YNHHS Medical Plan

The YNHHS Medical Plan connects you to the world-class care provided by our Signature Network of facilities and providers. You may also use Cigna Open Access Plus (OAP) or out-of-network providers, but you may pay more. It’s important to know that the organization has invested in our employees by keeping out-of-pocket costs—even for Cigna OAP services—lower than many of our health care industry peers.

When you enroll in the YNHHS Medical Plan, you automatically have prescription drug coverage.

Learn More

Learn more about the YNHHS Medical Plan on the YNHHS Medical page, which offers the same plan.

HDHP Medical Plans

You have two High-Deductible Health Plan (HDHP) options:

  • HDHP with Health Savings Account (HSA)
  • HDHP with Healthcare Reimbursement Account (HRA)

Both plans are administered by Cigna. You can select the HDHP with HRA only if you have Medicare or TRICARE as you are not eligible to participate in an HSA. With both plans, you pay the full cost of care until you meet your annual deductible. Your HSA or HRA can help you cover those costs.

Your medical plan is designed to help keep you and your family healthy. Used along with your other benefits—including dental and vision coverage, and services offered through the integrated employee assistance and work/life program—it’s also here to support you when you need care.

You can choose to waive medical coverage if you’re covered by another plan or your spouse is a YNHHS employee.

Under both HDHP plans:

  • Your coverage is identical.
  • You pay nothing for preventive care—including some preventive tests and prescription drugs—when you use network providers.
  • You pay the full cost of care until you meet your annual deductible, after which the plan begins to share costs with you.
  • You pay discounted rates when you use providers and facilities in the Yale New Haven Health System and Cigna Open Access Plus (OAP) network.
  • You have mental health and substance abuse benefits.
  • Special rules apply when you or your covered dependents are covered by more than one plan.
  • There’s a combined annual deductible for medical and prescription drug services. Until the deductible is met, your eligible medical and prescription drug costs are applied against the deductible.

The difference between the plans? The account that comes with them—the HSA or HRA.

The Health Savings Account (HSA) is a special account that you contribute to on a pretax basis through payroll deductions. Your employer contributes to it, too*. You can use the money in your HSA to cover your health care expenses until you reach your annual deductible, and the plan begins to share those costs with you. The HSA is not available to you if you are currently enrolled in Medicare or TRICARE.

When you enroll for the HDHP with HSA, you will receive a welcome packet from Cigna, our HSA administrator. Follow the instructions to open your account.

After you meet your deductible, you can use your HSA to cover any coinsurance.

  • In 2024, you can contribute up to $4,150 to your HSA if you have individual coverage and $8,300 if you’re covering others, too. And if you’re 55 or older, you can contribute an additional catch-up contribution of $1,000. Keep in mind your employer’s contribution, if any, when making your election. Total contributions to your account cannot exceed these IRS maximums.
  • Your HSA contributions reduce your taxable income.
  • Any unused funds roll over year after year, earning interest along the way.
  • The money in your HSA is yours to use forever on qualified medical expenses—even if you change employers or health plans or retire.
  • Once your balance reaches $1,000, you have the opportunity to invest it for potential growth.

Note: You can also open your HSA at a financial institution of your choice. However, unlike an account opened with Cigna, you will not be able to fund your HSA through direct payroll contributions, nor will you receive your employer’s contribution.

*For employer HSA contribution amounts, visit HRConnect and click Health Benefits.

Get the triple-tax advantage with the HSA

When you contribute to the HSA, you get a triple-tax advantage:

  1. Your contributions are deducted from your pay before taxes are taken out, which reduces your taxable income.
  2. Your contributions grow tax-free in your account for as long as they are in your account.
  3. Your distributions from the account are tax-free, as long as you use them to pay for qualified medical expenses.

The Healthcare Reimbursement Account (HRA) is a special account to which your employer contributes* to help you cover the cost of your health care expenses. You can use these funds to cover your costs as you reach your annual deductible. The HRA is available only to employees enrolled in Medicare or TRICARE.

  • As you receive services throughout the year, you pay out of pocket for expenses like coinsurance, copays, and other services, and then get reimbursed from your HRA up to the amount of your existing balance.
  • Once you’ve met your annual deductible, you can pay coinsurance for the care you receive; the plan will cover the rest.
  • You can use the HRA only while you are enrolled in this plan. You cannot take the money with you if you change plans or employers.
  • You cannot contribute to your HRA.

*For employer HRA contribution amounts, visit HRConnect and click Health Benefits.

Understand the Networks

How much you pay depends on the provider or facility you choose:

When you choose to receive care from a Cigna OAP network provider:

  • You’ll need to meet your annual deductible ($2,000 individual/$4,000 family) before the plan begins to share the cost of your care.
  • After you meet your deductible, you’ll pay 30% coinsurance for care until you reach your annual out-of-pocket maximum.
  • Once you meet your annual out-of-pocket maximum, the plan will pay 100% of covered expenses through that calendar year.

To find a provider in the Cigna OAP Network, visit myCigna.com or call 833-739-6447 (833-73-YNHHS). Or download the myCigna app to find health care services, resources, and important contacts.

When you use a provider or facility that is not in the Cigna Open Access Plus (OAP) provider network:

  • You’ll pay the most for care.
  • Cigna will pay a maximum allowable amount (MAA).
  • You will be responsible for costs up to your annual deductible, coinsurance, and any difference between the MAA and the amount billed by the provider.
  • You’ll need to file a claim for the care to be covered. Payments will be made directly to the provider unless you submit a bill showing you’ve paid it already. Get a claim form and instructions.

Get no-cost vaccines when you use the right ID card

You and your covered dependents can get no-cost vaccines for shingles, pneumonia, flu (ages 18 and older only), COVID-19, tetanus/diphtheria, and hepatitis A and B. To ensure 100% coverage, show the right ID card. If you are in a CVS Minute Clinic or Health Hub, use your medical plan ID card. Any other network pharmacy, use your CVS Caremark ID card.

How Benefits Compare Based on the Provider You Choose

Here’s a look at how the benefits compare based on whether you receive care from a Cigna OAP network provider or Out-of-Network provider. For a more complete list and any limitations, visit HRConnect to view the summary plan description (SPD). To see employee premium contributions for the medical plan, visit the enrollment site.

 Cigna Open Access Plus (OAP) Provider Out-of-Network Provider 

Annual Deductible* 

$2,000/$4,000 $2,000/$4,000 

Out-of-Pocket Maximum

$3,000/$6,000 $4,000/$8,000 

Member Coinsurance after Deductible 

0% after deductible 30% after deductible 
Member Coinsurance after Deductible 0% after deductible 30% after deductible 

* The $2,000 individual annual deductible only applies to “employee only” coverage. If you cover anyone else under this plan, your annual deductible is $4,000.

 Cigna Open Access Plus (OAP) Provider Out-of-Network Provider 
Preventive Care Exams0% deductible waived 30% after deductible
Office Visits 0% after deductible30% after deductible
 Cigna Open Access Plus (OAP) Provider Out-of-Network Provider 

Diagnostic Services
(Lab, x-ray, MRI, PET, CAT scan, nuclear cardiology) 

0% after deductible 30% after deductible

Rehabilitation Therapy 1
(Physical, speech, occupational, chiropractic, cardiac rehab) 

0% after deductible30% after deductible

1. Physical, speech, and occupational therapy visits are limited to a combined total of 60 visits per member per calendar year. For physical therapy and occupational therapy, prior authorization is required after the first visit. Chiropractic services are limited to 12 visits per member per calendar year.

 Cigna Open Access Plus (OAP) Provider Out-of-Network Provider 

Emergency Care
(Emergency room; copay waived if admitted)

$100 copay after deductible$100 copay after deductible

Urgent Care
(Walk-in and urgent care centers) 

0% after deductible30% after deductible

Ambulance Services

0% after deductible 0% after deductible 

(OnDemand and MDLIVE) 

0% after deductible N/A 
Cigna Open Access Plus (OAP) Provider Out-of-Network Provider 

Outpatient Surgery Performed in Hospital Ambulatory Care Center1

0% after deductible 30% after deductible 

Inpatient Surgery2 
(semi-private room and board)

0% after deductible 30% after deductible 

Outpatient Mental Health/Substance Abuse Services Performed in Office3

0% after deductible 30% after deductible 

Inpatient Mental Health/Substance Abuse Services4

0% after deductible  30% after deductible 

Skilled Nursing Facility 5 

0% after deductible 30% after deductible 

Durable Medical Equipment 6 

0% after deductible 40% after deductible 

Infertility Services 

100% up to lifetime maximum of $15,000 100% up to lifetime maximum of $15,000 

1. Hospital or surgical center facility charges only.
2. Room and board, lab work, medical supplies, and other hospital ancillary services.
3. The Employee and Family Resources (EFR) program provides up to six confidential counseling sessions at no cost to you.
4. Inpatient rehabilitative services are limited to 100 days per member per year.
5. Skilled nursing facility services are limited to 100 days per calendar year.
6. You must use a participating provider to be covered for durable medical equipment and prosthetic devices.

When to Connect with Cigna

For a medical, behavioral health, or substance abuse stays and/or service pre-authorizations, call 833-739-6447 (833-73-YNHHS).

Before receiving any of these services, you must call Cigna for preauthorization.

Otherwise, your benefits will be reduced.

  • Inpatient stays in a hospital, skilled nursing facility, hospice facility, subacute care or acute rehabilitation facility, or a behavioral health or substance abuse treatment center (CALL at least 24 hours before the start of your stay)
  • High-cost diagnostic imaging services prescribed by an out-of-network provider
  • Organ/tissue transplants, including evaluation, donor search, organ procurement/tissue harvest, or transplant

For admissions following emergency or urgent care, you, your representative, or your doctor must call Cigna within 48 hours of admission.

  • Benefits for inpatient stays will be reduced by $200.
  • Benefits for doctor fees will be reduced by 25%.
  • Find a provider in the Cigna Open Access Plus (OAP) Network.
  • Resolve insurance claim and billing issues.
  • Ask questions about preventive and/or diagnostic care.
  • Get general health information.

No ID Cards Needed

No ID cards are needed when you receive care under the HDHP Medical Plans. Your provider will be able to access all your information through their system when you tell them you’re covered under Cigna. If you want an ID card, you can simply download one from the Cigna app, which you can download from the App Store or Google Play.

Urgent Care & Telehealth

Can’t wait to see a doctor? Urgent care and telehealth services help you quickly connect with affordable care.

Urgent Care

When you need immediate care for an illness or injury, you can visit any Cigna urgent care center.


Telehealth is an ideal alternative for immediate treatment of an illness or injury when you can’t get to a doctor’s office or urgent care center. You and your covered family members can visit a doctor virtually, wherever you are, whenever you need care—via phone, tablet or computer. If you need medication, the doctor can even send a prescription to your pharmacy (within Connecticut, New York, Massachusetts and Rhode Island).

Use OnDemand or MDLIVE to connect to care outside the usual office hours. Telehealth is not an alternative to emergency care for a life-threatening condition.

See one of our own Northeast Medical Group (NEMG) providers weekdays from 7 a.m. to 7 p.m. ET, excluding holidays. To get started, download the MyChart mobile app.

The NEMG providers you see OnDemand can:

  • Diagnose symptoms
  • Order testing
  • Prescribe medication
  • Send prescriptions to the pharmacy of your choice in Connecticut, New York, Massachusetts, and Rhode Island

OnDemand does not cover pediatric services. Find more information about OnDemand at HRConnect.

How OnDemand works

  1. Register with MyChart online at ynhhs.org/ondemand or through the mobile app.
  2. Schedule your OnDemand visit. You’ll get reminder emails, phone calls, and app pushes to remind you of your upcoming visit.
  3. Complete e-Checkin on the mobile app or website 15 minutes before your visit. You’ll answer questions about your medical history and insurance coverage.
  4. Pay for your visit with a credit card, debit card or your HSA Bank Flexible Spending Account debit card.
  5. Join a virtual waiting room, where a medical assistant will greet you and confirm your information.
  6. Visit your OnDemand doctor.
  7. After your appointment, find a summary of your visit in the MyChart app.

When you or your child can’t wait for care MDLIVE is there for you 24/7/365.

Pediatric services are not covered by OnDemand. Call 888-MDCARE-8 or 888-632-2738.

For pediatric services, or to see a board-certified doctor after hours, on weekends and holidays, and when you’re out-of-state, visit MDLIVE online, download the mobile app or call 888-MDCARE-8 or 888-632-2738.

Prescription Drugs

You automatically have prescription drug coverage through CVS Caremark when you enroll in either of the High-Deductible Health Plans. You can use your HSA or HRA to pay for your share of the cost. You can fill covered prescriptions at participating CVS retail pharmacies or through the CVS Caremark mail service. For specialty medications, you’ll need to use specialty pharmacy services, as described below.

Until the deductible is met, all covered medical and prescription drug costs are applied against the deductible. You will pay the actual cost of your prescription, as negotiated between CVS Caremark and the pharmacy.

Your prescription will be covered only if it’s filled at a participating pharmacy.

  • You can fill up to a 30-day supply of a prescription at more than 5,000 participating pharmacies in the Connecticut, New York, and New Jersey area (64,000 nationwide), including major pharmacy and supermarket chains and most independent drug stores. Simply present the prescription and your CVS Caremark prescription drug card.
  • For maintenance medications, you must use the CVS Caremark Mail Service.
  • For specialty medications, you’ll need to use the YNHH Specialty Pharmacy Services or the Apothecary & Wellness Center or the CVS Specialty Pharmacy.

In an emergency or if you’re out of state and can’t get to a participating pharmacy, you’ll pay out of pocket and then file a claim for reimbursement from CVS Caremark.

Note: When a generic is available and you or your doctor chooses a brand-name drug, you’ll pay the brand-name coinsurance—plus the difference in cost between the two medications.

The High-Deductible Health Plans have a combined annual deductible for medical and prescription drug services. You’ll pay the full cost of services until you meet your deductible; for prescription drugs, you’ll pay the actual cost of your medication, as negotiated between CVS Caremark and the pharmacy.

Under these plans, the most you’ll pay out of pocket for medical care and prescription drugs in any calendar year is $3,000 per individual or $6,000 per family.

How much you’ll pay for your prescription depends on the type of medication and the amount prescribed. When the cost of a drug is less than the minimum copay, you’ll pay the lower amount.

Tier 30-Day Supply 90-Day Supply through  CVS Maintenance Choice 

Tier 1: Generic 

$10 copay after deductible $10 copay after deductible 

Tier 2: Brand Name 

$25 copay after deductible, if the drug is on the list of preferred brand drugs (the formulary) $50 copay after deductible 

Tier 3: Non-Preferred Brand and Specialty Medications*

$40 copay after deductible, if the drug isn’t on the list of preferred brand drugs (the formulary) $80 copay after deductible 

*Specialty medications are available through the YNHH Specialty Pharmacy Services or the Apothecary & Wellness Center or the CVS Specialty Pharmacy.

Preauthorization and Other Special Circumstances

Here are some drugs where preauthorization will be required and there may be other special circumstances to be aware of.

Some prescriptions, including compounded drugs, require preauthorization from CVS Caremark before they can be filled. Your pharmacist will let you know if your doctor needs to make that call.

If you’re taking raloxifene (brand name: Evista) or tamoxifen (brand name: Noladex) for primary prevention of breast cancer, these generics may be available at no cost to you through the preventive provisions of the Affordable Care Act. To learn if you qualify, your doctor will need to complete the Preventive Services Zero Cost Sharing Form and fax it to CVS Caremark.

The following drugs and medical supplies are not covered by the plan:

  • Medical devices and appliances
  • Experimental drugs
  • Drugs whose sole purpose is to promote or stimulate hair growth
  • Retin A (for those over age 28)
  • Weight-loss drugs
  • Immunization agents, biological sera, blood or blood plasma
  • Most over-the-counter drugs, vitamins, and nutritional supplements
  • Ostomy supplies
  • Prescription ophthalmic products used to improve the field of vision (e.g., presbyopia, blepharoptosis, drug-eluting contact lenses, etc.)

Need to fill a prescription?

Find a participating pharmacy near you.

Pay Nothing for Certain Preventive Drugs

The Affordable Care Act (ACA) makes many prescription medications, vaccines, and supplements—including contraceptives and statins—available to you at no cost.

Ready to Enroll?

To enroll or make changes to your benefits, visit bswift, our secure, online enrollment website. You’ll be prompted to enter your YNHHS username and password. If you are enrolling before your hire date, use this link to visit bswift and follow the temporary username and password instructions there. If you run into problems, call HRConnect at 844-543-2147. Need more info first? You’ll find details at HRConnect.