Yale Police Benevolent Association (YPBA) Coverage

Your Yale Health coverage is unique based on your role at the University.

You will receive all of your healthcare at the Yale Health Center unless your primary care clinician refers you to an outside clinician/specialist. Prior authorization is required for all referrals.

There is no limitation for pre-existing conditions, and most preventive, diagnostic and treatment services involve no deductibles and no claim forms.

Coverage Documents

   

Schedule of Benefits

A list that describes covered services and treatments, as well as patient cost-sharing amounts like copays, fees for no show/late cancellation, deductibles, and coinsurance percentages, under your Yale Health plan. 

Look here first when you have questions about what services are covered by your Yale Health plan, and what/if any amount you will have to pay for those services.

Go to the Schedule of Benefits when looking for information at a quick glance, and look over the list of services and the amount of coverage available for that service.

Disclaimer: the Schedule of Benefits does not list all services and treatments, and is subject to all the terms, conditions, and exclusions and limitations set forth in the Yale Health Student Handbook or Yale Health Employee Member Coverage Booklet (ie. “the plan document”). The plan document governs all questions of interpretation.

Summary of Benefits and Coverage

A list of medical services and treatments designed to help you understand the coverage you have with Yale Health. It also allows you to more easily compare Yale Health with different coverage options available to you.

A list of key features of Yale Health coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. 

Under the Affordable Care Act, Yale Health is required to provide you with this concise list which details, in plain language, simple and consistent information about Yale Health plan benefits and coverage.  

Go to the Summary of Benefits & Coverage when you are shopping for coverage, enrolling in coverage, and at the beginning of each new plan year, to better understand your Yale Health coverage and evaluate whether your coverage needs are being met.

Disclaimer: the Summary of Benefits & Coverage does not list all services and treatments, and is subject to all the terms, conditions, and exclusions and limitations set forth in the Yale Health Student Handbook or Yale Health Employee Member Coverage Booklet (ie. “the plan document”).  The plan document governs all questions of interpretation.

Employee Member Coverage Booklet

A detailed booklet that explains in detail the benefits and coverage provided under your Yale Health employee coverage.

The booklet describes the rights and obligations of you and Yale Health, what the plan covers, and how benefits are paid for that coverage. It is your responsibility to understand the terms and conditions of your plan outlined in this booklet. An employee covered under this plan and their covered dependents are subject to all the conditions and provisions of the plan.

Go to the Employee Member Coverage Booklet if you need more information after reviewing the Schedule of Benefits and the Summary of Benefits & Coverage. The Employee Member Coverage Booklet may not provide an answer for all questions, and you may need to contact your Primary Care Clinician, the Care Management Department, or Member Services for further direction.

Disclaimer:  The Employee Member Coverage Booklet is the plan document. It includes the Schedule of Benefits and any amendments or riders, and governs all questions of interpretation.

Glossary of Health Coverage and Medical Terms

A glossary of common health coverage and medical terms from The U.S. Center for Consumer Information & Insurance Oversight. It defines many commonly used terms, but isn’t a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any case, the policy or plan governs.