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.
View 2021 plan information for Stanford Health Care Alliance
Basics | |
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Overview |
The SHCA plan requires you designate a primary care provider (PCP) to coordinate your care. While Aetna provides administrative support for the SHCA plan, members do not access the Aetna network. SHCA is a separate, regional network of providers and facilities in the Bay Area. You may visit any SHCA network doctor or hospital. Check the SHCA website for a list of in-network providers. Some services require prior authorization from your PCP. There is no benefit if you see a Non-Network provider, except for emergency care or when clinically appropriate and prior authorized by SHCA. Group #868025 |
Referral Requirement | Visits to a specialist require a referral from your designated PCP. This includes any specialist you are currently seeing for ongoing care or for new patient visits. Visits to a specialist without a PCP referral may be denied due to lack of referral. Exception: Well-woman exams with an OB/GYN do not require a referral. |
Prior Authorization Requirement |
Prior authorization is required for the following services: Advanced Imaging (CT, MRI, MRA and PET); all electively scheduled inpatient hospital admissions, all elective outpatient procedures (example – endoscopic procedures, arthroscopic procedures, epidural steroid injections, etc); other procedures and services as defined on the pre-certification requirement list. |
Office copay |
$30 copay primary/$75 copay specialist |
Deductible |
No deductible |
Out-of-Pocket Maximum |
$3,500 per individual/$7,000 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) |
SHCA uses the Aetna Network pharmacies: |
Mail order drug program |
$20 generic; $80 brand name; $200 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 provides 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. Contact SHCA to locate an approved facility for non-emergency/non-life threatening medical services.
To learn more about SHCA Emergency Care benefit:
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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, contact SHCA to have an international claim form sent to you.