Yale Health

Frequently Asked Questions

I am an eligible student and I waived coverage, can I still use services at Yale Health?

Yes. If you waive Yale Health Hospitalization/Specialty Care coverage you still have Basic Coverage.  Please refer to the Student Guide to Yale Health for additional coverage information.

What is the deadline for students to waive portions of the Yale Health coverage?

September 15th for full-year or the fall term
January 31st for the spring term

How do I submit my student waiver for Hospitalization/Specialty Care coverage?

Complete the online form.

Do I need to enroll in student coverage?

Eligible students are automatically enrolled. For affiliate coverage or to enroll a dependent, fill out a Student Enrollment/Change Application Form.

How does MyChart work?

Information can be found on our MyChart page.

Who should I contact with questions about the cost of my premiums or my bill?

Employees should contact the Employee Service Center.

Students should contact Member Services at 203-432-0246 or member.services@yale.edu.

I am reaching age 65. Do I need to take any action?

If you are reaching age 65 and continuing to work you should contact the Social Security Administration to enroll in Medicare Part A. Medicare Part A may provide you with additional benefits beyond your Yale Health coverage. In most cases, there is no premium for Medicare Part A. You do not need to enroll in Medicare Part B if you are receiving your care at Yale Health. Yale Health will remain your primary insurance coverage until you stop working.

Will I be able to continue to see my physician at Yale Health once I am retired and enrolled in a Medicare program?

If you elect the Medicare Supplement with the University you may continue to use the primary departments at Yale Health and we will bill Medicare and your Medicare Supplement for your services.

If I retire from the University what happens to my coverage at Yale Health?

If you are under age 65 and eligible for retirement benefits you and your covered spouse or civil union partner and dependents may remain on Yale Health. When you (the retired member) or the enrolled spouse or civil union partner reach age 65 or become eligible for Medicare, Yale Health membership terminates and you become eligible for one of the Medicare programs offered by the University.

Can I use my outside insurance company’s prescription card at the Yale Health Pharmacy?

No. Drug cards for other insurance companies are not accepted at the Yale Health Pharmacy.

Where can I get my prescriptions filled when I am out of the area? (Will I get reimbursed?)

You can use any pharmacy. You will pay full price and then submit a Pharmacy Claim Form, which will be reviewed for reimbursement.  Please note, your reimbursement is dependent upon the benefit (for more information visit Understand Your Coverage) and formulary rules. For more information visit the Outside Pharmacy Use page.

(If you are a student you need to have Yale Health Hospitalization/Specialty Care coverage in order to be reimbursed.)

Is my 19-25 year old covered?

Yes. Your 19-25 year old dependent can be covered.

I am pregnant and traveling out of the area, will I be covered if I go into labor?

Starting from four weeks before your due date, or earlier if you are advised by your Yale Health clinician not to travel, charges associated with hospital admission will only be covered at Yale-Hew Haven Hospital.

I am covered under two insurance plans how do I know which plan is my primary coverage?

For a detailed explanation see the Coordination of Benefits section in the Member Coverage Booklet or Student Handbook.

On what date does my coverage start?

For employees - your coverage will start on the 1st of the month following your date of hire or if your date of hire is the 1st it will start on that day. For students – your coverage starts on the 1st day that you are required by your school to be on campus.

My spouse or civil union partner, who was an employee at Yale has passed away. I was covered under his/her Yale Health coverage. What do I need to do?

Contact the Employee Service Center Office at 203-432-5552. As the surviving spouse or civil union partner, you may qualify for continued coverage for a period of time at a reduced premium. You will also be eligible to extend your coverage for up to 36 months under the COBRA option.

I am an employee with Yale Health coverage and my spouse or civil union partner has passed away. What do I need to do?

Contact the Employee Service Center at 203-432-5552. The Employee Service Center will also assist you with other changes you may need to make to your benefit package.

How do I make changes to my information?

You can make changes to your demographic information such as address or telephone numbers through the Yale University Portal or calling the Employee Service Center at 203-432-5552.

My status at Yale is changing (i.e., post-doctorate associate to post-doctorate fellow) what do I do?

Please call Member Services at 203-432-0246 to discuss how your eligibility for coverage might change.

I am getting divorced or a civil union dissolution, what do I need to do?

You are required to notify the Employee Service Center at 203-432-5552 within 30 days of your divorce or civil union dissolution. Coverage for your spouse or civil union partner terminates at the end of that month.  He/she is eligible for COBRA coverage.

How do I add someone to my Yale Health coverage?

Employees can enroll their legally married spouse or civil union partner within 30 days of their marriage or civil union or their baby within 30 days of their birth by using the Yale University Portal or calling the Employee Service Center at 203-432-5552.

Employees can also enroll their legally married spouse or civil union partner or dependents under the age of 26 during the annual enrollment period, with coverage effective January 1st. No other relatives are eligible for coverage.

Students can enroll their legally married spouse or civil union partner within 30 days of their marriage or civil union or their baby within 30 days of their birth by using a Student Enrollment form.

Students can also enroll their legally married spouse or civil union partner or dependents under the age of 26 for the fall term or full year prior to the September 15th deadline or for the spring term prior to the January 31st deadline.  The fall term runs from August 1st-January 31st and the spring term runs from February 1st-July 31st.

I am losing my insurance coverage I have from another source (not Yale), can I enroll in Yale Health?

Yes. With proof of loss from the other insurance carrier within 30 days of the loss of coverage.

I am a new employee, how do I enroll?

You have 30 days from your start date to enroll. You should go through the Employee Service Center.

Do I have healthcare coverage when I am out of state?

Students: If you have taken Yale Health Hospitalization/Specialty Care coverage, you are covered outside of Connecticut for emergency care, acute care and pre-authorized short-term follow-up care. Please see the Terms of Coverage section of the Yale Health Student Handbook for details. If you have alternate insurance, you should check the specifics of that insurance.

Members: You are covered for emergency care when you are out-of-state.

An emergency medical condition is a sudden and severe condition, sickness or injury, including, but not limited to, severe pain, which would lead a prudent layperson including the parent or guardian of a minor child or the parent or guardian of a disabled individual possessing an average knowledge of medicine and health, to believe that failure to get immediate medical care could result in:

  • Placing one’s health in serious jeopardy
  • Serious impairment to a bodily function(s)
  • Serious dysfunction to a body part(s) or organ(s); or
  • In the case of a pregnant woman, serious jeopardy to the health of the unborn child.

Do I need a referral for Specialty Services?

Yes. Referrals to the Specialty Services Department are for a specific problem identified by a primary care clinician (PCC).  Routine, non-emergency appointments are typically scheduled within four weeks.

Who do I contact if I have a compliment or a good idea for the Yale Health?

Fill out a patient comment card. These pre-printed cards are available at all reception desks throughout the building and may be dropped off at the Member Services Department on the 1st Floor.  All are personally reviewed by the appropriate clinical and administrative staff.

Who do I contact if I have a complaint about a non-medical aspect of Yale Health?

Contact the department manager. If your complaint is not resolved, contact the patient representative in person or by calling 203-432-8134. If you have a general complaint, you can also fill out a patient comment card online or at the department’s reception desk.

What do I do if I’ve had a problem with my medical care?

Contact the department manager, whose role it is to see that the clinical area runs smoothly and responds to the needs of its members. You can also contact the patient representative, who has experience in investigating and resolving problems involved with the delivery of medical services.

The patient representative can be reached by phone at 203-432-8134. Or write to: Patient Representative / Yale Health / 55 Lock Street / P.O. Box 208237 / New Haven, CT 06520.

I am a student and have been on a leave of absence. What happens when I return to Yale?

Contact Member Services at 203-432-0246. If you are eligible, you will go right back onto Yale Health Basic and will automatically be re-enrolled in Yale Health Hospitalization/Specialty Care coverage unless you waive and provide proof of alternate hospitalization coverage.

Am I covered for prescriptions as an enrolled student?

Students enrolled in Yale Health Hospitalization/Specialty Care coverage are covered.  Please call Member Services at 203-432-0246 or review the Yale Health Student Handbook to check on your individual coverage and benefits. 

Students with Yale Health Hospitalization/Specialty Coverage can receive free generic oral contraceptives at the Yale Health Pharmacy.

What is a primary care clinician (PCC)?

Your primary care clinician is the medical professional who sees you regularly and who knows you best. Yale Health believes that a close relationship with a primary care clinician plays an essential role in providing efficient and personalized care.

Your primary care clinician is at the center of a team of dedicated healthcare professionals who work together to serve you. Your primary care clinician is also your access point for specialty care.

A primary care clinician is assigned to you upon enrollment in Yale Health. Female members are assigned a PCC in the Ob/Gyn Department as well as the Internal Medicine Department. Children are assigned a PCC in the Pediatrics Department.

If you would like to choose a different PCC, contact Member Services at 203-432-0246 to review the list of available clinicians.

I am a student and have waived Yale Health coverage, can I be seen in the Dermatology Department?

No.  Students who have waived Yale Health’s Hospitalization/Specialty Care coverage need to seek services from providers who accept their insurance.

What is an “emergency”?

Care for an emergency medical condition is covered at facilities worldwide. If you have an emergency medical condition, go to the nearest medical facility for treatment.

An emergency medical condition is a sudden and severe condition, sickness or injury, including, but not limited to, severe pain, which would lead a prudent layperson including the parent or guardian of a minor child or the parent or guardian of a disabled individual possessing an average knowledge of medicine and health, to believe that failure to get immediate medical care could result in:

  • Placing one’s health in serious jeopardy;
  • Serious impairment to a bodily function(s);
  • Serious dysfunction to a body part(s) or organ(s); or
  • In the case of a pregnant woman, serious jeopardy to the health of the unborn child.

I received a request that I provide my social security number and the social security numbers of my spouse and children to Yale Health. Is there some new reason why you need our social security numbers?

As a health insurance company we will be required to provide Form 1095-B to you and to the Internal Revenue Service. You will use the form to prepare your individual income tax return. The law requires social security numbers to be reported on Form 1095-B.

What if I refuse to provide my social security number to my health insurance company?

The information received by the Internal Revenue Service will be used to verify information on your individual income tax return.  If the information you provide on your tax return cannot be verified, you may receive an inquiry from the Internal Revenue Service.  You also may receive a notice from the Internal Revenue Service indicating that you are liable for a shared responsibility payment.

Is there a specific Internal Revenue Service form that will be mailed to me to provide the information to my health insurance company?

Yes. We will e-mail you a written request which discusses these new rules.