Explore your benefit options, compare plans, and review contributions and rates. f you are newly hired, newly benefits eligible, or have experienced a qualifying life event, visit Workday to enroll.
Your Benefits Options
Benefits Contributions/Rates and Resources
Compare Plans
| 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 Specialty Drugs 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: Specialty Drugs |
$10 Preferred Specialty Drugs 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 Specialty Drugs 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) |
| Teladoc | N/A | Deductible and coinsurance apply | $25 | $25 |
| Advocacy Services | N/A | Included | Included | Included |
| Urgent Care |
Yale Health Center: Yale New Haven Health Urgent Care sites: |
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 |
|---|---|---|---|
| Out-of-Network Deductible (Footnote 2) |
N/A | $1,750/$3,500 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 |
| Plan Information | Yale Health (Footnote 1) |
Aetna Smartcare (with Health Savings Account and Accident) | Aetna Choice |
|---|---|---|---|
| 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) | |
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 |