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Out of Area Coverage

Yale Health members and students with Yale Health Hospitalization/Specialty Care coverage are covered outside of Connecticut for emergency care, acute care and pre-authorized short-term follow-up care.

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.

Important note for pregnant patients: 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-New Haven Hospital.

Using a Pharmacy Other than 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.  Please note, your reimbursement is dependent upon the benefit (for more information visit 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.)