"Life off the Hill:" The Health Plan and You

I’m going to preface this post with a disclaimer: I’m not expert on the Yale Health Plan (YHP). In fact, when I was in your shoes, I knew that I was waiving the plan for my first year, so I didn’t educate myself about it at all. For the record, that’s not a good idea, because unless your spouse or partner has awesome insurance, you’re probably going to end up like me and switch onto the Yale plan with no idea what it’s like. So, consider this my gift to you: the YHP translated into simple English (since I need to read the stuff anyway).

So, when I first went on the Health Plan Website, I found this amazing sounding-plan. However, that plan was for employees, so I won’t taunt you with it. Since we’re not employees (although now I really want to be), you and I will be signing up for this plan, which is still pretty good. The YHP is available in two different areas of coverage, Hospitalization/Specialty Coverage and Prescription Plus Coverage, which must be purchased separately. An entire year of single-person coverage on both plans costs $1836.

At first, I thought this was ridiculous. The only job I’ve ever had that offered health care was at a hospital, so I got good health insurance cheaply (since everything was done in-house). I also got vision and dental (which isn’t included in the YHP, more on that later) for a ridiculously low price. However, my old health insurance had much higher co-pays than the YHP. YHP’s co-pays are ridiculously low—there’s no co-pay for a hospital visit (whereas my old plan featured a $400 co-pay for the first day and a $200 co-pay for the next four, which, given how expensive the equipments in those rooms are, isn’t bad), and the prescription plan only has a $100 deductible (I had a higher deductible for ambulance coverage on my old plan). So, in perspective, while I paid less for my old insurance than I will for the YHP, I paid more if I had to use it. So, for example, the concussion* that resulted in an ambulance ride and five hours in the hospital, which cost me over $300 (no including a $25 co-pay to have my primary care physician remove the surgical staples), would have been free on the YHP (since it would have been urgent care, which is fully covered).

So, here’s the break down of benefits:

Hospitalization/Specialty Coverage provides

• full outpatient coverage, full inpatient coverage
• thirty days of rehabilitation
• sixty days of psychiatric or substance abuse treatment
• full in- and out-of-network emergency coverage
• $5000 of dental surgery following “traumatic accidental injury” (which, for the record, does not include chewing injuries, although I can’t imagine what you’d have to chew to result in a dental trauma [nor do I want to])
• 90% coverage (up to $5000) of medical equipment rentals
• $5000 of infertility services (this is lifetime benefit, not a yearly benefit)
• full organ transplant coverage
• and coverage for podiatric, prosthetic, and speech therapy services in some circumstances.

Prescription Plus Coverage provides “excess coverage.” That means that it can be used to cover expenses not covered in the Hospitalization/Specialty Coverage, but will not be applied until any other discounts/reimbursements have been deducted. It provides 80% reimbursement (up to $15,000 per member per year) after a $100 deductible for the following services:

• inpatient psychiatric and substance abuse services beyond those covered in the Hospitalization/Specialty coverage
• pharmacy items (including diabetic supplies)
• and vaccinations.

However, even if you choose not to purchase either of the YHP’s plans, you’ll still receive full primary care coverage through the YHP, which includes routine check-ups, laboratory services, and standard preventive care.

Beginning this fall, Yale is offering vision and dental plans to graduate and professional students (that’s you). The plans were recently finalized, and I can’t find any Yale websites that have the information yet. As such, I’m going to attempt to link to two attachments (Dental and Vision that were sent out to current graduate and professional students last week.

If this all seems confusing and overwhelming, don’t worry; we’ll have someone speaking to you about your healthcare options during BTFO. Just don’t get a concussion before you get up here; it’s really embarrassing and it kills an afternoon. Plus, it will be a much cheaper experience once you’re on the YHP.

*The concussion is a funny story, actually. While I was in the ambulance, the paramedics were trying to determine if I was oriented to person, time, and place (I wasn’t). I couldn’t answer any of their questions, but each time I failed to answer, I told them that I wasn’t really stupid because I was going to Yale in a month. I don’t think they believed me.