Cardinal Care and Dependent Health Insurance for 2015-16

Vaden Health Center has announced Cardinal Care and the Student Dependent Health Insurance Plan rates for the 2015-16 academic year.

Cardinal Care

Cardinal Care will continue to be an annual plan. This means that acknowledgement of enrollment in the plan (or default enrollment in the absence of acknowledgement) OR waiver/exception in a student’s first registered quarter of the academic year, is a commitment that will extend through August 31. For 2015-16, the cost of the annual plan, September 1 through August 31, will be $4,680, an 8.9% increase over the 2014-15 rate of $4,296.

A number of changes will occur to the 2015-16 Cardinal Care coverage design. The plan will continue to provide robust, comprehensive benefits (comparable to a 'Platinum' plan under CoveredCA) and in-network care at Stanford Medical Center, but some of the cost share (copays and deductibles) will increase as a means to mitigate a larger rise in "up front" premium costs. Student input gathered in workshops and captured through the 2014 Student Health Insurance Survey was used in the planning process. We are extraordinarily pleased to be able to offer, for the first time, dental coverage as part of the Cardinal Care package of benefits. Diagnostic and preventive care and "basic" restorative services, up to $1,000 per year, will be offered through Delta Dental PPO providers. 

Below is a synopsis of the 2015-16 Tier 1 Cardinal Care benefits:

• Preventive immunizations at no cost share to the enrollee
• Generic contraception at no cost share to the enrollee
• Tier 1 primary care and behavioral health/substance abuse office visits with a $25 copay
• Tier 1 specialist office visits with a $30 copay
• Tier 1 inpatient hospital coverage at 100% after a $500 copay
• Tier 1 outpatient hospital services covered at 100% after a $250 copay
• Urgent care with a $50 copay
• Emergency Department care with a $100 copay—waived if admitted
• Specialty prescriptions (typically injectibles) with a $50 copay
• Tier 1 out-of-pocket maximum of $2,000
• Dental coverage for diagnostic and preventive services at 100% (up to $1,000 annually) 

Dependent Plan

The Student Dependent Health Insurance Plan (Dependent Plan) is available to dependents of students who are enrolled in Cardinal Care. The aggregate monthly premium costs will increase by 15.3% in 2015-16. A student spouse, for example, will pay $358.13 for monthly coverage. Rates for other family members will go up similarly, according to the following table.

The only benefits change made to the Dependent Plan for 2015-16 is an increase in the specialty prescription copay from $40 to $50. 

Dependent Plan enrollment is open to dependents of new students during a 30 day open-enrollment period that occurs ONLY at the beginning of the student's academic career, or when any student dependent experiences a qualifying life event.

Factors Contributing to Increased Costs

A number of factors continue to contribute to health insurance costs for students and their dependents. Chief among them are plan experience (the actual cost of all services provided in the prior year), trends in usage (what types of services enrollees are using), and where care is occurring. Ways to reduce costs, including those that might result from modifications in enrollee behavior (such as the use of "urgent care" services instead of "emergency" services if a situation allows it) are routinely considered. Ultimately, the insurance plans reflect the combination of cost and coverage that best serves the needs of the university's diverse population.

For 2015-16 Cardinal Care, the major driver of premium cost is once again utilization of health care services. Higher taxes and fees imposed by the Patient Protection and Affordable Care (PPACA) are also contibuting to increases. The cost associated with the addition of dental coverage is included in the 8.9% rise.  

For the Dependent Plan, PPACA taxes and fees also contributed to the rise in cost for 2015-16, but even more of a factor for this smaller group of enrollees is high rates of utilization of care. Since the plan experience occurs among a small number of individuals, the impact of use is greater on cost, which is why the percent increase is higher than for Cardinal Care. 

Summary and Future Considerations

This overview of Cardinal Care and the Dependent Plan for 2015-16 is intended to provide students and their families with key points about the upcoming plan year. As with previous years, new and returning students will be provided with more detailed information about health insurance and corresponding rates for 2015-16 in the annual health mailing from Vaden Health Center in the late spring/early summer.

Recognizing that rising health care costs are of great concern, Vaden Health Center will continue to solicit feedback and collect general information about health care priorities and coverage needs from students. We will also keep informed about changes in the insurance industry that might serve our population. Suitable options under CoveredCA, especially for student dependents, may be available.

For questions please contact Vaden's Insurance and Referral Office at 650-723-2135 or healthinsurance@stanford.edu.