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srcset="/sites/default/files/styles/main_menu_1440/public/2024-04/23-023_YaleHealth_484.jpg?h=deaec4b9&itok=cTW4Y7mB 1x" media="all and (min-width: 1440px)" type="image/jpeg" width="900" height="486"/> <img loading="eager" class="main_menu" src="/sites/default/files/styles/main_menu_1440/public/2024-04/23-023_YaleHealth_484.jpg?h=deaec4b9&itok=cTW4Y7mB" width="900" height="486" alt="children and parent in waiting area" /> </picture> </figure> </div> </div> </div> </details> </li> <li class="menu__item"> <a href="/forms-and-guidelines" data-drupal-link-system-path="node/911">Forms & Guidelines</a> </li> </ul> </nav> </div> <div class="site-header__tools"> <a href="/search" aria-label="Yale Health search page"> <i class="fal fa-search"></i><span class="visually-hidden">Search</span> </a> <button class="menu-toggle" data-js="menu-toggle" aria-controls="block-main" aria-expanded="false"> <span></span> <span></span> <span></span> </button> </div> </div> </header> <main id="site-main" class="site-main"> <div class="site-main__system"> <div class="region-system"> <div data-drupal-messages-fallback class="hidden"></div> </div> </div> <div class="region-content"> <div id="block-yale-health-content"> <article class="node node--page node--full" data-js="node-page"> <header class="node__header" data-js="node-header"> <h1 class="node__heading"> Managerial & Professional Staff, & Faculty, Post-Doctoral Associates & Fellows Coverage </h1> </header> <div class="node__content"> <div class="node__sections"> <div class="layout layout--one-column"> <div class="layout__content"> <div class="layout__regions"> <div class="layout__region layout__region--content"> <div class="layout__region-item"> <div class="paragraph paragraph--html-content paragraph--default" data-js="html-content"> <div class="paragraph__body"> <div class="ck-content"> <p>Your Yale Health coverage is unique based on your role at the University.</p><p>You will receive all of your healthcare at the Yale Health Center unless your primary care clinician refers you to an outside clinician/specialist. Prior authorization is required for all referrals.</p><p>There is no limitation for pre-existing conditions, and most preventive, diagnostic and treatment services involve no deductibles and no claim forms.</p><p><em>It is important to review all of your coverage documents. The documents complement each other and are not intended to stand alone. The Schedule of Benefits and the Summary of Benefits & Coverage do not list all services and treatments, and are subject to all the terms, conditions, and exclusions and limitations set forth in the Yale Health Employee Member Coverage Booklet (i.e., “the plan document”). The plan document governs all questions of interpretation.</em></p></div> </div> </div> </div> </div> </div> </div> </div> <section class="layout--has-header layout layout--one-column" aria-labelledby="heading-layout-866"> <div class="layout__content"> <div class="layout__header"> <header class="advanced-header-field advanced-header-field--heading-tag-h2"> <h2 id="heading-layout-866" class="advanced-header-field__heading"> Coverage Documents </h2> </header> </div> <div class="layout__regions"> <div class="layout__region layout__region--content"> </div> </div> </div> </section> <div class="layout--30-70 layout layout--two-column"> <div class="layout__content"> <div class="layout__regions"> <div class="layout__region layout__region--first"> <div class="layout__region-item"> <header class="advanced-header-field advanced-header-field--heading-tag-h3"> <h3 id="heading-header-868" class="advanced-header-field__heading"> <a href="/resource/schedule-benefits-mp-2024" target="_blank">Schedule of Benefits</a> </h3> </header> </div> </div> <div class="layout__region layout__region--second"> <div class="layout__region-item"> <div class="paragraph paragraph--html-content paragraph--default" data-js="html-content"> <div class="paragraph__body"> <div class="ck-content"> <p>A list that describes covered services and treatments, as well as patient cost-sharing amounts like copays, fees for no show/late cancellation, deductibles, and coinsurance percentages, under your Yale Health plan.</p><p>Look here first when you have questions about what services are covered by your Yale Health plan, and what/if any amount you will have to pay for those services.</p></div> </div> </div> </div> </div> </div> </div> </div> <div class="layout--30-70 layout layout--two-column"> <div class="layout__content"> <div class="layout__regions"> <div class="layout__region layout__region--first"> <div class="layout__region-item"> <header class="advanced-header-field advanced-header-field--heading-tag-h3"> <h3 id="heading-header-871" class="advanced-header-field__heading"> <a href="/resource/summary-benefits-and-coverage-mp" target="_blank">Summary of Benefits and Coverage</a> </h3> </header> </div> </div> <div class="layout__region layout__region--second"> <div class="layout__region-item"> <div class="paragraph paragraph--html-content paragraph--default" data-js="html-content"> <div class="paragraph__body"> <div class="ck-content"> <p>A list of medical services and treatments designed to help you understand the coverage you have with Yale Health. It also allows you to more easily compare Yale Health with different coverage options available to you.</p><p>A list of key features of Yale Health coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.</p><p>Under the Affordable Care Act, Yale Health is required to provide you with this concise list which details, in plain language, simple and consistent information about Yale Health plan benefits and coverage.</p></div> </div> </div> </div> </div> </div> </div> </div> <div class="layout--30-70 layout layout--two-column"> <div class="layout__content"> <div class="layout__regions"> <div class="layout__region layout__region--first"> <div class="layout__region-item"> <header class="advanced-header-field advanced-header-field--heading-tag-h3"> <h3 id="heading-header-874" class="advanced-header-field__heading"> <a href="/resource/yale-health-employee-coverage-booklet" target="_blank">Employee Member Coverage Booklet</a> </h3> </header> </div> </div> <div class="layout__region layout__region--second"> <div class="layout__region-item"> <div class="paragraph paragraph--html-content paragraph--default" data-js="html-content"> <div class="paragraph__body"> <div class="ck-content"> <p>A comprehensive booklet that explains in detail the benefits and coverage provided under your Yale Health employee coverage.</p><p>The booklet describes the rights and obligations of you and Yale Health, what the plan covers, and how benefits are paid for that coverage. An employee covered under this plan and their covered dependents are subject to all the conditions and provisions of the plan.</p><p><em>The Employee Member Coverage Booklet is the plan document. It includes the Schedule of Benefits and any amendments or riders, and governs all questions of interpretation.</em></p></div> </div> </div> </div> </div> </div> </div> </div> <div class="layout--30-70 layout layout--two-column"> <div class="layout__content"> <div class="layout__regions"> <div class="layout__region layout__region--first"> <div class="layout__region-item"> <header class="advanced-header-field advanced-header-field--heading-tag-h3"> <h3 id="heading-header-877" class="advanced-header-field__heading"> <a href="/resource/glossary-health-coverage-and-medical-terms" target="_blank">Glossary of Health Coverage and Medical Terms</a> </h3> </header> </div> </div> <div class="layout__region layout__region--second"> <div class="layout__region-item"> <div class="paragraph paragraph--html-content paragraph--default" data-js="html-content"> <div class="paragraph__body"> <div class="ck-content"> <p>A glossary of common health coverage and medical terms from The U.S. Center for Consumer Information & Insurance Oversight. It defines many commonly used terms, but isn’t a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any case, the policy or plan governs.</p></div> </div> </div> </div> </div> </div> </div> </div> <div class="layout--30-70 layout layout--two-column"> <div class="layout__content"> <div class="layout__regions"> <div class="layout__region layout__region--first"> <div class="layout__region-item"> <header class="advanced-header-field advanced-header-field--heading-tag-h3"> <h3 id="heading-header-880" class="advanced-header-field__heading"> <a href="/resource/amendment-mp-fac-post-doc-fellows" target="_blank">Amendments</a> </h3> </header> </div> </div> <div class="layout__region layout__region--second"> <div class="layout__region-item"> <div class="paragraph paragraph--html-content paragraph--default" data-js="html-content"> <div class="paragraph__body"> <div class="ck-content"> <p>Amendments to Coverage Booklet for Managerial & Professional, Faculty, Post-Docs and Fellows</p></div> </div> </div> </div> </div> </div> </div> </div> <div class="layout--30-70 layout layout--two-column"> <div class="layout__content"> <div class="layout__regions"> <div class="layout__region layout__region--first"> <div class="layout__region-item"> <header class="advanced-header-field advanced-header-field--heading-tag-h3"> <h3 id="heading-header-883" class="advanced-header-field__heading"> <a href="https://tic.hothprod.magellanhealth.com/YALEU/INN/YALEU_in-network-rates.json" target="_blank">Transparency in Coverage</a> </h3> </header> </div> </div> <div class="layout__region layout__region--second"> <div class="layout__region-item"> <div class="paragraph paragraph--html-content paragraph--default" data-js="html-content"> <div class="paragraph__body"> <div class="ck-content"> <p>The machine-readable file (MRF) is a document that publicly discloses pricing information and whose content can be readily processed by computers. The MRF does not contain any personal member health information or benefit details.</p></div> </div> </div> </div> </div> </div> </div> </div> </div> <aside class="node__side-content"> <section class="node__resources"> <h2>Resources</h2> <article class="node-teaser node-teaser--resource node-teaser--label" data-js="node-resource"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="https://yalehealth.yale.edu/sites/default/files/2023-07/MemberGuide2020_FINAL.pdf" target="_blank"><i class="fal fa-file-pdf"></i><div><span>Member Guide to Yale Health</span></div></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--resource node-teaser--label" data-js="node-resource"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="https://yh-web.yu.yale.edu/memberidcard/default.aspx?ticket=ST-110766-ECmh0h8qNLmV9o2gn5teW1CukLo-vm-cas6prdapp-01"><i class="fal fa-globe"></i><div><span>Meet Your Primary Care Team</span></div></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--resource node-teaser--label" data-js="node-resource"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="http://secure.its.yale.edu/cas/login?service=https%3A//yhpstudentwaiver.yale.edu/IDCard/default.aspx"><i class="fal fa-globe"></i><div><span>Download Your Yale Health Member ID Card </span></div></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--resource node-teaser--label" data-js="node-resource"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtMjY4"><i class="fal fa-globe"></i><div><span>Pharmacy Benefit - 4 Tier Formulary</span></div></a> </div> </header> <div class="node-teaser__content"> </div> </article> </section> <section class="node__related-departments"> <h2>Related Departments</h2> <article class="node-teaser node-teaser--department node-teaser--label" data-js="node-department"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/department/internal-medicine"><span>Internal Medicine</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--department node-teaser--label" data-js="node-department"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/department/obstetrics-and-gynecology"><span>Obstetrics and Gynecology</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--department node-teaser--label" data-js="node-department"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/department/pediatrics"><span>Pediatrics</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--department node-teaser--label" data-js="node-department"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/department/pharmacy-prescriptions"><span>Pharmacy / Prescriptions</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--department node-teaser--label" data-js="node-department"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/department/member-services"><span>Member Services</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> </section> <section class="node__related-topic-pages"> <h2>Topics</h2> <article class="node-teaser node-teaser--topic-page node-teaser--label" data-js="node-topic_page"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/topic/yale-health-pharmacy-benefit-managerial-professional-and-faculty"><span>Yale Health Pharmacy Benefit for Managerial & Professional and Faculty</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--topic-page node-teaser--label" data-js="node-topic_page"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/topic/out-area-coverage"><span>Out of Area Coverage</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--topic-page node-teaser--label" data-js="node-topic_page"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/topic/pharmacy-use-outside-yale-health-center"><span>Pharmacy Use Outside of the Yale Health Center</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--topic-page node-teaser--label" data-js="node-topic_page"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/topic/enrollment-and-eligibility"><span>Enrollment and Eligibility</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--topic-page node-teaser--label" data-js="node-topic_page"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/topic/late-cancellationno-show-fees"><span>Late Cancellation/No Show Fees</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> <article class="node-teaser node-teaser--topic-page node-teaser--label" data-js="node-topic_page"> <header class="node-teaser__header"> <div class="node-teaser__heading"> <a href="/topic/unpaid-post-doctoral-fellows"><span>Unpaid Post-Doctoral Fellows</span></a> </div> </header> <div class="node-teaser__content"> </div> </article> </section> </aside> </div> </article> </div> </div> </main> <footer 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