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Frequently asked questions

On this page:
• Questions about coverage
• Questions about coming and going
• Questions about general problem-solving
• Questions about bills, claims, and referrals
• Questions about medical records and confidentiality

Questions about coverage

Can I obtain coverage if I don’t meet the eligibility requirements for YHP Basic?
A number of situations arise in which Yale students do not meet the eligibility requirements for automatic enrollment in YHP Basic and for purchase of YHP Hospitalization/Specialty Coverage.  In these situations, you are not required by the University to have health insurance coverage, although you are advised to do so.  Included in this category are: students on leaves of absence; undergraduates in junior year abroad programs; medical students on reduced tuition; students registered as special students in degree candidate programs; students registered in absentia who are studying at another institution, and other degree-candidate students paying less than half of the term's tuition.

If you are in one of these categories, you can still obtain YHP coverage. However, you must pay for it yourself through YHP Affiliate Coverage, which combines YHP Basic and YHP Hospitalization/Specialty Coverage; under this coverage you cannot elect just YHP Basic. If you do purchase coverage this way, the services and benefits you receive will be exactly the same as if you had met the eligibility requirements for YHP Basic.

Students, such as visiting scholars or Yale non-degree students, who do not meet eligibility requirements for the use of YHP primary care services or for the purchase of YHP Affiliate Coverage may still use YHP services on a fee-for-service basis. Please note that each school—not YHP—determines eligibility. For more information, contact the Member Services Department (203-432-0246).

What happens to my coverage when I graduate?
If you are graduating and have YHP Hospitalization/Specialty Coverage at the time of commencement in May, you will be continued on your existing YHP coverage through August 31. If you have alternate (non-YHP) hospitalization coverage, your YHP Basic coverage remains in effect through August 31, and you should check with your other carrier about its coverage. If you complete your degree at a time other than at commencement, contact the Member Services Department for help with coverage options.

What happens to my coverage if I take a leave of absence in or out of the area?
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 YHP or you may purchase YHP Affiliate Coverage for the term during which the leave is taken. In order to secure continuous coverage through YHP, you must request enrollment in YHP and pay the premium prior to the beginning of the term during which the leave is taken. In order to secure continuous coverage through YHP, you must request enrollment in YHP and pay the premium 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 YHP Affiliate coverage, you must request enrollment within 30 days of the date the leave is granted. Unless you obtain continuing coverage through YHP, you will be responsible for all charges for medical services, including hospital services rendered by YHP clinicians or on behalf of YHP. If you are taking your leave in the New Haven area, you may also choose to use YHP on a fee-for-service basis. Member Services (203-432-0246) can provide more information.

What happens to my coverage if I withdraw from the University?
If you withdraw during the first ten days of the term the premium paid for the YHP hospitalization/specialty plan and, if applicable, the YHP Prescription Plus coverage, will be refunded. You will not be covered for any medical care received through YHP during that period. Your YHP 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 the YHP hospitalization/specialty care plan and YHP Prescription Plus and withdraw from Yale after the 10th day of the term, you will be covered by YHP 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 of spring term is August 31). Premiums 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 YHP hospital benefits until discharged from the hospital, subject to the limits of YHP coverage for the illness or injury.

Questions about coming and going

Although this section answers some commonly-asked questions, you should see the Terms of Coverage section of the Student Handbook for complete information about coverage for medical care when you are away from Yale.

What do I need to do about my medical care when I first arrive on campus?
You should:

• Transfer your medical records to YHP. Send them to Medical Records / Yale Health Plan / 17 Hillhouse Avenue / Box 208237 / New Haven, CT 06520.
• Complete the required health history form and make sure your pre-entrance immunizations are up-to-date.
• Let our clinicians know about your medical problems and/or drug allergies.
• Bring original written prescriptions for medications you will need refilled while on campus, or have those prescriptions phoned into the pharmacy (203-432-0033) by your current clinician.
• Visit us at 17 Hillhouse Avenue.

What do I need to do about my care when I leave Yale temporarily or permanently?
You should:

• Give your address change to the registrar of your college or school.
• If you have an ongoing medical condition, consult with your clinician(s) about a treatment plan.
• Obtain an adequate supply of prescription medications and supplies.
• Obtain updated prescriptions for vision care.
• Obtain copies of your immunization records.
• If you are going overseas, call the Travel Clinic (203-432-0093) to see if you need immunizations or other advance medical preparations. See the Travel Clinic section for more information.
• Transfer your records as soon as you find a new provider.
• If you have purchased YHP Hospitalization/Specialty Coverage, make sure you have an updated membership card.

How do I contact YHP while I am away from New Haven?
If you need medical advice or wish to report a claim, call the toll-free number: 877-YHP-CARE (877- 947-3273). For general information, you can contact YHP electronically by emailing us at member.services@yale.edu.

Do I have health care coverage when I am away from campus (school breaks, weekend trips, summer vacations, semesters abroad and so on) during the regular academic year?
If you have taken YHP Hospitalization/Specialty Coverage, you are covered away from campus for emergency care, urgent care and pre-authorized short-term follow-up care. Please see the Terms of Coverage section of the YHP Student Handbook for details. If you have alternate insurance, that plan will be billed for your medical care and you should check the specifics of that insurance.

What is considered an emergency?
An emergency condition is defined as an major acute medical problem or major acute trauma that requires immediate medical attention, or a condition that could lead to serious harm if treatment is not received or is delayed.

What should I do if I have an emergency?
First and foremost, you should seek care. Your health and well-being are of greatest importance! You do not need to call YHP before receiving emergency treatment. However, you should notify the Claims Department at 203-432-0250 within 48 hours (2 business days) of receiving treatment so that we may coordinate insurance coverage with the provider from whom you received the emergency care.

What if I am away and have a serious problem that might not qualify as an emergency?
You are also covered away from campus for urgent situations. An urgent medical situation is the sudden and unexpected onset of an acute medical problem or trauma requiring immediate medical attention. Care for nonacute phases of chronic conditions, maintenance care, and routine care are not considered urgent. If you are able to, you can call Urgent Care (203-432-0123) or your clinician to obtain medical advice over the phone. If that is not possible or appropriate, you should seek the care you need. If you are away from New Haven County, you may receive urgent care at any medical facility and receive the same coverage as for emergency care, including usual and customary follow-up care if pre-authorized.

What happens if I circumstances prevent me from contacting YUHS within 48 hours?
If your condition prevents you or your representative from contacting the Claims Department within 48 hours, you will still be covered for the emergency, but you should contact Claims as soon as possible to ensure that YHP clinical staff are aware of your condition and to request Claims to authorize follow-up care should it be needed. Remember to carry your YHP card with you at all times; it can provide valuable information if you can’t communicate.

What if my emergency requires follow-up care?
Short-term follow-up care that is pre-authorized will be covered. YHP clinical staff will assist in coordinating follow-up care, if needed. For assistance with pre-authorization, call YHP’s toll-free number, 877-YHP-CARE.

What should I do for follow-up care if I am away from New Haven in the summer and need to continue treatment?
Each person requires a different treatment plan, so you should consult with your clinician. In general, if you are on a treatment plan and are going to travel, your clinician will be able to develop a method of ensuring care as you travel. Please remember that while emergency and urgent care are covered while you are out of the area, routine care is not covered by your YHP Hospitalization/Specialty Coverage. If you have alternate insurance, you should look into the terms of its out-of-area coverage.

Can I use YHP services if I return to New Haven during the summer?
Yes. The health center at 17 Hillhouse Avenue is open year-round, 24 hours a day. You will have the same coverage as you did before you left.

For how long am I covered after I leave campus?
The last day of fall term coverage is January 31. The last day of spring term coverage is August 31. YHP Basic, YHP Hospitalization/Specialty Coverage, Prescription Plus and Affiliate Coverage all remain in effect for the entire term, providing the student and any enrolled dependents remain eligible.

I’ve been on a leave of absence. What happens when I return to Yale?
Contact Member Services. If you are eligible, you will go right back onto YHP Basic and will automatically be re-enrolled in YHP Hospitalization/Specialty Coverage and Prescription Plus unless you waive and provide proof of alternate hospitalization coverage.

Are my dependents covered for emergency and urgent care?
The same guidelines apply. If your dependents are enrolled in YHP Hospitalization/Specialty Coverage their emergency care is covered as described above.

How do I obtain prescription refills while I am away?
To transfer your prescription to your local pharmacy, have them call the YUHS Pharmacy (203-432-0033). If you have Prescription Plus coverage, retain the receipt and submit it to the Claims Department for reimbursement.

Questions about general problem-solving

As part of our commitment to providing high-quality care, YHP encourages members to communicate directly with the administration so that we can help you resolve problems, listen to your suggestions for improving services, and find out what you think is working well. Please note that, in addition to the resources below, you also have access to YHP’s Member Advisory Committee, which is made up of representatives from all around the university. Meetings are held monthly, at which time problems are reviewed and recommendations are made. Members are assured confidentiality regarding any issues they raise. For further information, please contact the Member Advisory Committee / Yale Health Plan / 17 Hillhouse Avenue / P.O. Box 208237 / New Haven, CT 06520.

How do I contact YHP for general information about membership, using YHP services, and other non-medical matters?
Visit or call the Member Services Department during business hours. Representatives are available to answer questions regarding membership, eligibility and general benefits. In the New Haven area call 203-432-0246. Out of state you can use our toll-free line: 877-YHP-CARE. You do not need an appointment to come in and talk with a representative. You can also e-mail us at member.services@yale.edu.

What do I do if I’ve had a problem with my medical care?
Contact the department manager, whose role it is to see that the clinical area runs smoothly and responds to the needs of its members. Or, contact the patient representative, who has experience in investigating and resolving problems involved with the delivery of medical services. The patient representative can be reached by phone (203-432-0109) Or write to: Patient Representative / Yale Health Plan / 17 Hillhouse Avenue / P.O. Box 208237 / New Haven, CT 06520.

I have a complaint about a nonmedical aspect of YHP service. Whom do I contact?
Contact the department manager. If your complaint is not resolved, contact the patient representative in person or by calling 203-432-0109. If your complaint is a general one, you can also fill out a patient comment card, which is available at the department’s reception desk.

I have a compliment or a good idea for the health plan. Whom do I contact?
Fill out a patient comment card. These pre-printed cards are available at all reception desks throughout the building and may be dropped off in the box opposite the elevators on the first floor. All are personally reviewed by the director of YHP and appropriate clinical and administrative staff. You can also call or write to the director or any of the associate directors, whose names and addresses you can get from Member Services.

Questions about bills, claims, and referrals

What services do I get for free and what services involve billing either to me or my insurance company?
YHP Basic services are free to students who meet eligibility requirements. If you have alternate (non-YHP) hospitalization/specialty insurance and obtain services other than the ones included in YHP Basic, you may be responsible for co-payments even if your alternate insurance covers those services. The YHP Hospitalization/Specialty Coverage does not require any co-payments.

So if my alternate insurance receives a claim for services I received at YHP, does that mean that those services are not part of YHP Basic, are not free and are my responsibility?
Yes, unless a billing error has been made. If you want to check, you can call the Billing Department at 203-432-7877 or 432-0275.

I have alternate (non-YHP) hospitalization insurance. I received a service through YHP that I thought was covered by that insurance, but (1) I’ve just received an EOB (explanation of benefits) saying that they won’t pay and/or (2) I’ve found a charge on my bursar bill for those YHP services. Why? And what should I do?
There are three possibilities:

1. The service or treatment you received may not be covered by your alternate insurance for any number of reasons: that service is not covered at all; your insurance may require prior approval for some services, and you did not obtain that approval; you may have received treatment at YHP for a condition that your plan thinks should have been treated in the plan’s network. If your plan doesn’t pay, YHP then bills your bursar account.
2. The service is covered, but is subject to a co-payment or deduction, for which you are being billed.
3. Incorrect information in your records may have caused the denial.

First you should call the YHP Billing Department (203-432-7877 or 432-0275) to see if your information is correct. If it isn’t, the corrections will be made and the claim will be sent again. However, if your information is accurate, the dispute over the claim is then between you and your insurance plan and you will have to follow through with them.

How do I know if my alternate insurance is paying for services I receive at YHP?
Often, you will receive an EOB (explanation of benefits) with the payment information from your plan. If the EOB indicates a partial payment or denial for services then you will be billed for the unpaid balance on your bursar account.

What do I do if I change my outside insurance, or if there is a change in the plan?
Contact the Billing Department with the updated information and provide YHP with a copy of your new insurance card.

I thought that services and treatments in the in-patient care facility (ICF) were free. Why did I get a bill for my stay there?
Students receiving YHP Basic benefits who are admitted to the ICF by a YHP clinician do receive room and board, nursing care and primary care at no charge. Those who have purchased YHP Hospitalization/Specialty Coverage also receive approved specialty services at no charge. However, if you have alternate insurance, specialty care services ordered or rendered by a YHP clinician during an ICF stay will be billed to your other insurance. That company may or may not cover those services. If it does not, you will be billed directly via your bursar account.

I checked with my alternate insurance company. They said they’ve already paid a claim sent to them by YHP for services I received at YHP. But I see a charge on my bursar bill. What do I do?
Call the Billing Department to verify that payment has been received by YHP. If it has been paid, you will receive credit on your bursar bill.

I have YHP Hospitalization/Specialty Coverage and Prescription Plus—in other words, I thought I was covered for absolutely everything. But I received a bill. What’s going on?
Certain covered services and items will normally be billed to you. An example of this is durable medical equipment such as crutches or braces. You pay that bill and then submit it to the Claims Department. They will reimburse you, subject to the contract provisions.

I have YHP Hospitalization/Specialty Coverage. I was referred by a YHP clinician for a medical procedure within the YHP network but outside 17 Hillhouse, a procedure I thought was covered. Why did I receive a bill?
Check to make sure that what you received is actually a bill. It may have been a copy of their invoice describing the procedure and telling you that the claim has been sent to YHP for payment. If it is a bill there may have been an error. Contact the Claims Department.

How do I file a claim with YHP?
Claims for reimbursement of covered services should be accompanied by itemized bills for services rendered (charge card receipts and balance due statements are not acceptable). Bills for services must include diagnosis and procedure codes for determination of coverage. Claim forms are available in the Claims Department. Please submit claims to: Yale Health Plan / 17 Hillhouse Avenue / P.O. Box 208237 / New Haven, CT 06520.

How long do I have to file a claim?
Claims for covered services are honored for one year from the date of service. If the delay is the responsibility of the clinician or facility who rendered the service, the deadline may be extended.

I filed a claim, but haven’t received either reimbursement or notification for a several weeks. Is this normal?
If you haven’t received a response to a claim within 60 days of filing, contact the Claims Department. Or you can call sooner to see if the claim has been received and is being processed.

I have YHP Hospitalization/Specialty Coverage. When I saw my YHP primary clinician we discussed a treatment that might be helpful. I obtained the treatment, paid the provider’s bill, and submitted the claim to YHP. But the claim was denied. Why?
Although your clinician may have discussed a treatment, you must receive a referral and have prior approval in order for the treatment to be covered. If you obtain treatment without a referral and prior approval, the claim will not be paid. The same applies if you want a second opinion.

I have YHP Hospitalization/Specialty Coverage. I received a referral from a YHP clinician and obtained prior authorization to see a specialist outside 17 Hillhouse. But I got a bill from the specialist. Why?
Different network providers have different policies; some will bill YHP directly for prior-approved services, while some will bill you. Bring or send the bill to the Claims Department and, if the service is covered, the claim will be paid.

What do I do if I’m having a problem getting a claim paid?
Contact the Claims Department (203-432-0250). A claims representative can answer questions regarding claims processing and YHP benefits. The office is open weekdays from 8:30 am to 5:00 pm. You do not need an appointment.

Is there an appeals process if my claim has been denied, or if I’ve been told by the Claims Department that the service I’ve been referred for won’t be covered?
If you’ve received a denial, contact the Claims Department. A claims representative will research the reason for the denial, including the possibility that incomplete or incorrect information was entered on your record. Because provider confidentiality policies vary, the Claims Department may not be able to initiate the request for medical records for you. So you may be asked to obtain a copy of your visit record and submit it for reconsideration. The Claims Manager is also available to provide assistance to you in reviewing a claims decision.

If this review shows that the records substantiate the denial, you will receive written confirmation of the denial, usually within 90 days after receipt of the claim by YHP or within 180 days under special circumstances. If an extension is required, you will be given written notice within 90 days. This notice will state the reason for the extension and the date by which a decision will be made. Upon receipt of this decision, you may then ask the Claims Review Committee to reconsider the denial. You must make this request in writing within 60 days of receipt of the denial notice. You should state the reasons why you believe the denial is incorrect and include any supporting documents. In most cases, you will receive the final decision within 60 days of the date the request for review is received.

When do I need a referral?
You do not need a referral to use a primary care clinician (including those in the Ob/Gyn and Sports Medicine Departments) or to use the Urgent Care or Mental Hygiene Departments. You also do not need a referral to use the Ophthalmology Department. Some services available to you under YHP Basic coverage do require a referral from your primary care clinician. These include nutritional counseling and laboratory services. You need an in-house referral if your primary care clinician refers you to specialist within 17 Hillhouse Avenue. If you are are referred outside of 17 Hillhouse for any services—office visits, treatments, tests, consultations—you need an out-patient referral and you must follow the steps given below. No referrals are needed for the use of fee-for-service departments.

Who gives me the referral and what do I when I get it?
Usually you will receive a referral from your YHP primary care clinician. If your primary care clinician has referred you to a specialist in-house, that specialist can also refer you. Referrals can also be made by clinicians in the Urgent Care Department.

If you are referred in-house, make the appointment and bring with you the referral form you will have received from the referring clinician.

If you are referred outside 17 Hillhouse, the process is as follows: (1) Obtain the referral form from the clinician referring you, or from another authorized person in that department. (2) Bring the form to the Claims Department, where the referral will be entered into our system and a coverage determination will be made. (3) Go to your appointment. If you have alternate (non-YHP) Hospitalization/Specialty Coverage, make sure to bring your insurance card and any other pertinent information to the outside provider so that your other insurance can be billed. (4) Make sure that the person who checks you in for your appointment records all the information correctly.

What if there isn’t time to go through the whole referral process?
Under certain circumstances, the approval can be processed by phone and must then be followed up with the necessary paperwork.

What does the referral cover?
A referral covers only the specific services that your YHP clinician has requested on that form and that the Claims Department has authorized.

What happens if the outside clinician wants to see me for additional appointments, or wants me to have tests?
If the outside provider wants you to have additional consultations, treatments or testing, that provider must contact the referring YHP clinician to have a new referral generated. If this happens, it is a good idea for you to check with your clinician or with the Claims Department to see that the contact has been made and that the proper paperwork is in place before you proceed with the additional appointments.

Is there a time limit on referrals?
Yes. Generally, a referral issued is for a 4-month period. If additional appointments are required past the 4 months or you need additional services within the 4-month period, you must get another referral.

Questions about medical records and confidentiality

What is YHP’s confidentiality policy?
Your medical records are strictly confidential, stored in a restricted area and available only to individuals involved in your care and authorized administrative personnel on a need-to-know basis. No one else is authorized to obtain information in your records without your written consent, provided that you are 18 years old or over.

Mental Health records (except for those involving ICF admissions) are kept in the Mental Hygiene Department and filed separately from other medical records. They are available only to appropriate mental health personnel. These records are not released to anyone—including other YHP clinicians or administrative personnel—without your permission.

Information from your medical record and from providers or hospitals incident to the doctor-patient relationship will not be disclosed without your written consent except for the purposes of providing health care to the member, administering YHP coverage, or as authorized by law

I’m under 18. Do you have to tell my parents about treatment I request or receive at YHP?
No. Your medical records are confidential. But keep in mind that if you have alternate (non-YHP) hospitalization coverage, bills or explanations of benefits may be sent to your home address where family members could see them.

I'm over 18 can my parents receive my health information?
Students who are over 18 and wish to give their parents the authorization to speak with the student's Primary Care Clinician or receive the student's health information need to complete and sign the Health Information Release Form provided by the Health Information Services Department (or found at http://www.yale.edu/uhs/forms/index.html under Health Information Services Forms) and return it to the Health Information Services Department. Without receipt of this completed form parents or any other persons will not have access to any students health information.

How do I get copies of my medical records?
Upon your written request and authorization, your medical records will be forwarded to any designated individual or institution. We are glad to provide up to ten (10) pages of records at no cost, including copies for personal use and those sent to doctors' offices, hospitals, insurance companies, attorneys, employers, and others. There is a 65 cents per page charge for any additional pages. You may obtain copies of your records by filling out a Health Information Request Form provided by the Health Information Services Department (or found at http://www.yale.edu/uhs/forms/index.html under Health Information Services Forms). Mail or fax the completed form to the Health Information Services Department (address and fax number are found directly on the form and below). Call the Health Information Services (formerly known as Medical Records) at 203-432-7785 for more information. Please plan ahead as requests are generally processed in the order received and at certain times of year the waiting time for obtaining records may be as long as three weeks. Please note that the following items can be released as soon as the completed form is received: immunization records, prescription records and the most current physical.

How long do you keep medical records?
Medical records are generally kept for 7 years after you leave the University. Records are kept for 10 years if you stayed in our in-patient care facility (ICF), if you were pregnant while you were a YHP member or if you were born while your parent was a YHP member. If you were injured on the job while employed at Yale, your records will be kept for 20 years.

How can I reach the Health Information Services Department?
Yale University Health Services
Health Information Services Department
17 Hillhouse Avenue
P.O. Box 208237
New Haven, CT 06520-8237
Phone: (203)432-7785
Fax: (203)432-1102