Security Benefits 2022
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 Weekly Pre-Tax Contributions
|Employee + child(ren)||$8|
|Employee + spouse||$10|
Alternately, you may enroll in Aetna Select or Aetna Smart Care Health Savings Account (HSA) and Accident coverage through Yale’s Aetna program after you complete three years of service. Be sure to review and compare the features of the plans on the next page.
If you participate in the Aetna Smart Care Plan and elect an HSA, the university will provide a one-time deposit of $500, $750 or $1000 depending on your coverage election (new enrollments only), into your account. In addition, monthly contributions of $50, $75 or $100, based on your coverage election, will be deposited into your account to help you pay for future medical costs. Accident Coverage provides lumpsum benefits for covered accidents and some hospital stays—free of charge—for you and your covered dependents.
Health Savings Account (HSA) with Aetna Smart Care
You can open a Health Savings Account (HSA) anytime to cover eligible healthcare expenses. Unused funds will roll over from year to year—and earn interest. If you contribute to an HSA, you can also open a limited purpose FSA to cover certain dental and vision expenses.
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†*Orthodontia
* $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
Find links to provider documents and websites, benefits counseling resources, and helpful information on key benefits, such as Retirement, Paid Time Off, and more.
|Medical||Dental & Vision||Other|
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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
|AETNA SMARTCARE (WITH HEALTH SAVINGS ACCOUNT AND ACCIDENT)
|Legacy AETNA Choice (closed to new enrollments)|
|In-Network Deductible||N/A||N/A||$1,500/$3,000 single/family||N/A|
|Annual Out-of-pocket Limit (includes deductible)||N/A||N/A||$4,000/$6,850 single/family||N/A|
|Health Savings Account Monthly Employer Contribution||N/A||N/A||$50 Single
$75 Single + Child(ren)
$75 Single + Spouse
|Prescription Drugs (up to a One-month supply)
$50 Non-preferred & Specialty
Co-pays apply when purchased at the Yale Health pharmacy, outside pharmacy prescriptions are the greater of 20% of the cost or the co-pay
$50 Non-preferred & Specialty
|opay without a deductible applies to certain Preventive drugs. View the Smart Care Preventive Medicine Drug list. If not on the preventive list, deductible and coinsurance will apply.
After Deductible is met, the following copays apply:
40% Non-preferred & Specialty
$50 Non-preferred & Specialty
|Durable Medical Equipment||N/A||N/A||10% coinsurance||N/A|
|Office Visit: Primary Care Provider (PCP) Mental Health||$0||$20||Deductible and coinsurance apply||$20|
|Office Visit: Specialist (including Urgent Care)
|$0||$30||Deductible and coinsurance apply||$30|
|Routine Eye Exams||$0||$30||Deductible and coinsurance apply||$30|
|Emergency Room||$70, waived if admitted
or referred by YHP
|$100, waived if admitted||Deductible and coinsurance apply||$100, waived if admitted|
|Teladoc||N/A||N/A||Deductible and coinsurance apply||N/A|
|Urgent Care||N/A||N/A||Deductible and coinsurance apply||N/A|
|Diagnostic X-ray/Lab||$0||$0||Deductible and coinsurance apply||$0|
|Complex Imaging (MRI, CT Scan, etc.)
|$0||$50 (waived at preferred facilities)||Deductible and coinsurance apply||$50 (waived at preferred facilities)|
|Outpatient Surgical||$0||$0||Deductible and coinsurance apply||$0|
|$0||$0||Deductible and coinsurance apply||$0|
|Physical Therapy/Chiropractic||Physical therapy: $0
Chiropractic: up to 12 visits per year,
at a $50 reimbursement per visit
|$30||Deductible and coinsurance apply||$30|
|$20,000 Lifetime maximum; Pre-authorization required.||$20,000 Lifetime maximum; Pre-authorization required.||$20,000 Lifetime maximum; Pre-authorization required.||$20,000 Lifetime maximum; Pre-authorization required.|
|In-Vitro Fertilization & ART
|Four (4) cycles, Lifetime maximum; Pre-authorization required.||Four (4) cycles, Lifetime maximum; Pre-authorization required.||Four (4) cycles, Lifetime maximum; Pre-authorization required.||Four (4) cycles, Lifetime maximum; Pre-authorization required.|
|Plan INformation||Yale Health
(WITH HEALTH SAVINGS ACCOUNT AND ACCIDENT)
|LEGACY AETNA CHOICE (CLOSED TO NEW ENROLLMENTS)|
|Annual Out-of-pocket Limit (includes deductible)||N/A||N/A||$6,500/$13,000
- 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.
- If eligible, the HSA employer contribution will be prorated for non-calendar year effective dates. The employer contribution requires HSA eligibility, account set up, and is contingent on enrollment in the Aetna Smart Care. The university will provide a one-time deposit of $500, $750 or $1000 depending on your coverage election (new enrollments only), into your account.
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?
If you are covered by more than one insurance plan—such as your employer plan and your spouse’s employer plan—you must disclose this information to Yale Health or Aetna. Failure to disclose this information may affect the terms of your coverage or denial of claims.
Coordination of Benefits (COB) is the method used to determine which plan pays first, which pays second, and the amount paid by each plan.
Out-of-network facility charges for all Yale medical plans will be based on Medicare reimbursement levels, or what is considered reasonable and customary. This change applies to voluntary (non-emergency) facility use only. If you choose to utilize an out-of-network facility when an in-network facility is available, you may be subject to balance billing for any amount that exceeds the reasonable and customary reimbursement level.
End Stage Renal Disease (ESRD) and Medicare: If you or a family member is diagnosed with ESRD, you will need to enroll in Medicare by the 30th month of Medicare eligibility. During the 30-month coordination period your medical plan will be your primary coverage and Medicare can be optional. After 30 months, Medicare will be your primary coverage and your medical plan will only cover what Medicare would not have paid.
If you are enrolled in an additional insurance plan, you must provide information about that plan to Yale Health or Aetna.
Log in to the Aetna website 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|