Service and Maintenance Benefits 2021
Visit the medical comparison chart below to learn more about your options.
Yale’s flagship plan, Yale Health, offers a variety of on-site health care services including primary care, specialty care, 24/7 acute care, radiology, lab, and pharmacy. When your condition requires specialized care or a hospitalization, there’s an extensive network of specialists drawn largely from the faculty of Yale School of Medicine. Emergency care is covered globally.
Yale Health Enrollment Fees
Employees hired on or after January 20, 2017 and enrolled in the Yale Health plan are subject to enrollment fees. Please log into Workday and select the enrollment tier that corresponds to your coverage. The fees are outlined below. Employees must re-enroll in the appropriate Employee + Spouse coverage during the annual enrollment period (November 30 - December 11). The purpose of re-certification is to determine if your spouse has access to other medical coverage and if so, whether they’re enrolled in that coverage.
|Yale Health Enrollment Fees||Fee||Period|
|Employee + Child(ren)||$10.00||20 weeks (1st year)|
Employee + Spouse or Family coverage
|$10.00||30 weeks (1st year)|
Employee + Spouse or Family coverage
|$12.50||50 weeks (per year)|
After you complete three years of service, you may remain a member of Yale Health or choose the Aetna Select plan for your medical coverage. Be sure to review and compare the features of the plans on the next page.
Flexible Spending Account
With a Flexible Spending Account (FSA), you can reduce your taxable earnings and receive reimbursement of eligible out-of-pocket expenses. Yale offers two kinds of FSA: a healthcare and a dependent care FSA. You must enroll or re-enroll in an FSA during Yale’s annual enrollment. Remember to plan carefully as your FSA funds will not roll over to the following year.
Delta Dental is Yale’s exclusive dental carrier. (review Dental Plan documents for more information).
- 100% for Preventive & Diagnostic
- 80% for Basic Restorative*
- 50% for Major Restorative*
- 50% coverage†*
* $1,000 lifetime maximum; † Dependents under age 19
EyeMed offers two options: EyeMed Basic, which provides allowances for frames and lenses, and EyeMed Enhanced, which also covers eye exams and more frequent hardware allowances as well as other valuable enhancements.
Health Expectations Program
The Health Expectations Program (HEP), a healthcare management program, applies to all union employees and their spouses enrolled in Yale Health and Aetna medical insurance plans. It is designed to positively impact your overall health through preventive healthcare goals and offers a health coaching program when serious or chronic health conditions arise. Preventive healthcare screenings are provided at no cost to you.
Benefits Resources and Rates
|Medical||Dental & Vision||Other|
The university values its community members and regularly evaluates and adds to its menu of impressive signature benefits, including our Yale Advantages employee discount program.
Now is the time to take charge of your health and financial well-being by learning more about your full benefit offering at Yale, including home and family, personal, health and wellness, and educational benefits.
|Home & family||personal||health & wellness||education|
|Plan Information||Yale Health
LEGACY AETNA CHOICE (CLOSED TO NEW ENROLLMENTS)
- Yale Health only provides out-of-area coverage for emergency and urgent care. A $50 late cancellation or no show penalty may apply to certain services. See Yale Health website and plan document for details.
- A three year exclusion rule applies to new hires. In the first three (3) years of service employees are eligible for Yale Health plan only.
- The amount of out-of-pocket expenses per calendar year you must pay for services before the plan pays any expenses.
- The amount you must pay for services, after the deductible has been paid.
- The maximum amount you have to pay toward the cost of your medical care in the course of the calendar year not including deductible or co-pays.
- Yale Health DAW: Your plan may have a preferred cost-sharing requirement. This means that if you request an Alternative or Non-preferred medication when a Preferred is available, you pay the difference in cost between the Alternative or Nonpreferred and Preferred medication in addition to your co-pay (or co-insurance). The prescription must state Dispense As Written (DAW) or Preferred substitution will apply. New prescriptions may require pre-authorization or other limits. Aetna DAW: If a Preferred drug is available and an Alternative or Non-preferred drug is dispensed, you will be charged the applicable co-pay plus the difference in cost between the Alternative or Non-preferred drug and Preferred drug cost even if your provider requests the Alternative drug. In most cases, the Preferred drug is the same chemical entity/ active ingredient as the Non-preferred drug.
- There is a $25 co-pay for in-network visits to facilities deemed to be an Urgent Care Facility by Aetna.
- List of preferred facilities can be found on the Aetna member services website.
- In-Vitro Fertilization & Advanced Reproductive Technology (ART), are subject to life time limit of four (4) cycles. Artificial insemination (IUI) is subject to the $20,000 limit. See Plan Documents & Notices for plan details.
This is a lifetime limit per contract regardless of carrier chosen.
- Referrals are required in order to see providers other than primary care providers.
This chart is a summary of the benefits provided under each option. For complete details, refer to the Yale Health and Aetna Plan Summary of Benefits and Plan documents located on the Plan Documents and Notices page.
The applicable plan documents govern all questions of interpretation.
Required Disclosures and Important notices are located on the Summary Annual Reports & Required Disclosures page.
Do you have other insurance?
For members covered by more than one insurance plan (such as your employer plan and your spouse’s employer plan) Coordination of Benefits (COB) is the method used by Yale Health to determine which plan pays first, which pays second, and the amount paid by each plan. Yale Health will use the COB method to ensure that members covered by more than one insurance plan will receive the benefits they are entitled to while avoiding overpayment by either plan.
If you are enrolled in an insurance plan in addition to Yale Health, you must provide information about that plan to Yale Health on the Insurance Information Update (COB) form.
Failure to disclose this may affect the terms of your coverage or denial of claims. Visit Health Coverage for more information about coordination of benefits.
Provider Contact Information
|Flexible Spending Accounts (FSA)
Commuter: Effective 01/01/2021- 11/10/2021
|Yale Spending Account||877-352-5552; #6|
|Commuter: Effective 11/11/2021||HealthEquity||877-924-3967|
|Yale Signature Benefits||Optum||866-416-6586|
|Staff Pension Plan||Alight||877-352-5552; #5|