Yale Health

Frequently Asked 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.

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.

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.

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.

What should I do if I have an emergency?

If you have a medical emergency, call 911. When possible, call Acute Care at 203-432-0123 before going to the hospital emergency department.  When you call and let us know you are going to the Emergency Department, a nurse can follow up on your care and make sure that your primary care clinician knows as well. If you are unable to call before you go, be sure to call the Referrals Department at 203-432-7397 within 48 hours of receiving care.

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.

I am a staff/faculty member. What do I do if there is a mental health emergency?

When emergency care is necessary, please follow the guidelines below:

  • Seek the nearest emergency room, or dial 911 or your local emergency response service for medical and ambulatory assistance. If possible, call Magellan directly at 800-327-9240, TDD 800-456-4006 provided a delay would not be detrimental to your health.
  • After assessing and stabilizing your condition, the emergency room should contact Magellan directly at 800-327-9240, TDD 800-456-4006 to obtain your medical history and to assist the emergency physician in your treatment.
  • If you are admitted to an inpatient facility, have the facility contact Magellan as soon as reasonably possible.
  • If you seek care in an emergency room for a non-emergency condition, the plan will not cover the expenses.