Changes to Cardinal Care
Q: Why are premiums and copays increasing again? 4
Q: What happens if my therapist or doctor doesn’t accept the new Wellfleet plan? 4
Q: Where can I get answers to a specific insurance question? 5
Q: Who decides health care costs that affect students? 5
Q: What are the bounds for Emergency Grant‑in‑Aid (EGIA) covering unexpected out‑of‑pocket costs? 5
Q: Will we know about insurance changes earlier in the future? 5
Q: Can insurance info and doctor‑finding tools be easier to use? 6
Q: What about vision and dental coverage? 6
SGWU met with Stanford administrators on 7/21/2025. You can read our notes by scrolling down to “Meeting Notes.”
Additionally, if you’ve used or tried to use Emergency-Grant-In-Aid to cover health care costs, please fill out our survey here.
The Cardinal Care student health insurance program is changing for the academic year 2025-2026. SGWU will meet with university representatives to discuss the changes and ask questions on behalf of union members.
Under our contract, graduate students with at least a 25% TA/RA appointment (or equivalent fellowship) will continue to receive a full subsidy for Cardinal Care. The Graduate Family Grant and Graduate Student Aid Fund can help cover the cost of health insurance for students, children, spouses/registered domestic partners.
[Last updated: June 10, 2025]
2024-2025 (link) | 2025-2026 (link) | |
Provider | Aetna | Wellfleet + Blue Shield + Cigna |
Premium | $7,620 | $8,232 (+8%, but covered by Stanford for most graduate students) |
Tiers | In-network providers are tiered. Most students go to Tier 1 (Stanford University Medical Center, Menlo Medical Clinic, and Sutter Health), but you can see Tier 2 (all other Aetna providers). No out-of-network coverage. | No tiers. In-network options are Blue Shield of California PPO in California and Cigna PPO outside California. Limited out-of-network coverage. |
Deductible First $X that insurance does not cover | In-network: $100 Tier 1, $500 Tier 2 | In-network: $150 for individual, $300 for family (+50%) |
Out-of-pocket-maximum Max you would pay out of pocket per year | $2,000 (at Stanford University Medical Center, Menlo Medical Clinic, and Sutter Health), $4,000 at other Aetna providers | $3,000 for individual, $6,000 for family (+50%) |
Copay What you pay per visit | Preventative care: free Primary care: $25 Specialist care: $25 Rehabilitative Services: $25 Chiropractic & Acupuncture: $25 | Preventative care: free Primary care: $35 Specialist care: $35 Rehabilitative Services: $35 Chiropractic & Acupuncture: $35 (+40%) |
Urgent Care | $50 copay | $50 copay (+0%) |
Emergency Room | $100 copay | $250 copay (+250%) |
Outpatient Surgery | $250 copay after meeting deductible (100% coverage for Tier 1 but only 70% coverage for Tier 2) | $250 copay after meeting deductible (+0%) |
Inpatient Medical Hospitalization | $500 copay after meeting the deductible (100% coverage for Tier 1, 70% coverage for Tier 2) | $500 copay after meeting the deductible (+0%) |
Inpatient Mental Health | $250 copay after meeting deductible (100% coverage for Tier 1 but only 70% coverage for Tier 2) | $250 copay after meeting deductible (+0%) |
Complex Imaging (MRI, CT, PET, etc.) | 100% (Tier 1) or 70% (Tier 2) coverage after two $100 copays. | $250 copay after meeting deductible (+0%) |
Diagnostic Lab & X-ray (Non-Complex) | 100% coverage (Tier 1) or 70% coverage (Tier 2). No deductible. | 100% coverage. No deductible. (+0%) |
Dental | $25 deductible for PPO; $50 deductible for non-PPO, $1,000 annual maximum | $25 deductible for PPO, $50 deductible for non-PPO, $1,000 annual maximum (+0%) |
Pharmacy/Rx | Copays are $10 (generic), $35 (brand formulary), $50 (brand non-formulary), $50 (specialty) | Copays are $10 (generic), $35 (preferred brand), $50 (non-preferred brand), $50 (specialty) (+0%) |
International coverage | Out-of-U.S. care reimbursed under Tier 2, after meeting Tier 2 deductible Plan also includes emergency assistance services provided by On Call International if > 100 miles from home | Plan will include Travel Assistance for urgent and emergent services, medical evacuation and repatriation if > 100 miles from home |
Dependent/spousal coverage | Monthly premiums for dependent care are: Spouse $635.00; Child $330.20; Children $594.37; Spouse + Child $965.20; Spouse + Children $1,229.37 | Dependent care “will be available,” details not yet known |
The following are meeting notes from SGWU leadership’s meeting with Stanford administrators to discuss changes to Cardinal Care.
SGWU’s previous summary of plan changes can be found here.
Please fill out our Emergency-Grant-In-Aid usage survey here.
Stanford explained that premiums for Cardinal Care have risen 0–10% annually over the last 15 years, with the past 2–3 years facing “extraordinary pressures” that pushed them toward the upper end of that range. Administrators cite several factors, including high local healthcare costs that rise faster than inflation and change in benefits to include out-of-network coverage under the Wellfleet / Blue Shield network.
Stanford says they have “very little control” over premiums, which are primarily set by the insurance carrier based on prior year claims. Administrators pointed to high emergency room utilization and encouraged students to divert ER usage to Hoover Pavilion or urgent care for non-emergency situations.
Administrators emphasized that they try to minimize out‑of‑pocket costs at the time of care (e.g. the copay) by shifting costs upfront into the insurance premium.
SGWU raised the fact that premium and copays are both rising significantly this year. Stanford administrators did not provide a transparent breakdown of cost drivers or detailed strategies for reducing student financial burden.
Provider credentialing is ongoing until September 1, so your provider may still join the network. There is a six‑month “transition of care” period where existing providers are covered at in‑network rates.
After that, students can still choose to see out‑of‑network providers under Wellfleet, which was not possible under the Aetna plan. Out‑of‑network care is covered at 50% of the “usual and customary” amount set by Wellfleet.
For example: If Wellfleet considers $200 the customary rate and your provider charges $300, Wellfleet pays $100, and you are responsible for the remaining $200.
SGWU leadership raised that therapists and doctors for chronic illnesses are important relationships built over a long period of time, and that students may strongly prefer to remain with their current provider who understands their health situation and history. Under the new plan, this can lead to high, unpredictable out‑of‑pocket costs.
Stanford claims fewer than 60 students will have disrupted care but provided no supporting data. Furthermore, SGWU reiterated our position that 60 students is still too many to have disruptions to critical health care.
Stanford noted that TimelyCare is also available at no co‑pay for telehealth users.
For Cardinal Care, the Provost makes the final decision, based on recommendations from ~15 Stanford administrators and Mercer, a national actuarial consulting firm. Administrators noted that Mercer has a strong influence in cost modeling and negotiation.
SGWU brought up that students have no direct voice in these decisions, despite bearing the financial consequences.
Administrators could not give a clear answer, but promised to follow up with additional guidance.
SGWU emphasized that clear guidance–– ahead of time–– is critical since it impacts students’ health care decisions.
Typically, premiums are released in early March. This year’s delay was called an “anomaly.”
Stanford will not run a new RFP this year, meaning Wellfleet will remain in place for AY 26‑27.
Stanford says they are asking Wellfleet to improve its app and website. The Student Health Matters website will also be updated, and information will be presented at NGSO and GOALIE.
SGWU communicated student concerns that the current tools are confusing and hard to navigate.
SGWU requested that Stanford post this information clearly and transparently, as it remains scattered across multiple sites.