Stanford Health Care Alliance Plan Documents and Resources
General Resources
Plan Documents
- 2024 Summary of Benefits and Coverages (SBC)
- 2023 SHCA Summary of Benefits and Coverages (SBC)
- 2023-2024 SHCA Summary Plan Description (SPD)
- 2023-2024 SHCA Schedule of Benefits (SOB)
Formulary
You can verify if your current Rx is included in Aetna's formulary. If not, you will need to work with your doctor to identify a replacement drug.
Helpful Documents
- Get Your Medical ID Card - You must know your medical ID number. If you are new to SHCA or have lost your card, call SHCA Member Care Services at 855-345-7422 for assistance
- Urgent and Emergency Care Outside of the SHCA Service Area
- How to Know When it's an Emergency - Reference sheet of common complaints, injuries and illnesses
Claim Forms
- Medical Expenses Claim Form - For when you had to pay out of pocket for medical services received due to out of area Urgent and Emergency Care, including international care
- Pharmacy Expenses Claim Form - For when you had to pay out of pocket for Rxs received from an Out-of-Network Pharmacy, including international pharmacies
COMPLIANCE
Transparency in Coverage - Machine Readable Files
The Transparency in Coverage rule released by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury requires group health plans, such as Stanford’s, and health insurers to make price information available to consumers. We are required to post the following links for each of our medical plan vendors effective July 1, 2022. The information available through these links is provided in good faith compliance with the Machine-Readable Files approach. These files display negotiated rates for covered items and services between the health plans and in-network providers for the plans. Some in-network provider arrangements do not prescribe rates for all covered items and services. In those cases, the provider’s reimbursement might be determined in several different ways, but this file would not contain that information. Pharmacy Machine readable files are not an enforced requirement and will not be available.