Member Services
FAQs
For detailed coverage information please review the
Member Coverage Booklet and Schedule of Benefits.
Students please review the Student Handbook.
• Questions about enrollment
• Questions about coverage
• Questions about cost
• Miscellaneous questions
• Student questions
Enrollment
- 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. - How do I get an ID card?
You will receive an ID card in your new member packet in the mail once your application is processed. You can also fill out an ID card request form. - 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. - How do I add someone to my Yale Health coverage?
You can enroll your legally married spouse or civil union partner within 30 days of your marriage or civil union or your baby within 30 days of their birth by using the Yale University Portal or calling the Employee Service Center at 203-432-5552.
You can also enroll your 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. - I am getting divorced or a civil union dissolution, what do I need to do?
You are required to notify the Employee Service Center 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. - My status at Yale is changing (i.e., post-doctorate associate to post-doctorate fellow) what do I do?
Please call Member Services (203-432-0246) to discuss how your eligibility for coverage might change. - 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. - 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 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.
Coverage
- 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. - I am traveling out-of-state, am I covered?
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.
- 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, Student Handbook or YPBA member's handbook. - 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 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. - Is my 19-25 year old covered?
Yes, your 19-25 year old dependent can be covered. - Where can I get my prescriptions filled when I am out of the area? (Will I get reimbursed?)
You can always use any pharmacy. You will pay full price and then submit a claim for reimbursement based on the plan guidelines. - 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. - I have a dependent child covered under my policy and she is pregnant, is the birth covered? Will the baby be covered?
Third generation babies are not covered. The dependent child, mother of the baby, is covered for labor and delivery. None of the charges associated with the baby will be paid as the baby is not eligible for coverage. - 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. - 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. - 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 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.
Cost
- Who should I contact with questions about the cost of my premiums or my bill?
Employee Service Center. - Where can I pay my bill?
If you have received a bill from Yale Health you can contact our Billing Department. If you receive a bill from an outside provider you can contact our Claims Department.
Miscellaneous
- I have a concern or complaint who should I contact?
You should always contact the department manager first and then the Patient Representative, 203-432-8134. You can also fill out a comment card. - Do I need a referral to see a specialist?
Yes, your primary care clinician will provide you with a referral. Referrals for services outside of 55 Lock Street require an outpatient referral which must be approved by the Care Coordination Department. - Do I need to select a primary care clinician?
A primary care clinician is assigned to you upon enrollment in Yale Health. If you would like to choose a different PCC, contact Member Services at 203-432-0246 to review the list of available clinicians.
Female members are assigned a PCC in the ObGyn Department as well as the Department of Internal Medicine. Children are assigned a PCC in the Department of Pediatrics. View the specific department page to learn about each of our clinicians.
- How does YHOL work?
See Yale Health Online
Students
Student should review the Student Guide to Yale Health and the Student Handbook for detailed coverage information.
- Do I need to enroll in student coverage?
Students are automatically enrolled. For affiliate coverage or to enroll a dependent go here. - How do I submit my student waiver for Hospitalization/Specialty and/or Prescription Plus coverage?
Complete the online form. - 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 - I am a student and I waived coverage, can I still use services at Yale Health?
Yes, if you waive Hospitalization & Specialty coverage as well as Prescription Plus coverage you still have Basic Coverage. - Am I covered when I go home for holidays/breaks/summer?
You are covered for emergency care when you are away from the New Haven area.
An emergency condition is defined as a major acute medical problem or major acute trauma that requires immediate medical attention or a condition that could lead to serious harm or death if care is not received or is delayed. - When should I get my pre-entrance physical?
Get your pre-entrance physical within 18 months of your arrival at Yale. You cannot receive your pre-entrance physical exam at Yale Health Center. - I could not get all of my pre-entrance immunizations what should I do?
You will be placed on “Health Hold” until all of your forms are complete and processed. You will not be allowed to register for classes until this obligation is met. - Are pre-entrance immunizations covered by Yale Health?
No, you will have to pay for them. - I am a student and I do not want to use the Mental Health & Counseling Department at Yale Health, am I covered for outpatient psychotherapy?
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. - I am enrolled in Yale Summer Sessions do I have coverage?
No, but students who are enrolled in summer sessions and live on campus pay a fee that gives them access to basic services. - I am a student and need to change my personal information (i.e., address, phone number) how do I do that?
Please go to Student Information Systems.
