Premiums, copays, coinsurances, and deductibles vary by employer. Please consult the comparison charts in the open enrollment information provided by your benefits department.

If you have other coverage besides Stanford Health Care Alliance, please contact Member Care Services with your other plan’s information. We will update your eligibility records and review if and how any coordination of benefits may be applied.

Stanford Health Care Alliance requires proof of disability to enroll dependents over age 26 on a parent’s health plan. Member Care Services can assist with this process.

By choosing an SHCA physician as your personal doctor, you have a dedicated care partner. Your personal doctor will collaborate and consult with other providers for all your care needs—from routine through specialty care. It is recommended that you choose a personal doctor within 90 days of when your membership becomes active.

If you are undergoing certain treatments or need more time after your initial enrollment to switch doctors, you can request a short-term extension through the Transition of Care process.

Yes. In an emergency, call 911 or go to the nearest emergency room, no matter where you are. As long as it’s an emergency, you are only responsible for a copay. Any follow-up care must come from one of the current in-network doctors in the plan.

Stanford Walk-In Clinic and Express Care Clinics are open daily with same-day appointments available for minor injuries and illnesses. In addition, the plan includes a wide range of urgent care centers across the Bay Area and beyond.

For emergencies, you get access to any emergency room—anytime, anywhere. Member Care Services can help you locate urgent care services when you are traveling in the United States.

You have access to a wide range of laboratory, therapeutic, diagnostic, and supplementary services, including physical therapy, occupational therapy, speech therapy, radiology, MRI, and more. 

Your treating provider will submit prior authorization requests, when necessary. Prior authorization is required for certain tests and procedures that may be recommended by your physician. To find out which services require prior authorization, contact Member Care Services.

The care you receive from our providers is tracked and coordinated using an electronic medical record system. As a member of SHCA, you have access to your records through the MyHealth portal. You can also request shared access to medical records for another adult and for children age 17 and under.

Member Care Services can help transfer your medical records to your new SHCA doctor. Plus, easy transfer of your medical records is possible through the connected system between Stanford Health Care and most of our in-network hospitals. 

Yes, preventive care such as routine exams, well-woman visits, and related lab work is covered at no cost when you see an in-network provider. Please contact Member Care Services for detailed information on covered preventive services and frequency limitations.

The prescription drug benefit has a list of covered medications, also known as a formulary. The amount you pay may vary based on the prescription type—generic, preferred, or nonpreferred. Some prescription drugs may require prior authorization or alternative medications.

Yes, most prescriptions are eligible for 90-day refills, with free shipping to your home or office.

Your benefit plan is through Stanford Health Care Alliance (SHCA). Aetna is our Third-Party Administrator. In this role, Aetna processes and pays claims, sends the explanation of benefits, contracts with the doctors and hospitals, and houses the DocFind provider tool.

No. Your coverage and benefits have not changed.  You are still enrolled in the same plan as before with added benefits now provided through Stanford Health Care Alliance.  As an SHCA member you will now have access to our Member Care Services and Care Management which are now under the SHCA umbrella instead of Aetna. 

We manage the benefit operations, maintain the care network, provide member services, outreach to patients to ensure certain care needs are met, provide patient education and care management.

As an employee, you may have several options to choose from, including:

• The EPO plan (Exclusive Provider Option)
• The HDHP plan (High-Deductible Health Plan)
• The POS II plan (Point-of-Service plan)