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.

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.

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.

Why might my prescription claim be denied?

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:

  • The drug is not covered under the benefit (check the Drug List)
  • The drug required prior authorization (labeled "Prior authorization" on  the Drug List)
  • The Yale Health co-pay is greater than the amount you paid for the drug (your cost for the drug is $28, but it is a Tier 3 drug, so the co-pay is $35)
  • It is too early to fill the prescription
  • There is no “days supply” listed on the receipt (see instructions on claim form)

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.

What is out of network coverage?

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 Referrals Department.

Why did I receive a bill from Yale Health?

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 Yale Health Hospitalization/Specialty Care coverage you may be billed for services not included in Basic Coverage. See the Student Handbook.

I am a student and have Yale Health Hospitalization/Specialty Care coverage. I thought I was covered for absolutely everything, but I received a bill. Why?

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.

I checked with my alternate insurance company. They said they have already paid a claim sent to them by Yale Health for services I received at Yale Health. But I see a charge on my bursar bill. What do I do?

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.

I thought that services and treatments in Inpatient Care were free for students. Why did I get a bill for my stay there?

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 Care 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 Inpatient Care 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.

I am a student and have alternate hospitalization insurance. I received a service through Yale Health and received an explanation of benefits saying that they won’t pay. What should I do?

There are three possibilities:

  • The service or treatment you received may not be covered by your alternate insurance for any number of reasons.  The service may not covered at all, your insurance may require prior approval for some services and you did not obtain that approval or you may have received treatment at Yale Health for a condition that your plan thinks should have been treated in the plan’s network. If your plan doesn’t pay, Yale Health then bills your bursar account.
  • The service is covered, but is subject to a copayment or deductible for which you are being billed.
  • Incorrect information in your records may have caused the denial.

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.

I am a student, if my alternate insurance receives a claim for services I received at Yale Health, does that mean that those services are not part of Yale Health Basic for students, are not free and are my responsibility?

Yes.  If you feel you were billed in error, call the Billing Department at 203-436-8882.

I am a student. What services do I get for free and what services involve billing either me or my insurance company?

To determine coverage for Yale Health Basic or Yale Health Hospitalization/Specialty Care coverage, please refer to the Student Handbook.

Are my dependents covered for emergency and Acute Care under my student health coverage?

The same guidelines apply. If your dependents are enrolled in Yale Health Hospitalization/Specialty Care coverage their emergency care is the same as yours as the enrolled student.

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.

When does student coverage start and end?

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.

I am a student. Can I use Yale Health services if I return to New Haven during the summer?

Yes. The Yale 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.

I am a student. What should I do for follow-up care if I am away from New Haven in the summer and need to continue treatment?

Each person requires a different treatment plan, so you should consult with your clinician. Please remember that 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.

What happens if circumstances prevent me from contacting Yale Health within 48 hours?

If your condition prevents you or your representative from contacting the Referrals Department within 48 hours, you will still be covered for the emergency, but you should contact Referrals as soon as possible to ensure that Yale Health clinical staff is aware of your condition. Remember to carry your Yale Health card with you at all times.  It can provide valuable information if you can’t communicate.

Are pre-entrance immunizations covered for students?

No.  It is strongly recommended that you receive all of your required immunizations from your healthcare provider prior to your arrival on campus.

What happens to my coverage if I withdraw from the University?

If you withdraw during the first 15 days of the term, the fees paid for Yale Health Hospitalization/Specialty Care coverage and 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 Yale Health Hospitalization/Specialty Care coverage and withdraw from Yale after the 15th 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.

What happens to my coverage if I take a leave of absence in or out of the area?

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.

Can I obtain coverage if I don’t meet the student eligibility requirements for Yale Health Basic?

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 Care 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, School of Management (SOM) students registered in the Executive MBA program, 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 Care 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.

Are physical exams covered for students?

Physical exams are covered by our Basic Coverage that all eligible students receive free of charge even if they waive Yale Health Hospitalization/Specialty Care 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.

I am a student. Do I have to pay anything?

Eligible students do not have to pay anything for Basic Coverage and all that it covers, but there is a fee for Yale Health Hospitalization/Specialty Care coverage. Review the Student Handbook for more information.

Where are the forms to sign up for student coverage?

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

What is “Basic Coverage” for students?

Details of Basic Coverage can be found in the Student Handbook and an overview is in the Student Guide to Yale Health.

I am a student and I waived coverage. Can I still use services at Yale Health?

Yes, eligible students who waive Yale Health Hospitalization/Specialty Care coverage, still have Basic Coverage.

What if I lose my medication?

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.

What is step therapy?

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.

What is prior authorization for prescriptions?

Some medications require approval beyond the clinician's prescription before they can be dispensed, or in other words, require prior authorization.  These medications include many Tier 3 drugs, specialty medications and drugs that have step therapy requirements. 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.

I am a student and I waived Yale Health Hospitalization/Specialty Care coverage. Can I be seen in the Ophthalmology/Optometry Department?

No.  Waived students are not seen in this department. Students who waived Yale Health Hospitalization/Specialty Care coverage need to seek services from providers who accept their insurance.

Are eye exams covered by Yale Health?

Yes.  Routine eye exams are covered for Yale Health members and students with Hospitalization/Specialty Care coverage.

Please note:

  • The department does not perform exams for contact lenses.

  • Neither contact lenses nor eyeglasses are covered by any Yale Health insurance.

  • Medicare does not cover the refraction fee for an eyeglass prescription. If you are a Medicare patient, you will be billed for this service and will be responsible for the payment.

Are glasses covered by Yale Health?

No. The purchase of glasses is an out-of-pocket cost for the patient.

Can I purchase contacts in a store, or online with my eyeglass prescription?

No. The eyeglass prescription needs to be brought to someone certified to conduct your contact lens fitting.

Are contacts or the contact lens exam covered by Yale Health?

No. These are out-of-pocket costs for the patient. We do not measure, fit, or evaluate for contact lenses.  Our staff can assist with locating an area provider.

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.

Appointments

Are there screenings available to help me determine if I might need counseling?

Yale Health offers free, anonymous, and confidential online screenings to Yale students. Only the student sees the results of the screening.

The purpose is to help students determine if a consultation with a mental health counselor would be helpful.

Click here for anonymous and confidential online screenings for depression, eating disorders, alcohol dependency, anxiety/PTSD.

How do I schedule an appointment?

You can contact the department directly at 203-432-0290.

Initial Evaluation: Students requesting an appointment are given an initial time for evaluation within two to four weekdays. Following this initial appointment, most students are able to be connected with their therapist typically within a couple of weeks. We have added MHC staff clinicians, so we anticipate that the number of students waiting longer than that will be greatly reduced compared with previous years.

At the initial evaluation, the clinician will give the student a card with contact information so that they can remain in touch. The clinician will also inform the student about next steps including when the student will hear back about followup.   

Urgent situations: In urgent situations,  any student can speak with an on-call clinician 24 hours per day, every day of the year (daytime through MHC at 203-432-0290 and after hours through Acute Care 203-432-0123). 

If you have any questions or your situation changes while waiting for your appointment with your designated clinician, you should feel free to contact the clinician from your initial assessment.

Can I request or change therapists?

During your initial assessment you will have the opportunity to discuss your preferences for a clinician.  Depending upon your clinical needs and mutual schedules some or all of your preferences may be accommodated.

If you would like to switch therapists please call 203-432-0290 and leave a message advising that you would like to change to a different therapist. Your newly assigned therapist will call you directly to schedule your first appointment.

Are there emergency services available for student mental health & counseling?

Mental health professionals are available 24/7 for urgent situations. During regular office hours, a clinician may be reached through the Department of Mental Health & Counseling at 203-432-0290. After office hours and on weekends and holidays, a mental health clinician may be reached for urgent situations through the Acute Care Department at 203-432-0123.

Are there emergency services available for rape crisis/sexual assault?

For rape crisis/sexual assault call 203-432-2000. Counselors are available to talk to students or meet with them 24/7.  Information is also available at through the Sexual Harassment and Assault Response and Education Center - The SHARE Center.

I am a student who has waived Yale Health Hospitalization/Specialty Care coverage. Can I still use the lab?

Yes.  All  eligible students are covered for laboratory services requested by their primary care 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.

Are there excluded conditions and treatments for behavioral health services?

As with other Yale Health benefits there are some exclusions and limitations, see the Member Coverage Booklet.

 

What is prior authorization for behavioral health and how do I get it?

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.

If my behavioral health provider is not part of the network, will my care still be covered by Yale Health?

No. Coverage is only for pre-authorized care by a network provider.

Is there a cost for using the mental health/behavioral health benefit?

There is no cost for pre-authorized treatment by a network provider.

How can I check to see if my behavioral health outpatient provider is covered in the network?

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.

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 have Yale Health Hospitalization/Specialty Care coverage. When I saw my primary care clinician we discussed a treatment that might be helpful. I obtained the treatment, paid the bill, and submitted it to Yale Health, but the claim was denied. Why?

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.

What if my emergency requires follow-up care?

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 the Referrals Department at 203-432-7397.