Stanford Health Care Alliance (SHCA) is a select network health plan in which Stanford Health Care physicians and affiliated providers in multiple specialties take responsibility for working together to carefully coordinate and deliver your care.
The SHCA plan is one of two health plans offered to employees-only at no cost.
View detailed information about the Stanford Health Care Alliance
Basics | |
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Overview |
The Stanford HealthCare Alliance ACO plan requires you designate a primary care provider to coordinate all of your care. You may visit any Stanford HealthCare Alliance network doctor or hospital. Some services require prior authorization from your primary care physician. Group #976248 |
Pre-Authorization Requirement |
Pre-authorization from your primary care provider is required for the following services: Advanced Imaging (CT, MRI, MRA and PET); all electively scheduled inpatient admissions; all elective outpatient procedures (example- endoscopic procedures, arthroscopic procedures, epidural steroid injections, etc.); physical therapy; durable medical equipment; speech therapy. |
Office copay |
$20 copay primary/$50 copay specialist |
Deductible |
No deductible |
Out-of-Pocket Maximum |
$3,000 per individual/$6,000 family |
Preventative Care | |
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Physical exams for adults |
100% |
Physical exams for children |
100% |
Pap smears |
100% (as part of the office visit) |
Immunizations |
100% Travel immunizations not covered. |
Well-woman visits | 100% |
Prescription Drugs | |
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Pharmacy (Retail) |
Stanford HealthCare Alliance uses the Blue Shield Network pharmacy: |
Mail order drug program |
$20 generic; $60 brand name; $150 non-formulary -- up to a 90-day supply |
Birth Control Pills |
Included in Prescription Drug benefit |
Traveling Outside the U.S.
If you are enrolled in the SHCA plan, SHCA provide services in the greater Bay Area only. If you choose to remain in SHCA, you receive no coverage for routine services outside the service area.
SHCA provides “Emergency Care” coverage anywhere you may experience an emergency that is life threatening in nature. You may be able to access a Blue Shield Urgent Care facility for non-emergeny/non-life threatening medical services.
To learn more about SHCA Emergency Care benefit:
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Review the SHCA Summary of Benefits and Coverage
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Call SHCA Member Care Services at (855) 345-SHCA (7422)
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If you need to file a claim for emergency care received while overseas, download the Blue Shield international claim form or contact SHCA to have an international claim form sent to you.