Postdoctoral Associates Benefits Enrollment

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Your Benefits Options

Benefits Contributions and Rates

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Plan Information	Yale Health (Footnote 1)	Aetna Smartcare (with Health Savings Account and Accident)	Aetna Choice	Legacy Aetna Choice (closed to new enrollments)
In-Network Deductible (Footnote 2)	None	$1,750/$3,500 single/family	$900/$1,800 single/family	$150/$300 single/family
Co-Insurance (Footnote 3)	None	10%	10%	0%
Annual Out-of-pocket Limit (includes deductible) (Footnote 4)	$3,000/$6,000 single/family	$4,000/$6,850 single/family	$4,000/$6,850 single/family	$4,000/$6,850 single/family
Health Savings Account Annual Employer Contribution (Footnote 5)	N/A	$850 Single $1,275 Single + Child(ren) $1,275 Single + Spouse $1,700 Family (pro-rated for new hires based on hire date)	N/A	N/A
Prescription Drugs (Footnote 6)	$10 Preferred $45 Alternative 40% Non-preferred (min/max $60/$120) Specialty Drugs (40% coinsurance to a max $120 co-pay) 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 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: $10 Preferred $45 Alternative 40% Non-preferred (min/max $60/$120) Specialty Drugs (40% coinsurance to a max $120 co-pay)	$10 Preferred $45 Alternative 40% Non-preferred (min/max $60/$120) Specialty Drugs (40% coinsurance to a max $120 co-pay) PrudentRX - Specialty medications on PrudentRx list will be subject to a 30% coinsurance unless you enroll in Prudent Rx Solution program. $0 cost share will apply if you enroll in the program.	$10 Preferred $45 Alternative 40% Non-preferred (min/max $60/$120) Specialty Drugs (40% coinsurance to a max $120 co-pay) PrudentRX - Specialty medications on PrudentRx list will be subject to a 30% coinsurance unless you enroll in Prudent Rx Solution program. $0 cost share will apply if you enroll in the program.
Durable Medical Equipment	10% coinsurance	10% coinsurance	10% coinsurance	N/A
Preventative Care	$0	$0	$0	$0
Office Visit PCP/ Mental Health Specialist	$0	Deductible and coinsurance apply	$25	$25
Office Visit: Specialist (Footnote 1)	$0	Deductible and coinsurance apply	$40	$40
Emergency Room	$150 (waived if admitted)	Deductible and coinsurance apply	$150 (waived if admitted)	$150 (waived if admitted)
Telemedicine	N/A	10% coinsurance	$25	$25
Advocacy Services	N/A	Included	Included	Included
Urgent Care	Yale New Haven Health Urgent Care sites: $75 Yale Health Center: $0 Mon-Fri 8am-6pm, (After hours $20)	Deductible and coinsurance apply	$50	$50
Routine Eye Exams (Footnote 1)	$0	Deductible and coinsurance apply	$40	$40
Physical Therapy/Chiropractic	Physical therapy: $20 Chiropractic: up to 12 visits per year, at a $50 reimbursement per visit	Deductible and coinsurance apply	$40 (reviewed for medical necessity after 25 visits)	$40 (reviewed for medical necessity after 25 visits)
Inpatient Hospital	$400	Deductible and coinsurance apply	Deductible and coinsurance apply	$400
Outpatient Surgical	$300	Deductible and coinsurance apply	Deductible and coinsurance apply	$300
Diagnostic X-ray/Lab	$20 (x-ray) outside Yale Health	Deductible and coinsurance apply	Deductible and coinsurance apply	$20 (x-ray)
Complex Imaging (MRI, CT Scan, etc.)	$100 outside Yale Health	Deductible and coinsurance apply	Deductible and coinsurance apply	$100

Plan Information	Yale Health (Footnote 1)	Aetna smartcare (with Health Savings Account and Accident)	Aetna Choice	Legacy aetna choice (closed to new enrollments)
Out-of-Network Deductible (Footnote 2)	N/A	$1,750/$3,500 single/family	$2,000/$4,000 single/family	$2,000/$4,000 single/family
Co-insurance (Footnote 3)	N/A	30%	30%
Annual out-of-pocket limit (includes deductible) (Footnote 4)	N/A	$6,500/$13,000 single/family	$6,000/$12,000 single/family	$6,000/$12,000 single/family

Plan Information	Yale Health (Footnote 1)	Aetna Smartcare (with Health Savings Account and Accident)	Aetna Choice	Legacy Aetna Choice (closed to new enrollments)
Fertility Services (Footnote 7)	$20,000 Lifetime maximum; Pre-authorization required.	Fertility benefits are administered through Progyny. To learn more or for questions about your Progyny fertility benefit, call 866-881-4029. (Footnote 8)
In-Vitro Fertilization & ART (Footnote 7)	Four (4) cycles, Lifetime maximum; Pre-authorization required.	Fertility benefits are administered through Progyny. To learn more or for questions about your Progyny fertility benefit, call 866-881-4029. (Footnote 8)

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.
The amount of out-of-pocket expenses you must pay for service before the plan pays any expenses per calendar year.
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 one year, including co-insurance and deductible.
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 an annual deposit of $850, $1,275 or $1700 depending on your coverage election, into your account.
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.
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.
Through Progyny’s benefit, members have access to a comprehensive suite of fertility treatment options.
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 under 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.

Visit Yale Health Health Coverage for coordination of benefits information or download the (COB) form.

Log in to the Aetna website for more information about coordination of benefits.

Benefits Around Every Corner

Explore all of Yale’s benefits and resources.

Provider contact information

Provider	Contact	Telephone
Medical	Yale Health	203-432-0246
Medical	Aetna	866-253-8886
Vision	EyeMed	866-299-1358
Dental	Delta	800-494-4138
Dental	CIGNA	800-367-1037
Flexible Spending Accounts (FSA) Commuter	HealthEquity	877-924-3967; #6
Tuition Assistance	Bright Horizons EdAssist Solutions
Well-Being	Optum	866-416-6586
403(b) Plans	TIAA	855-250-5424
Staff Pension Plan	Yale Pension Service Center	877-352-5552; #2