Making educated choices about health care during Open Enrollment at Stanford

Open Enrollment, which begins Monday, Oct. 26, and extends through Friday, Nov. 13 (11:59 pm PT), is the annual opportunity for benefits-eligible employees and retirees to change health care plans and to add or drop eligible dependents from coverage.

If employees choose not to take action during Open Enrollment, their coverage will “roll over” and reflect the higher 2016 premiums, or default into new plans.

Each year, employees must re-enroll in the following plans: Health Savings Account (HSA); Health Care Flexible Spending Account (FSA) and the Dependent Day Care Flexible Spending Account (FSA). Employees who have been awarded a Child Care Subsidy Grant (CCSG) from Stanford must enroll in a dependent day care FSA to accept the grant.

University Human Resources (UHR) encourages employees to review and confirm their plans; otherwise they will have to wait until the next Open Enrollment period to make changes, unless they experience a qualifying life event, such as a birth, marriage or change to job status.

The plan changes for 2016 are comparable to previous annual benefit changes and include increases in health plan premium costs, deductibles, out-of-pocket maximums and co-pays for office visits, prescription drugs and other services.

Among the other changes, which are outlined below in more detail: Stanford has discontinued the Blue Shield PPO Plan. The university will again offer free employee-only coverage through the Stanford Health Care Alliance Plan, but not through the Kaiser HMO plan; and will offer a new plan that meets the minimum essential coverage requirements of the federal Affordable Care Act (ACA) – the Blue Shield ACA Basic High Deductible Health Plan.

How to learn more

A variety of tools and publications designed to help employees and their families make decisions about health care plans are available on the 2016 Open Enrollment website, including a comparison tool to compare how medical and dental plans cover various services and a health plan evaluator that provides a detailed estimate on total out-of-pocket costs based on personal data.

UHR has organized benefit fairs (Nov. 4, 9, 10 and 11); 10 information sessions (the first one is Monday, Oct. 26 in the Clark Center Auditorium); and webinars (Oct. 30 and Nov. 5), and the schedules are on its website.

Randy Livingston, vice president of business affairs at Stanford, said keeping health care plan costs low for employees has been a challenge for the university.

Nationally, health care costs have continued to climb and are expected to rise 5.8 percent annually through 2024, according to recent reports. The rise in national health care spending can be attributed to a variety of factors: an increase in patients with chronic illnesses; the aging population; poor lifestyles and obesity; and the cost of new drugs designed to treat chronic illnesses.

“While many community members might prefer that Stanford simply contribute more, employee health care benefits have been absorbing an increasing share of the university’s operating budget, constraining the funds available for salary increases and other benefits,” Livingston said.

Neal Evans, director of health benefits at Stanford, said one way employers can slow down increases in plan premiums is to increase co-pays, deductibles and out-of-pocket maximums – as Stanford has done for 2016.

Evans added that co-pays, deductibles and out-of-pocket maximums may also increase in 2017 and 2018 if the Affordable Care Act’s excise “Cadillac” tax remains unchanged.

“We want to be transparent about changes to our programs and share information early so that our employees are informed and can make the best decision for their health needs,” Evans said. “Our approach will focus on solutions that allow the university to stay aligned with our core mission while continuing to provide sustainable benefits to our employees within the legislative and financial requirements.”

What will stay the same?

Stanford will continue to offer the Blue Shield EPO, the Blue Shield Healthcare + Savings Plan (formerly the Blue Shield High Deductible Health Plan), the Kaiser HMO plan and the Stanford Health Care Alliance (SHCA) plan.

Stanford, which offers free employee-only coverage through the lowest-price plan, will continue to offer that benefit to employees who enroll in the Stanford Health Care Alliance. (The Kaiser HMO is no longer the lowest-price plan, which means employee-only coverage through Kaiser is no longer free.)

The university continues to offer vision and dental plans as part of its comprehensive health care benefits. Employees will continue to receive expanded access to out-of-network outpatient mental health providers for the Blue Shield EPO, Blue Shield Healthcare + Savings and the SHCA plans.

Stanford will continue to offer benefits-eligible employees a monetary incentive and other rewards to encourage healthy lifestyle behaviors through its BeWell@Stanford Wellness Incentives Program. Overall financial incentives will remain the same in 2016.

Benefits-eligible university employees who complete the Stanford Health and Lifestyle Assessment (SHALA) and the Wellness Profile by Nov. 30, 2015, are eligible to receive a taxable wellness incentive ranging from $200 to $480 in 2016, depending on their participation level. Spouses and registered domestic partners of participating benefits-eligible university employees are eligible for a $240 taxable wellness incentive. Employees who earn six “BeWell Berries” can receive a $100 taxable incentive.

What will change?

In 2016, health plan premiums will rise, except for the Blue Shield Healthcare + Savings Plan, whose employee contribution rates will decrease. Deductibles and out-of-pocket maximums will rise next year. Co-pays for office visits, prescription drugs and other services also will increase in 2016.

Stanford is discontinuing the Blue Shield PPO. Employees currently enrolled in the Blue Shield PPO who do not update their elections will be defaulted into the Blue Shield Healthcare + Savings Plan, formerly known as the Blue Shield High Deductible Health Plan. The Healthcare + Savings Plan is a PPO high deductible plan with access to the optional Health Savings Account (HSA). This plan provides access to the same in-network providers under the PPO Plan as well as non-network providers (at a higher out-of-pocket cost).

Stanford is offering a new plan – the Blue Shield ACA Basic High Deductible Health Plan – that meets the minimum essential coverage requirements of the federal health care reform legislation, the Affordable Care Act (ACA). This new plan has a higher deductible and higher out-of-pocket costs than the Blue Shield Healthcare + Savings Plan. In addition, the ACA Basic Plan only covers 60 percent of costs after the deductible versus the Healthcare + Savings Plan, which covers 80 percent of costs after the deductible.

The Stanford Health Care Alliance (SHCA) is switching administrators from Blue Shield to Aetna. Plan members will receive new ID cards by January 1, 2016.  For a list of in-network providers, plan members should check the SHCA website.

Coverage for gender reassignment procedures has been extended to the Blue Shield EPO, Blue Shield Healthcare + Savings and the Stanford Health Care Alliance plans. Previously, only the Kaiser HMO plan offered this benefit.

The Health Care FSA maximum election is increasing to $2,550 in 2016.

The HSA maximum limit for families is rising to $6,750 in 2016.

Stanford is changing its long-term care (LTC) insurance provider to Genworth Financial Inc. in 2016. Employees currently enrolled in LTC insurance through CNA Financial Corp. may continue coverage, or purchase a new policy through Genworth.

For a limited time – Oct. 12 through Nov. 13 – Genworth is offering active, full-time employees under age 66 a special opportunity to apply for LTC insurance using a brief health questionnaire, rather than a “full evidence of good health form.” Active employees considering retirement should take advantage of this benefit now, as LTC insurance is not available to retirees. To learn more, or to apply, visit www.genworth.com/groupltc, or call (800) 416-3624. (The group I.D. is Stanford and the access code is groupltc.)

Cardinal at Work website

When ready to enroll, employees can go to the new Cardinal at Work website and log into My Benefits using SUNet ID and Password, or University ID and Benefits PIN. Once logged in, follow the instructions to enroll. In My Benefits, employees can chat live with a University HR Service Team specialist or submit an online form if they have questions or need guidance on Open Enrollment elections.