Yale Health

Frequently Asked Questions

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.

What do I do if I have a need to see someone today but it is not an “acute" problem?

For advice about medical problems which are not acute during regular business hours and days, please contact Internal Medicine for adults 203-432-0038, Pediatrics for children at 203-432-0206, or Student Health for students and student dependents 203-432-0312. The nurse will give you home care advice or get you an appointment with your primary care team.

During evenings and weekends, please call Acute Care at 203-432-0123.

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.

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.

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.

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.

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.

How do I know if my drug is covered and what tier it is in?

Review the Yale Health Drug List on our web site.  The Drug List:

  • Provides access to quality medications
  • Promotes appropriate and cost-effective therapy
  • Provides clinicians with information relating to alternative therapies
  • Gives members information to help them discuss medications with their clinician

What services are available through Magellan Health Services?

You and your dependents have access to a full range of behavioral health services as part of your Yale Health benefit, which includes treatment for stress, depression and anxiety as well as other mental health and substance use issues.

Magellan also manages Yale University's Counseling and Support Services (formerly known as the Employee Assistance Program). This service includes confidential, solutions-focused, brief consultation or counseling for all types of personal issues.