Withdrawals from the University
If you withdraw from the university 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.
Leaves of Absence from the University
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.
Health Coverage Overview for Undergraduate Students on Medical Leave of Absence
Students approved for a medical leave of absence and who are already enrolled in the Yale Health Hospitalization/Specialty Coverage have the option to enroll in Yale Health’s Undergraduate Affiliate Coverage at the start of their medical leave of absence. This enrollment must be selected by the eligible student as Yale University does not require students to purchase hospitalization coverage when taking a medical leave of absence.
Students are responsible for completing and submitting the Undergraduate Affiliate Coverage Enrollment Form to Member Services within 30 days of the date the leave is granted. Any fees for coverage must be paid as a part of the enrollment process.
Financial assistance may be available to students who receive a Yale Hospitalization Scholarship as part of their financial aid package; please contact Yale Undergraduate Financial Aid to learn more.
|Coverage:||Yale Health Undergraduate Affiliate Coverage: Care required for students who reside in Connecticut is managed by Yale Health. Care necessary for patients who reside elsewhere will be administered by Aetna Healthcare.|
Note that the requirements of each plan differ, in both the financial responsibility of the patient [see chart below] and the way services are approved and managed. Coverage for services administered by Aetna also requires the student to select a primary care provider (PCP) from the Aetna network who will manage their care, including ensuring referrals for additional services are placed and approved in accordance with plan guidelines.
|For both Yale Health and Aetna-managed services, a referral is not a guarantee of payment and must be reviewed and approved by the coverage provider. Claims and referrals are subject to the terms and conditions of either plan administrator.|
|Where access to mental healthcare is needed, a PCP is not required.|
How is the Undergraduate Affiliate Coverage different from Yale Health Hospitalization/Specialty Care coverage?
Undergraduate Affiliate Coverage - for care delivered outside of Connecticut – is administered by Aetna. Aetna requires an Aetna-affiliated primary care provider (PCP) to manage the care of students needing specialty and hospital services; mental health services may be sought without a PCP.
When a student is within the Yale Health coverage area, their access to Yale Health and its services is identical to what they were eligible for under their Yale Health Hospitalization/Specialty Care coverage.
When a student is outside Yale Health’s coverage area, they will be subject to certain additional out-of-pocket costs, as determined by Aetna.
How will a student connect with an Aetna PCP?
Yale Health’s Student Medicine department may be involved, to facilitate the transition of care to a local clinician as needed for students who will be outside Yale Health’s service area. IT MUST BE NOTED that Yale Health clinicians are not Aetna-recognized PCPs and referrals for services will not be accepted or approved for coverage until an Aetna network PCP is involved and assumes clinical responsibility. Selection of a suitable PCP to start and continue any necessary treatment is the responsibility of the student. Aetna maintains lists of network providers nationally to assist in identifying potential PCPs for students in areas outside of Connecticut.
Mental Health and Counseling (MHC) clinicians may also be involved in helping transition students to local mental health providers. While a PCP isn’t necessary to seek and receive care for mental health concerns, state licensure and other barriers may prevent Yale Health MHC staff from extended participation in the student’s out-of-area care plan.
What is the Plan’s Cost?
|Student plus spouse||$7,883||$7,883||$15,766|
|Student plus child/ren||$7,096||$7,096||$14,192|
|Family (student plus spouse plus child/ren||$11,120||$11,120||$22,240|
What regions are excluded?
The Aetna Healthcare coverage area excludes the Yale Health service area, Alaska, Hawaii, and all international locations. The Yale Health service area is defined as Connecticut.
For more information
If you have questions about the Undergraduate Affiliate Coverage, you can contact Member Services at 203-432-0246 or firstname.lastname@example.org.