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Member Services

FAQs

• 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 Yale University Benefits office.
• 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 contact Member Services to request one.
• I am losing my insurance coverage I have from another source (not Yale), can I enroll in YHP?
  Yes, with proof of loss from the other insurance carrier within 30 days of the loss of coverage (See the Enrollment section in the Member Handbook, Student Handbook or YPBA member's handbook.)
• How do I add my spouse to my coverage?
  You can enroll your legally married spouse within 30 days of your marriage. Coverage is effective the 1st of the month following the event after documentation has been provided. You can also add your legally married spouse to your coverage during the open enrollment period in November with coverage effective January 1st.
• How do I add my baby to my coverage?
  You can enroll your baby within 30 days of their birth or during the open enrollment period in November, with coverage effective January 1st.
• Can I enroll my parents under my coverage?
  No, only your legally married spouse, same gender domestic partner and dependent children under 19 years of age can be added to your coverage.
• Can I add my relatives to my YHP coverage?
  You may add your legally married spouse, same gender partner and your children. No other relatives are eligible for coverage on your plan. (See the Enrollment section in the Member Handbook, Student HandbookorYPBA member's handbook.)
• I am getting divorced what do I need to do?
  You are required to notify us within 30 days of your divorce. Coverage for your spouse terminates at the end of that month; he/she is eligible for COBRA coverage. (See the Termination of Coverage section in the Member Handbook, Student HandbookorYPBA member's handbook.)
• 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?
  If you have changes in your demographic information (address, telephone number(s)), please contact us. You can also complete a change form available from this page. Giving us this information will help your clinicians reach you as needed.
  
  If you want to add, change or delete coverage for your or your dependents, please contact our office. There are specific enrollment periods for faculty, staff and students. Any changes (same sex civil union partnership, marriage, adoption, birth, divorce) must be made within 30 days of the event. Proof of the change may be required.
• I am an employee covered on the Yale Health Plan and my spouse has passed away-what do I need to do?
  Contact the Benefit Office at 432-5550, you will need to complete some paperwork to remove your spouse’s name from your coverage. Then Benefit Office will also assist you with other changes you may need to make to your benefit package such as beneficiary information on your life insurance/retirement plans.
• My spouse, who was an employee at Yale has passed away. I was covered under his/her YHP coverage; what do I need to do?
  Contact the Yale University Benefit Office at 432-5550. As the surviving spouse, 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.
• I am legally separated from my spouse, how does that affect my spouse’s coverage?
  You can remove your legally separated spouse from your coverage with documented proof (they are then eligible for COBRA) or they can remain covered under your plan (See the Termination of Coverage section in the Member Handbook, Student Handbook or YPBA member's handbook.)

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 (See the Out of Network Coverage section in the Member Handbook, Student Handbook or YPBA member's handbook.)
• 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 Handbook, 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 YHP clinician not to travel, charges associated with hospital admission will only be covered at Yale Hew Haven Hospital. (See the Acute Care/Medical Surgical section in the Member Handbook, Student Handbook or YPBA member's handbook.)
• Is my 19-25 year old covered?
  Yes, your 19-25 year old can be covered if they meet certain criteria, please see the Eligibility section in the Member Handbook, Student Handbook or YPBA member's handbook.
• Where can I get my prescriptions filled when I am out of the area? (Will I get reimbursed?)
  You can use any pharmacy. You will pay full price and then submit a claim for reimbursement based on the plan guidelines. (See the Prescription section in the Member Handbook, Student Handbook or YPBA member's handbook.)
• Can I use my outside insurance company’s prescription card at the YHP Pharmacy?
  No, drug cards for other insurance companies are not accepted at the YHP 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 YHP?
  If you are under age 65 and eligible for retirement benefits you and your covered spouse and dependents may remain on YHP. When you (the retired member) or the enrolled spouse reach age 65 or become eligible for Medicare, YHP 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 YHP 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 YHP 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 YHP 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 YHP. YHP will remain your primary insurance coverage until you stop working.

Cost

• How much do I have to pay for YHP coverage? What is my contribution?
  You may or may not be required to contribute to the cost of your coverage. Faculty, Postdoctoral Associates and Managerial and Professional Staff can go to benefits calculator; and C&T, S&M and Yale Police can go to benefits rates for the specific information.
• Who should I contact with questions about the cost of my premiums or my bill?
  University Benefits office.
• Where can I pay my bill?
  If you have received a bill from YUHS you can contact our Billing Department. If you receive a bill from an outside provider you can contact our Claims Department.
• Are flu shots free for everyone?
  Yes

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.
• 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 17 Hillhouse require an outpatient referral which must be approved by the Care Coordination Department.  (See the Outpatient Coverage section in the Member Handbook, Student Handbook or YPBA member's handbook.)
• Do I need to select a primary care clinician?
  We believe that health care is best when it is built on a strong relationship between you and your primary care clinician (PCC). A primary care clinician is assigned to you upon enrollment in YHP. It is also important to let us know who you have chosen for your primary care clinician (PCC) or if you have made a change to your PCC. If the PCC you request is not taking new patients at the time you contact us, you will be offered the waitlist. When we are able to move you into that clinician’s panel, we will notify you by telephone.
  
  Female members are assigned a PCC in the ObGyn Department as well as the Department of Internal Medicine. Dependents are assigned a PCC in the Department of Pediatrics. For a complete list of primary care clinicians, you can pick up a directory at many locations throughout the Health Center.
  
  Your clinician will provide preventive care, treat you for routine conditions, monitor ongoing problems, and coordinate any specialty care you might need. If your primary care clinician is not available, you will still be able to receive care from the other physicians or nurse practitioners in the department. The nurse coordinator with support staff are readily available to assist in your care as well.
• How does YHOL work?
  See Yale Health Online

Students

• What is “Basic Coverage”?
  See the YHP Basic Coverage section of the Student Handbook.
  
• Where are the forms to sign up for student coverage?
  Students are automatically enrolled. For affiliate coverage or to enroll a dependent go here.
• How do I submit my student waiver?
  Complete the online form.
• What is the deadline for students to waive portions of the YHP 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 YHP?
  Yes, if you waive Hospitalization & Specialty coverage as well as Prescription Plus coverage you still have Basic Coverage.
• Are routine eye exams included in Basic Coverage?
  Yes, one annual routine eye examination is included in 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 (see the Student Handbook).
• What happens if my pre-entrance health form is not in by the June 30th deadline?
  If you will not be able to submit your form by the deadline please contact Student Medicine.
• How long is my physical “good for”?
  For your pre-entrance health form your physical should have been completed within the last 18 months.
• Can I get my pre-entrance physical at YUHS?
  No, all pre-entrance requirements should be obtained prior to your arrival at Yale.
• I could not get all of my pre-entrance immunizations what should I do?
  It is a pre-entrance requirement and it is preferred that they be completed prior to arriving on campus. If that is not possible they can be done in our Immunization Department, however all fees are the responsibility of the student. Please be aware that you will be placed on “Health Hold” until all of your forms are complete and processed by our Immunization Department. You will not be allowed to register for classes until this obligation is met.
• Are pre-entrance immunizations covered?
  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 YHP, am I covered for outpatient psychotherapy?
  No, All mental health care is provided at 17 Hillhouse Avenue; 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 see Student Information Systems.