Internal Medicine 203 432 0038
Student Health 203 432 0312
Mental Health & Counseling for Students 203 432 0290
Pharmacy 203 432 0033
Yes. If you waive Hospitalization & Specialty coverage as well as Prescription Plus coverage you still have Basic Coverage. Please refer to the Student Guide to Yale Health for additional coverage information.
September 15th for full-year or the fall term
January 31st for the spring term
Complete the online form.
Students are automatically enrolled. For affiliate coverage or to enroll a dependent, fill out a Student Enrollment/Change Application Form.
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.
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 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.
No. Drug cards for other insurance companies are not accepted at the Yale Health Pharmacy.
You can use any pharmacy. You will pay full price and then submit a Pharmacy Claim Form, which will be reviewed for reimbursement.
Yes. Your 19-25 year old dependent can be covered.
Starting from four weeks before your due date, or 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.
For a detailed explanation see the Coordination of Benefits section in the Member Coverage Booklet or Student Handbook.
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.
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.
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.
Please call Member Services at 203-432-0246 to discuss how your eligibility for coverage might change.
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.
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.
Yes. With proof of loss from the other insurance carrier within 30 days of the loss of coverage.
You have 30 days from your start date to enroll. You should go through the Employee Service Center.
Students: If you have taken Yale Health Hospitalization/Specialty 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:
When you use an outside pharmacy (not the Yale Health Pharmacy at 55 Lock Street) you will be treated as a cash customer and they will not check to see if your prescription is covered under your insurance plan. This means that when you submit your claim it could be denied because:
Your pharmacy benefit is subject to the rules and limitations of the formulary (Member Coverage Booklet or Student Handbook) even when you use an outside (out-of-network) pharmacy.
In general, outpatient care received outside of the Yale Health network of health care clinicians and facilities is not covered under Yale Health. The two exceptions to this are outpatient care received for an emergency or urgent condition (see the section Emergency Care Coverage in the Member Coverage Booklet for a full explanation) and care that has been arranged by a Yale Health clinician and approved in advance by the Care Coordination Department.
Member: Certain services are not covered under Yale Health basic coverage. For example, there may be a co-pay or deductible for certain items. See the Prescription/Supplemental Benefit Plan in the Member Coverage Booklet.
Student: If you waived Specialty Hospital Coverage you may be billed for services not included in Basic Coverage. See the Student Handbook.
Certain covered services and items will normally be billed to you. An example of this is durable medical equipment such as crutches or braces. You pay that bill and then submit it to the Claims Department. They will reimburse you, subject to the contract provisions.
Call the Billing Department at 203-436-8882 to verify that payment has been received by Yale Health. If it has been paid, you will receive credit on your bursar bill.
Students receiving Yale Health Basic benefits who are admitted to Inpatient Care by a Yale Health clinician do receive room and board, nursing care and primary care at no charge. Those who have purchased Yale Health Hospitalization/Specialty Coverage also receive approved specialty services at no charge. However, if you have alternate insurance, specialty care services ordered or rendered by a Yale Health clinician during an ICF stay will be billed to your other insurance. That company may or may not cover those services. If it does not, you will be billed directly via your bursar account.
There are three possibilities:
First you should call the Billing Department at 203-436-8882 to see if your information is correct. If it is incorrect, the corrections will be made and the claim will be sent again. However, if your information is accurate, the dispute over the claim is then between you and your insurance plan and you will have to follow through with them.
Yes. If you feel you were billed in error, call the Billing Department at 203-436-8882.
To determine coverage for Basic or Hospitalization/Specialty coverage, please refer to the Student Handbook.
The same guidelines apply. If your dependents are enrolled in Yale Health Hospitalization/Specialty Coverage their emergency care is covered as described above.
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 Coverage and Prescription Plus unless you waive and provide proof of alternate hospitalization coverage.
Fall Term and full-year coverage for incoming students begins on the date dormitories open or the date you are required to be on campus for orientation. The coverage year ends on July 31 and the following year’s coverage begins on August 1 with no lapse in coverage. Even students who graduate are covered through July 31.
Yes. The health center at 55 Lock Street is open year-round, 24 hours a day. You will have the same coverage as you did before you left.
Each person requires a different treatment plan, so you should consult with your clinician. Please remember that while emergencies are covered while you are out of the area, but routine care is not. If you have alternate insurance, you should look into the terms of its out-of-area coverage.
If your condition prevents you or your representative from contacting the Care Coordination Department within 48 hours, you will still be covered for the emergency, but you should contact Care Coordination as soon as possible to ensure that Yale Health clinical staff is aware of your condition and to request Care Coordination to authorize follow-up care should it be needed. Remember to carry your Yale Health card with you at all times. It can provide valuable information if you can’t communicate.
No. It is strongly recommended that you receive all of your required immunizations from your healthcare provider prior to your arrival on campus.
If you withdraw during the first 10 days of the term, the fees paid for the Yale Health Hospitalization/Specialty Care plan and, if applicable, the Yale Health Prescription Plus coverage, will be refunded. You will not be covered for any medical care received through Yale Health during that period. Your Yale Health membership will be terminated retroactive to the beginning of the semester and any services rendered or claims paid will be billed on a fee-for-service basis.
If you have purchased the Yale Health Hospitalization/Specialty Coverage and Yale Health Prescription Plus Coverage and withdraw from Yale after the 10th day of the term, you will be covered by Yale Health for 30 days following the date of withdrawal or through the last day of the term, whichever comes first. The last day of fall term is January 31. The last day spring term is July 31.
Fees will not be pro-rated or refunded. If you are hospitalized on the effective date of withdrawal or during the 30-day period during which coverage is extended, you are eligible for Yale Health hospital benefits until discharged from the hospital, subject to the limits of Yale Health coverage for the illness or injury.
If you are granted a leave of absence, the University does not require you to purchase hospitalization coverage. But you may decide to purchase outside insurance that will cover you for any care received at Yale Health or you may purchase Yale Health Affiliate Coverage for the term during which the leave is taken.
In order to secure continuous coverage through Yale Health, you must request enrollment in Yale Health and pay the appropriate fees prior to the beginning of the term during which the leave is taken. If a leave of absence is granted during the term and you want Yale Health Affiliate coverage, you must request enrollment within 30 days of the date the leave is granted.
Unless you obtain continuing coverage through Yale Health, you will be responsible for all charges for medical services, including hospital services rendered by Yale Health clinicians or on behalf of Yale Health. If you are taking your leave in the New Haven area, you may also choose to use Yale Health on a fee-for-service basis. The Member Services Department at 203-432-0246 can provide more information.
A number of situations arise in which Yale students do not meet the eligibility requirements for automatic enrollment in Yale Health Basic and for purchase of Yale Health Hospitalization/Specialty Coverage. In these situations, you are not required by the University to have health insurance coverage, although you are advised to do so.
Included in this category are students on leaves of absence, undergraduates in junior year abroad programs, medical students on extended study/reduced tuition, students registered as special students in degree candidate programs, students registered in absentia who are studying at another institution, and other degree-candidate students paying less than half of the term's tuition.
If you are in one of these categories, you can still obtain Yale Health coverage. However, you must pay for it yourself through Yale Health Affiliate Coverage, which combines Yale Health Basic and Yale Health Hospitalization/Specialty Coverage.
Under this coverage you cannot elect just Yale Health Basic. If you do purchase coverage this way, the services and benefits you receive will be exactly the same as if you had met the eligibility requirements for Yale Health Basic.
Students, such as visiting scholars or Yale non-degree students, who do not meet eligibility requirements for the use of Yale Health primary care services or for the purchase of Yale Health Affiliate Coverage may still use Yale Health services on a fee-for-service basis. Please note that each school—not Yale Health—determines eligibility. For more information, contact the Member Services Department 203-432-0246.
Physical exams are covered by our Basic Coverage that all students receive free of charge even if they waive Yale Health coverage. However, adults (people over the age of 18) do not require a physical exam every year.
Adults typically need a physical exam every five years in their 20s and 30s, every two years in their 40s, and every year after age 50. We recommend that students get a physical exam once in the year prior to graduating. Students with specific health conditions such as diabetes or HIV should get physical exams more frequently.
No. All mental health care is provided at 55 Lock Street. There is no reimbursement for outpatient mental health and counseling care received from outside clinicians.
You do not have to pay anything for Basic Coverage and all that it covers, but there are fees for Hospitalization & Specialty and Prescription Plus coverage. Review the Student Handbook for more information.
Students are automatically enrolled. For affiliate coverage or to enroll a dependent, fill out the Student Enrollment/Change Application Form.
Details of Basic Coverage can be found in the Student Handbook and an overview is in the Student Guide to Yale Health.
Yes. If you waive Hospitalization & Specialty coverage as well as Prescription Plus coverage you still have Basic Coverage.
Your medication may be replaced, but it is not a covered benefit so you will need to pay full price. It may also need to be reapproved by your clinician; e.g. controlled substances.
Step therapy is the recommendation of certain medications for use after a patient has attempted treatment with a preferred product, according to standards of care or institutional guidelines.
Some medications require approval beyond the clinician's prescription before they can be dispensed, or in other words, require prior authorization. This process ensures appropriate use of certain drugs which are approved for very specific conditions.
When prescribing any of these drugs, the clinician will be asked to submit a prior authorization form to the pharmacy, documenting the clinical need for the medication as well as other clinical criteria related to the use of the medication. This form will then be reviewed by a clinical team. The team will work with your clinician to review the request and develop the optimal therapy for you.
If the request is approved, a member of this clinical team will notify you of the approval. If the request is not approved, both you and the prescribing clinician will be notified. Denials can be appealed through the Yale Health appeal process.
No. Waived students are not seen in this department. Students who waived Yale Health coverage need to seek services from providers who accept their insurance.
Yes. Routine eye exams are covered for Yale Health members and students with Hospitalization/Specialty coverage.
No. The purchase of glasses is an out-of-pocket cost for the patient.
No. The eyeglass prescription needs to be brought to someone certified to conduct your contact lens fitting.
No. These are out-of-pocket costs for the patient.
Students enrolled in Prescription Plus 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 Center Pharmacy.
No. All mental health services are provided free of charge at the Yale Health Center.
Every Yale student enrolled in a degree program is eligible for counseling at Mental Health & Counseling completely free of charge regardless of if they have waived Yale Health Hospitalization/Specialty Coverage.
Consultations, counseling, psychotherapy, and crisis intervention are available to all students and to eligible spouses and civil union partners. A referral is not needed and appointments can be made by phone and or in person for an initial consultation.
Some students go to the Mental Health & Counseling Center for just a few visits while others come for ongoing therapy. Decisions about the appropriate treatment are made on an individual basis.
Yes. All students are covered for laboratory services requested by their primary care clinicians.
No. Students who have waived Yale Health’s Hospitalization & Specialty coverage need to seek services from providers who accept their insurance.
As with other Yale Health benefits there are some exclusions and limitations, see the Member Coverage Booklet.
All levels of care require prior authorization. By obtaining prior authorization for care, Magellan can ensure the appropriateness of your care, and refer you to a participating provider so that you do not have any out-of-pocket expenses.
You need to obtain prior authorization for all mental health/behavioral health services by contacting Magellan at 800-327-9240, TDD 800-456-4006.
No. Coverage is only for pre-authorized care by a network provider.
There is no cost for pre-authorized treatment by a network provider.
You can call Magellan at 800-327-9240 or TDD 800-456-4006 to inquire if your current provider is part of the network or to get answers to your benefit questions.
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:
Check to make sure that what you received is actually a bill. It may have been a copy of their invoice describing the procedure and telling you that the claim has been sent to Yale Health for payment. If it is a bill, contact the Claims Department at 203-432-0250.
Although your clinician may have discussed a treatment, you must receive a referral and have prior approval in order for the treatment to be covered. If you obtain treatment without a referral and prior approval, the claim will not be paid. The same applies if you want a second opinion.
Short-term follow-up care with prior authorization will be covered. Yale Health clinical staff will assist in coordinating follow-up care, if needed. For assistance with prior authorization, call Care Coordination at 203-432-5791.
