account (HSA)

  • No employee-paid premiums unless a working spouse access fee applies
  • Free preventive care including preventive prescriptions
  • Flexibility to use in- or out-of-network providers (with higher benefits in-network)
  • SHC/LPCH inpatient hospital charges waived after deductible
  • Highest deductible among three medical plan options
  • Health Savings Account (HSA) feature with HSA funding provided by SHC/LPCH

Exclusive Provider Organization (EPO)

  • Employee-paid premiums*
  • Free preventive care
  • You must use in-network providers to receive coverage (except in an emergency); referrals not needed
  • SHC/LPCH inpatient hospital charges waived
  • Lower deductible than PPO
  • Copays for physician office visits and prescription drugs with no deducible
Kaiser HMO
  • Employee-paid premiums if you earn $27.51 or more per hour*
  • Free preventive care
  • You must use Kaiser providers to receive coverage (except in an emergency)
  • Copays for most services and no deductibles

Waive all coverage

Your next opportunity to elect medical/vision coverage will be the next Fall Open Enrollment, unless you experience a mid-year qualifying life event.

Your 2012 Benefit Choices: Dental

DeltaCare USA DHMO

  • No employee-paid premiums
  • Choose up to three primary care dentists for your family from the DeltaCare network
  • Most preventive, diagnostic and basic services covered at 100%
  • Limited network
  • Includes adult orthodontia

Delta Dental PPO

  • Employee-paid premiums for spouse/eligible same-sex domestic partner
  • Visit any provider, but typically pay less in-network
  • No deductible for diagnostic preventive care including routine exams, cleanings and X-rays
  • Must meet annual deductible first, for basic and major care

Waive all coverage

Your next opportunity to elect dental coverage will be the next Fall Open Enrollment, unless you experience a mid-year qualifying life event.

Your 2012 Benefits Choices: Vision

VSP

  • Hospital-paid coverage for you and your family
  • Automatic enrollment when you sign up for a medical plan
  • Visit any licensed provider, but you will maximize your benefit when you use an in-network provider

Health Incentive Accounts (HIA)

If you enroll in the EPO or Kaiser HMO and earn your wellness incentive, you receive $100 from SHC and LPCH that will be deposited into a Health Incentive Account you control. You’re free to use this money any time during the year to help pay for your medical expenses. The funds in your account do not roll over, so you must use all your HIA money in 2012.

*House Staff premiums do not apply.

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