Yale Police Benevolent Association 2020

Medical Insurance

Visit the medical comparison chart below to learn more about your options.

Yale Health

Yale Health buildingYale’s flagship plan, 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.

Aetna Smart Care (with Health Savings)

If you participate in the Aetna Smart Care and elect an HSA, the university will provide a one-time deposit, of $500, $750, or $1,000 depending on your coverage election, into your account. The onetime deposit is applicable to new enrollments only. In addition, a monthly university contribution of $50, $75, or $100, depending on your coverage election, will be deposited into your account. You can also fund the account with pre-tax payroll contributions (subject to annual IRS limits). Aetna Accident Coverage will also be provided, free of charge, for you and your covered dependents.
Accident Coverage provides lumpsum benefits for covered accidents and some hospital confinements.

Aetna

After you complete three years of service, you may remain a member of Yale Health or choose the Aetna Choice POS II plan for your medical coverage. Be sure to review and compare the features of the plans on the next page.

Aetna Choice POS II (Legacy)

Following the 2020 open enrollment, any employee enrolled in the Legacy Point of Service Plan who voluntarily opts to enroll in a different plan offered by Yale will be permanently precluded from re-enrolling in the Legacy Point of Service Plan.

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.

Dental Insurance

Delta Dental

Delta Dental is Yale’s exclusive dental carrier. Now is the time to make changes to dependent or family dental coverage. In addition to the information below, there is no annual deductible and no out of pocket maximum (review Dental Plan documents for more information).

  • 100% for Preventive & Diagnostic
  • 80% for Basic Restorative*
  • 50% for Major Restorative*
  • 50% coverage†* for Orthodontia

Orthodontia

* $1,000 lifetime maximum; † Dependents under age 19

Vision Insurance

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, designed to encourage you and your spouse to take action in meeting your healthcare goals. This voluntary program for YPBA applies to employees and spouses enrolled in Yale Health and Aetna Healthcare 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.

You and your spouse will be auto-enrolled in the program with the opportunity to opt out of HEP on a quarterly basis. A fee per week will be payroll deducted if you opt out of the program.

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

Signature Benefits

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

Compare Plans

In-Network
Plan Information Yale Health
(Footnote 1)
AETNA SMART CARE
(WITH HEALTH SAVINGS ACCOUNT AND
PERSONAL ACCIDENT)
Aetna Choice Legacy Aetna Choice (Footnote 2)
Annual Deductible
(Footnote 3)
None $1,500/$3,000 single/family $850/$1,700 single/family none
Co-insurance
(Footnote 4)
None 10% 10% None
Out-of-Pocket Maximum
(Footnote 5)
$6,350/$12,700 single/family $4,000/$6,850 single/family $4,000/$6,850 single/family None
Health Savings Account Monthly
Employer Contribution
(Footnote 8)
N/A $50 Single
$75 Single + Child(ren)
$75 Single + Spouse
$100 Family
N/A N/A

Prescription Drugs (up to a One-Month Supply)
(Footnote 6)

$5 Generic
$25 Preferred
$45 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
Copay without a deductible applies to certain Preventative drugs. Visit 2020 Benefit Enrollment Page for a list. If not on the preventative list, deductible and coinsurance will apply. After Deductible is met, the following copays apply:
$10 Preferred
$35 Alternative
40% Non-preferred & Specialty
(min/max $50/$100)
$10 Preferred
$35 Alternative
40% Non-preferred &
Specialty
(min/max $50/$100
$5 Preferred
$25 Alternative
$45 Non-preferred &
Specialty
Preventative Care $0 $0 $0 $0
Office Visit: PCP/
Mental Health Specialist, including Urgent Care (Footnote 7)
$0 Deductible and coinsurance apply $25 / $40 $15 / $25
Routine Eye Exams $0 Deductible and coinsurance apply $40 $25
Teladoc N/A Deductible and coinsurance apply $25 N/A
Emergency Room $70 (co-pay waived if admitted or referred by Yale Health) Deductible and coinsurance apply $150 $100, waived if admitted
Diagnostic X-ray/Lab $0 Deductible and coinsurance apply 10% $50 (waived at preferred facilities)
Outpatient Surgical $0 Deductible and coinsurance apply 10% $0
Inpatient Hospital Services $0 Deductible and coinsurance apply 10% $0

Physical Therapy/Chiropractic

Physical Therapy: $0
Chiropractic: Up to 12
visits per year, $50 max
reimbursement per visit
Deductible and coinsurance apply $40 co-pay $25
Infertility Services
(Footnote 9)
$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
(Footnote 9)
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.
Out-Of-Network
Plan INformation Yale Health
(Footnote 1)
AETNA SMART CARE
(WITH HEALTH SAVINGS ACCOUNT AND
PERSONAL ACCIDENT)

AETNA CHOICE

LEGACY AETNA CHOICE

(FOOTNOTE 2)

Annual Deductible
(Footnote 3)
N/A $1,500/$3,000 single/family $2,000/$4,000 single/family $250/$750 single/family
Co-insurance
(Footnote 4)
N/A 30% 30% 30%
Out-of-Pocket Maximum
(Footnote 5)
N/A $6,500/$13,000 single/family $6,000/$12,000 single/family $1,000/$3,000 single/family

Footnotes:

  1. 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.
  2. This is the Legacy Choice POS II. 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.
  3. The amount of out-of-pocket expenses per calendar year you must pay for services before the plan pays any expenses.
  4. The amount you must pay for services, after the deductible has been paid.
  5. 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.
  6. 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.
  7. There is a $25 co-pay for in-network visits to facilities deemed to be an Urgent Care Facility by Aetna.
  8. List of preferred facilities can be found on the Aetna member services website.
  9. 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.
  10. Referrals are required in order to see providers other than primary care providers.

The applicable plan documents govern all questions of interpretation.

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

For Contact Telephone
Medical Yale Health 203-432-0246
  Aetna 866-253-8886
Vision EyeMed 866-299-1358
Dental Delta 800-494-4138
  CIGNA 800-367-1037
Flexible Spending Accounts (FSA)
Commuter
Tuition Reimbursement
Yale Spending Account 877-352-5552; #6
Counseling and Support Services Magellan Health Services 800-327-9240
403 (b) Plans TIAA 855-250-5424
Staff Pension Plan ALIGHT 877-352-5552; #5