Effective January 1, 2020, Californians must maintain minimum essential coverage for each month on or after that date. Californians who fail to have qualifying health coverage will owe a state penalty for each month they lack coverage. In addition, those responsible for ensuring their spouse or dependents maintain coverage may owe a penalty if their spouse or dependents do not have minimum essential coverage. Californians who owe a penalty will pay when they file their taxes.
Stanford requires all postdocs, regardless of visa status or funding source, to have a comprehensive medical plan that includes minimum essential coverage (MEC) as defined by the Affordable Care Act (ACA). In addition to MEC, there are Stanford-defined criteria a medical plan must have to meet Stanford's requirements for a comprehensive medical plan. In some instances, this includes during an unpaid leave of absence.
The Affordable Care Act's 10 Essential Health Benefits
- Ambulatory patient services (outpatient care)
Care you receive without being admitted to a hospital, such as a doctor's office, clinic, or same-day (outpatient) surgery center. Services also include home health services and hospice care.
- Emergency services (trips to the emergency room)
Care you receive for conditions that could lead to severe disability or death, such as from accidents or sudden illnesses, if not treated immediately. Emergency care includes transport by ambulance to the emergency room.
- Hospitalization (treatment in a hospital for inpatient care) Care you receive as a hospital patient, including care from doctors, nurses, and other hospital staff, laboratory and other tests, medications you receive during your hospital stay, and room and board. Hospitalization coverage also includes surgeries, transplants, and care received in a skilled nursing facility, such as a nursing home that specializes in the care of the elderly.
- Maternity and newborn care
Care that a woman receives during pregnancy (prenatal care), including labor, delivery, and post-delivery. Care for the newborn baby.
- Mental health services and substance/addiction treatment
Inpatient and outpatient care evaluating, diagnosing, or treating a mental health condition or substance abuse disorder, including behavioral health treatment, counseling, and psychotherapy. Limits of plans must be at parity with other medical and surgical services.
- Prescription drugs
Medications that a doctor prescribes to treat an illness or condition.
- Rehabilitative services and devices Help recover skills, such as speech therapy after a stroke, develop skills, such as speech therapy for children, and devices to help gain or recover mental and physical skills lost to injury, disability, or a chronic condition.
- Laboratory services - Testing that helps a doctor diagnose an injury, illness, or condition, or to monitor the effectiveness of a particular treatment.
- Preventative services, wellness services, and chronic disease management
Includes counseling, and preventive care, such as physicals, immunizations, and screenings designed to prevent or detect certain medical conditions. Care for chronic conditions like asthma and diabetes.
- Pediatric services - Care provided to infants and children, including well-baby/child visits and recommended vaccines and immunizations. Must offer dental and vision care to children younger than 19.
Other provisions of ACA mandate the following:
- 2022 Out-of-pocket maximums shall not exceed $8,700/individual and $17,400/family
- Deductibles will vary, but cannot exceed the out-of-pocket maximum - J1 visa holder's deductible cannot exceed $500
- A medical plan must cover at least 60% of medical expenses once a deductible is met
- No maximum dollar limit on Essential Benefits or total medical expenses for a single incident
- No pre-existing clauses or waiting periods
Stanford requires your policy to cover any medically necessary services, regardless of how incurred. Your policy cannot exclude services for injuries or sickness caused by:
- participation in a riot or civil disorder
- war or any act of war declared or undeclared
- extreme sports such as skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, bungee jumping, rock climbing, or any other extreme sport that could cause bodily harm not mentioned here
- self-inflicted wounds
Please email Postdoc Benefits at email@example.com if you have any questions or need your medical policy reviewed.
Department of State (DOS) requires J visa scholars to have these additional coverages:
- Repatriation of remains of $25,000
- Emergency medical evacuation to the home country of $50,000
Repatriation of remains and medical evacuation coverage is available for an additional monthly charge of $1.25 through the Postdoctoral Scholar Benefits program by electing the Extended Travel Assistance Program through Assist America. You may elect this plan through Benelogic within 31 days of your postdoc appointment start date or during Open Enrollment. Open Enrollment is usually in late October through early November, with all elections becoming effective January 1 of the following year.