Stanford Care

7/28/2019 Stanford Care

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Cardinal Care Stanord Universitys StudentHealth Insurance

20122013 Academic YearStanord requires all students to have health insurance coverage.

To help you meet this requirement, we oer Cardinal Care an

annual comprehensive health insurance plan covering a wide range

o services. This guide explains the eatures and cost o Cardinal Care,

and where to ind more inormation.

Insure your health; protect your education

Health Insuranceor Stanord StudentsInormation andRequirements

Insurance and Reerral OiceVaden Health Center866 Campus DriveStanord, CA 94305-8580Phone:(650)723-2135Email: [email protected]

Web: http://vaden.stanord.edu/insurance/index.html

L.A. Cicero/Stanord News Service



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How Cardinal Care Works with theCampus Health Service Fee

Cardinal Care complements the on-campus servicesby covering o-campus health care or a wide array oservices such as major medical care (e.g., hospitalization,emergency room visits), annual eye examinations,prescription drugs, diagnostic X-rays and laboratory tests,and mental health and substance use disorder treatment.

The Campus Health Service Fee supports on-campus servicesat Vaden Health Center (http://vaden.stanord.edu/ees). Theon-campus services at Vaden Health Center include primarycare medical visits, counseling and psychological evaluations,short-term therapy and health and wellness programs.

Cardinal Care Features

Eective 9/1/12, to comply with the Aordable Care Act,preventive care services and prescription contraceptives will becovered at 100%.

ApartnershipwithHealthNetforoff-campusmedicalcare

Being part o Health Net means that you have access to anextensive nationwide network o providers and pharmacies.

Tier 1 When you receive treatment rom Stanord UniversityMedical Center or Menlo Medical Clinic/UHA with a reerralrom a Vaden Health Center clinician, you pay only a $20 copay.

Tier 2 When you receive treatment rom any Health NetPPOpreferredproviderinCaliforniaorFirstHealth provideroutside o Caliornia, Cardinal Care pays 80% o eligibleexpenses ater you pay a $200 annual deductible. This tierallows you to use Stanord University Medical Center withouta reerral rom a Vaden Health Center clinician. I you donothaveaccesstoaHealthNetPPOpreferredproviderin

Caliornia or First Health provider outside o Caliornia,within 100 miles o where you are located, or when studyingor traveling outside the United States, non-emergent treatment

will be covered under Tier 2.

Prescriptiondrugs When you purchase prescription drugsat the Vaden pharmacy, or any other participating Health Netpharmacy nationwide, you only pay a $10 copay or genericdrugs or a $25 copay or brand-name drugs.

ApartnershipwithMHN,aHealthNetcompanyspecializinginbehavioralhealth,foroff-campusmentalhealth and substance use disorder benefts CounselingandPsychologicalServicescancoordinateyourcarewith

MHN or you can access services directly through an MHNnetwork provider.

Year-round,worldwidecoveragewithOnCallInternational1 Cardinal Care provides coverage to enrollees

whenever you are traveling more than 100 miles rom yourpermanent residence.

I you need assistance or a medical emergency or behavioralhealth issue while traveling more than 100 miles rom yourpermanent residence, you have access to comprehensiveemergency assistance services provided by On CallInternational.2 Some o these services include:

Emergency medical evacuation3

Medically necessary repatriation3

Medical/behavioral health/dental/pharmacy/hospital reand deposit arrangements

Prescriptiondrugreplacementassistance

PrintanOnCallmemberIDcard,DescriptionofServicesbrochure romwww.healthnet.com/cardinalcare.

1Thisisonlyanoutlineofyourplanbenets.PleaserefertotheDescription

of Services which can be downloaded at www.healthnet.com/cardinalcare for

conditions, limitations and exclusions.

2Travel period must not exceed one year.

3Medical evacuation and repatriation services must be pre-approved and arrang

On Call International.

Personalized Identification Card

All Cardinal Care members will receive a Health Net ID cardThis card identifes you as a Cardinal Care member and giveyou access to preerred providers and pharmacies nationwideKeep it with you and present it whenever you receive medica

care. ID cards will be sent to the mailing address listed in youAxessaccount.Pleasenotethatyouridenticationnumberwbe your Stanord University ID with a prefx o U.

Health Net oers several options or accessing an image,printing a copy, or ordering a replacement o your ID card:

via smart phone with Health Net Mobile; or

online at www.healthnet.com/cardinalcare; or

call 1-800-250-5226.

Cardinal Care coverage beginson September 1 and ends on August 31.

More details can be ound at http://vaden.stanord.edu/insurance or contact the Vaden Health Center Insurance andReerral Ofce at (650) 723-2135 or healthinsurance@stanord

L.A.Cicero/StanfordN ewsService


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Summary of BenefitsThe tables below and on the opposite page summarize the Cardinal Care medical, mental health and substance use disorder beneits. Theemay be limitations and conditions which must be eviewed pio to the application o beneits. We encouage you to eeence thislist o coveed sevices, as well as plan deinitions and exclusions in the detailed plan contact.

TIEr1 TIEr23

MediCALBeNefitS

1

tYPeOfPrOviderPlanposon SanoUnsyMcalCn

(with a eeal om Vaden Health Cente)2HalhNPPOPosnCalonaanfsHalhPosousCalona 4

DeductiblesAnnual deductible (or all services)

Outpatient hospital emergencycare services deductible

None

$50 per visit(waived i admitted, no reerral necessary)

$200

$50 per visit(waived i admitted)

PccaonPenaltyfornotprecertifyingtreatment(Health Net requires precertiication orinpatient services such as admission to ahospital, surgery or maternity stay.)

Coinsurance level reduced to 50%

Coinsurance level reduced to 50%

Annualou-o-pockmaxmum(Excluding mental health, substance use disordertreatment, prescription drugs, some amilyplanning services, expenses related to non-certiied services, and services not covered underthe plan.)

$500

$1,500

Lietime maximum o medical coveage Unlimited Unlimited

Pnca5

OB/GYN examinations6,7$0

$0 (deductible waived)

SugeySurgeon or assistant surgeon services

100%

80% ater you meet the plan year deductible

Hospalanskllnusngaclysays8

Semiprivate hospital room or intensive care unit

with ancillary services (includes acute caredetoxiication admissions)

100%


Physcanmcalscs

Primarycarephysicianofficevisit7

Outpatient specialist and consultant visits7

Rehabilitative therapy (including physical,speech, occupational, respiratory and cardiactherapy)

Hospital visits

ProvidedbytheVadenHealthCenter 9

100% ater a $20 copay or each visit


100%



100% ater a $40 copay or each visit (maximumo 60 visits per plan year)


Geneal medical sevices

Chemotherapy/radiation therapy/nuclear medicine8(Professionalserviceonly)

Organ transplants (nonexperimentaland noninvestigational)

Blood, blood plasma, blood derivativesand blood actors

X-ray and laboratory7


100%

100%

100%






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TIEr1 TIEr23

MediCALBeNefitS1(continued) tYPeOfPrOvider

Planposon SanoUnsyMcalCn(with a eeal om Vaden Health Cente)2

HalhNPPOPosnCalonaanfsHalhPosousCalona4

PgnancyanmanycaNormal delivery, cesarean section andcomplications o pregnancy

Prenatalandpostnatalofficevisits

Genetic testing o etus

100%


100%




repoductive health5,8Inertility services and supplies

Sterilization:Vasectomy

Tubal ligation7

50%

100% ater a $50 copay

100%


100% ater a $100 copay

100%

Annual eye exam 100% ater a $20 copay 80% ater you meet the plan year deductible

Pscponugs 100% ater you pay a $10 copay or generic drugs or $25 or brand-name drugs that you purchaseatVadenHealthCenteroranotherPreferredHealthNetpharmacy.Prescriptioncontraceptiveswill be covered at $0 copay5. You receive no coverage or prescriptions illed at an out-o-networkpharmacy. Call your local pharmacy to veriy membership in the network or call Health Net at1-800-250-5226.

BeHAviOrALHeALtHBeNefitS10

MeNtALHeALtHANdSUBStANCeUSediSOrdertreAtMeNt

tYPeOfPrOvider

MHNNwokPo Ou-o-NwokPo

Outpatient teatment

Inpatient teatment in a hospital o esidential

acility

$20 copay

100%

Pre-authorizationrequired,exceptinanemergency. I you need emergency inpatienttreatment, you or a amily member or yourdoctor or hospital must call MHN within 24hours o admission.

Not covered

Not covered

Ou-o-pockmaxmum $500

1TheCardinalCareplanmaynotcoverallyourhealthcareexpenses.ThePlanexcludescoverageforcertainservicesandcontainslimitationsontheamountsitwillpay.Out-o-network providers are not covered.

2 For services to be covered at Stanord University Medical Center under Tier 1, you must be reerred by a Vaden Health Center clinician.3Health Net First Health providers are made available to members outside o Caliornia. To search or a Health Net First Health provider, go to

www.healthnet.com/cardinalcare or call 1-800-250-5226.

4Providersincludedoctors,hospitalsandpharmacies,includingStanfordUniversityMedicalCenter.5These modiications were made to comply with the Aordable Care Act and may be subject to change.

6Preventivecare:Includesannualpreventivephysical,preventivevision/hearingscreenings,newbornwell-careintherst30daysoflife,well-womanexams,preventivelaband

X-ray services.

7Preventivecareservicesforwomeninclude:femalecontraceptiveservices,devicesandsupplies;femalefamilyplanning;femalepreventivesterilizations;screeningforgestational

diabetes, domestic violence and HIV; breasteeding devices and supplies; applicable emale counseling or sexually transmitted inections, HIV, domestic violence, contraceptives,

and breasteeding.

8For ull coverage, these services must be precertiied.

9PrimarycareisprovidedatVadenHealthCenterifyouhavebeenchargedtheCampusHealthServiceFee.

10This table is only an overview. For complete inormation, reer to the ull Summary o Beneits booklet available at www.healthnet.com/cardinalcare.


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Cost o CoveageThe cost o Cardinal Care is $3,600 or the 20122013 academic year. The annual ee or CardinalCare will be billed over 3 quarters or 4 quarterso coverage. Students will be charged $1,200in Autumn, Winter and Spring quarters and willnot be billed in Summer quarter. Students enrolledin Cardinal Care will be covered during leaves oabsence, breaks, quarters in which they are not

registered (including summers), and immediatelyollowing graduation.

Enolling in Cadinal CaeAll students are required to have health insurancecoverage and are automatically enrolled inCardinal Care at the beginning o each academicyear. Upon enollment in Cadinal Cae inAutumn, you coveage begins Septembe 1 andends on August 31. You will be covered the entireacademic year.

Waiving Cadinal CaeThe process to opt-out o Cardinal Care diers or

domestic and international students. Details can beound at http://vaden.stanord.edu/insurance/index.html. As with the decision to enroll in Cardinal Care,the decision to waive Cardinal Care coverage is bindingor the entire academic year.

Domestic students who have comparable healthinsurance coverage can opt-out o Cardinal Careor the annual period by providing inormation aboutthe alternative insurance plan as part o the waiverprocess in Axess. The waiver screens are located athttp://axess.stanod.edu and the deadline towaive o Autumn quate is Septembe 15.

International students must have health insurancebenefts that meet or exceed minimum standards setby the University in order to opt out o Cardinal Care.International students may request an exception toCardinal Care enrollment each year by working withtheir insurance company to complete an InsuranceCoverage Certifcation Form. The alternative insurancepolicy must cover the entire academic period oSeptember 1 through August 31. The deadline to

submit the Insuance Coveage Cetifcation Fomis August 15 o Autumn quate. Additional detailsand the orm can be ound at http://vaden.stanord.edu/insurance/2012_cardinalcare.html.

Dependent Health CaeA separate health insurance plan is available orchildren and spouses/domestic partners o Stanordstudents. Students can enroll their dependents onlyat the beginning o their academic career at Stanordor upon a qualiying lie event or the dependent.For more details and the application, contact theVaden Health Center Insurance and Reerral Ofce at(650) 723-2135 or [email protected] orvisit http://vaden.stanord.edu/insurance/index.html.

Dental and Vision Cae OptionsCardinal Care covers your initial visit to a dentistto stabilize an injury to natural and sound teeth,but not other types o dental care. The VadenHealth Center Insurance and Reerral Ofceprovides inormation about both dental plans and adiscount program through OptumHealth Allies.

Cardinal Care covers one routine eye exam per year.

To request inormation about the dental and visionoptions available to you, stop by the Insurance and

Reerral Ofce, call (650) 723-2135, or [email protected].



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Cardinal Care Resources

Benefits of Health Net Membership Online 24/7

Health Net has created a dedicated custom websiteexclusively or Stanord students. Its our way o making

it easier or you to get things done.When you become a Health Net member, go online towww.healthnet.com/cardinalcare, clickRegister Nowandfll out the registration orm. Its that simple. Be sure tohave your ID card handy. As a registered member o thewebsite, youll have 24/7 access to the user-riendly toolsand health inormation you need most. You can:

Viewyourbenetdetailsandcopayamounts.

PrintatemporaryIDcardororderanewone.

ParticipateinHealthImprovementprograms.

LookupspecichealthconditionsusingourHealth Encyclopedia.

ChatlivewithaHealthNetCustomerServiceagentMonday through Friday, 8:00 a.m. to 6:00 p.m.Pacictime.

Andsomuchmore!

www.healthnet.com/cardinalcare an easy way to getmoredoneatyourconvenience!

Health Net Mobile

All o Health Net in the palm o your hand.

Health Net is paving the way with our new, innovativeHealth Net Mobile available or Apple and AndroidTM

smartphones. Health Net Mobile is the easiest way toconnect to a HealthNet.com online account, and isdesigned to help our members on the go.

Registered members can use this application to quicklyget plan, copay and deductible inormation, as well asaccess to a Mobile ID card to veriy eligibility. Visitwww.healthnet.com/cardinalcare or more inormation.

Decision Power

Healthy Discounts

OurDecisionPowerHealthyDiscountsprogram

supports your good health with valuable discountson health-related products and services, such as:

Fitnessclubmemberships

Vitamins

Eyewear

Weightmanagementprograms(includingWeight Watchers and Jenny Craig)

Andmore

CA90968 (5/12) Printed on recycled paper

All Healthy Discount programs are subject to change. This inormation is not intended as a substitute or proessional medical care.

Pleasealwaysfollowyourhealthcareprovidersinstructions.HealthNetDecisionPowerHealthyDiscountsoffersdiscountsonhealthproductsandreduced-feehealthservices.DecisionPowerHealthyDiscountsisnotpartofyourHealthNetbenetprogram,isnotintended to take the place o any covered benefts, and is oered to the member in addition to, rather than instead o, covered benefts.

DecisionPowerHealthyDiscountsprovidersareindependentbusinesses.Memberspurchaseservicesand/orsuppliesdirectlyfromtheproviders.QuestionsregardingtheDecisionPowerHealthyDiscountsprogramshouldbedirectedtoHealthNetsMemberServicesDepartment.QuestionsregardingaDecisionPowerHealthyDiscountsprovidershouldbedirectedtothatprovider.

This overview provides highlights o beneft inormation about Cardinal Care, the Stanord student health insurance plan. Your plancontract, which you will receive ater you enroll, contains the exact terms and conditions o your Health Net coverage. I there is adiscrepancy between the inormation provided in this brochure and the provisions o the plan documents, the plan documents will gove

HealthNetLifeInsuranceCompany,Inc.andMHNaresubsidiariesofHealthNet,Inc.HealthNetandDecisionPowerareregisteredservice marks o Health Net, Inc. All other identifed trademarks/service marks remain the property o their respective companies.

All rights reserved.

Issue Resource Contact Information

Medical benefits Health Net 1-800-250-5226

No-cost language assistance can be provided by

calling this number.

www.healthnet.com/cardinalcare

Mental health and

substance use disorder

benefits

MHN 1-800-327-0307 (available 8/1/12)

No-cost language assistance can be provided by

calling this number.

www.healthnet.com/cardinalcare

Cardinal Care

enrollment information

Vaden Insurance and

Referral Office

(650) 723-2135

http://vaden.stanford.edu/

insurance/index.html

email: [email protected]

Documents

Stanford Care