Medical Plan Benefit Comparison Charts
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Advantage Plus
Plan - Advantage Plan
Women and Children
Well-woman visit: OB/GYN Preventive Exam 1
(one per calendar year)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Mammography and Bone Density Test
(Only screening mammography. Does not include breast ultrasounds.)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Screening Breast Ultrasound
(if there is dense breast tissue or a history)
YNHHS Facility/Provider
$20 copay
Anthem PPO Provider
$20 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Maternity Care 2
(Only in-office pre-natal care. Inpatient Hospital and Doctor or Surgeon services also apply, see below.)
YNHHS Facility/Provider
100%, subject to a $40 copay for initial visit
Anthem PPO Provider
100%, subject to a $40 copay for initial visit
Out-of-Network Provider
50% of MAA subject to the deductible
Well Baby/ Well Child Care 3
(includes immunizations)
- seven exams from birth to age one year
- seven exams from age one to five years
- one exam every year from age 6 to 21 years
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Specialized Infant Formula
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Infertility Services Phases II and III treatment, plus medication
(up to maximum lifetime benefit of $8,000)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Office Visits and Physician Services
Primary Care Physician Office Visit 3
(other than for preventive care visits)
Tier 1: Preferred Primary Care Providers4
YNHHS Facility/Provider
100%, subject to a $20 copay
Anthem PPO Provider
100%, subject to a $30 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Specialist Office Visit 3
YNHHS Facility/Provider
100%, subject to a $40 copay
Anthem PPO Provider
100%, subject to a $40 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Routine Adult Exams 3
one exam every calendar year starting at age 22
(includes immunizations)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Doctor or Surgeon Services including maternity claims
(other than an office visit)
YNHHS Facility/Provider
90%, subject to the deductible
Anthem PPO Provider
90%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Allergy Shot Administration in Doctor’s Office
(no MD visit)
YNHHS Facility/Provider
100%, subject to a $20 copay
Anthem PPO Provider
100%, subject to a $20 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Nutrition Counseling
(includes diabetes self-management training)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Ancillary Services
Lab Services
(blood work and lab tests)
YNHHS Facility/Provider
100%, subject to a $30 copay
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
X-Rays, including diagnostic mammograms
(facility charges)
YNHHS Facility/Provider
100%, subject to a $30 copay
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
High Cost Diagnostic Imaging—PET/SPECT/MRI/MRA/CTA/CAT/
(facility charges)
YNHHS Facility/Provider
100%, subject to a $100 copay
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Colorectal Cancer Screening 5
(includes fecal occult blood test, barium enema, flexible sigmoidoscopy and screening colonoscopy)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Chiropractic Visits
(maximum 50 visits per year, combined with PT, OT and Speech)
YNHHS Facility/Provider
100%, subject to a $20 copay
Anthem PPO Provider
100%, subject to a $30 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Physical, Occupational and Speech Therapy
(maximum 50 visits per year, combined with Chiropractic)
YNHHS Facility/Provider
100%, subject to a $10 copay
Anthem PPO Provider
100%, subject to a $30 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Inpatient and Outpatient Care
Inpatient Hospital Services
(room and board, lab work, medical supplies and other hospital ancillary services)
YNHHS Facility/Provider
100%, subject to a $800 copay
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Outpatient Surgery
(hospital or surgi-center facility charges)
YNHHS Facility/Provider
100%, subject to a $400 copay
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Infusion and Radiation Therapy
YNHHS Facility/Provider
100%, subject to a $40 copay
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Behavioral Health and Substance Abuse
Inpatient Behavioral Health and Substance Abuse Treatment
(facility charges)
YNHHS Facility/Provider
100%, subject to a $800 copay
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Outpatient Behavioral Health and Substance Abuse Treatment
NOTE: The Employee and Family Resources (EFR) program provides up to six (6) confidential counseling sessions at no cost .
See Employee Assistance and Work/Life Services
YNHHS Facility/Provider
100%, subject to a $30 copay
Anthem PPO Provider
100%, subject to a $30 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Urgent and Emergency Care and Telehealth
Emergency Department
YNHHS Facility/Provider
$150 copay (copay waived if admitted)
Anthem PPO Provider
$150 copay (copay waived if admitted)
Out-of-Network Provider
$150 copay (copay waived if admitted)
Urgent Care Facility and Walk-In Medical Center
(not Primary Care visit)
YNHHS Facility/Provider
$30 copay (copay waived if admitted)
Anthem PPO Provider
$30 copay (copay waived if admitted)
Out-of-Network Provider
n/a
Ambulance
YNHHS Facility/Provider
n/a
Anthem PPO Provider
100%, subject to the deductible
Out-of-Network Provider
100%, subject to the deductible
MDLIVE
YNHHS Facility/Provider
100%, subject to a $15 copay
Anthem PPO Provider
100%, subject to a $15 copay
Out-of-Network Provider
n/a
Non-Acute Care
Skilled Nursing Facility 7
(up to 120 days per calendar year after a hospital stay)
YNHHS Facility/Provider
90%, no deductible
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Home Health Care
(up to 120 days per calendar year)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
90%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Hospice Care
(up to 60 days per calendar year)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
90%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Other
Durable Medical Equipment
YNHHS Facility/Provider
n/a
Anthem PPO Provider
90%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Hearing Aids
(two hearing aids per 36 months)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Orthotics
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Women and Children
Well-woman visit: OB/GYN Preventive Exam 2
(one per calendar year)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Mammography and Bone Density Test
(Only screening mammography. Does not include breast ultrasounds.)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Screening Breast Ultrasound
(if there is dense breast tissue or a history)
YNHHS Facility/Provider
$20 copay
Anthem PPO Provider
$20 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Maternity Care
(Only in-office pre-natal care. Inpatient Hospital and Doctor or Surgeon services also apply, see below.)
YNHHS Facility/Provider
100%, subject to a $50 copay for
initial visit
Anthem PPO Provider
100%, subject to a $50 copay for
initial visit
Out-of-Network Provider
50% of MAA subject to the deductible
Well Baby/ Well Child Care 1
(includes immunizations)
- seven exams from birth to age one year
- seven exams from age one to five years
- one exam every year from age 6 to 21 years
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Specialized Infant Formula
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Infertility Services Phases II and III treatment, plus medication
(up to maximum lifetime benefit of $8,000)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Office Visits and Physician Services
Primary Care Physician Office Visit 4
(other than for preventive care visits)
Tier 1: Preferred Primary Care Providers4
YNHHS Facility/Provider
100%, subject to a $30 copay
Anthem PPO Provider
100%, subject to a $40 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Specialist Office Visit 4
YNHHS Facility/Provider
100%, subject to a $50 copay
Anthem PPO Provider
100%, subject to a $50 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Routine Adult Exams 1
one exam every calendar year starting at age 22
(includes immunizations)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Doctor or Surgeon Services including maternity claims
(other than an office visit)
YNHHS Facility/Provider
80%, subject to the deductible
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Allergy Shot Administration in Doctor’s Office
(no MD visit)
YNHHS Facility/Provider
100%, subject to a $20 copay
Anthem PPO Provider
100%, subject to a $20 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Nutrition Counseling
(includes diabetes self-management training)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Ancillary Services
Lab Services
(blood work and lab tests)
YNHHS Facility/Provider
100%, subject to a $30 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
X-Rays, including diagnostic mammograms
(facility charges)
YNHHS Facility/Provider
100%, subject to a $30 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
High Cost Diagnostic Imaging—PET/SPECT/MRI/MRA/CTA/CAT/
(facility charges)
YNHHS Facility/Provider
100%, subject to a $200 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Colorectal Cancer Screening 3
(includes fecal occult blood test, barium enema, flexible sigmoidoscopy and screening colonoscopy)
YNHHS Facility/Provider
100%, no copay
Anthem PPO Provider
100%, no copay
Out-of-Network Provider
50% of MAA subject to the deductible
Chiropractic Visits
(maximum 50 visits per year, combined with PT, OT and Speech)
YNHHS Facility/Provider
100%, subject to a $30 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Physical, Occupational and Speech Therapy
(maximum 50 visits per year, combined with Chiropractic)
YNHHS Facility/Provider
100%, subject to a $20 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Inpatient and Outpatient Care
Inpatient Hospital Services
(room and board, lab work, medical supplies and other hospital ancillary services)
YNHHS Facility/Provider
100%, subject to a $1,200 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Outpatient Surgery
(hospital or surgi-center facility charges)
YNHHS Facility/Provider
100%, subject to a $600 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Infusion and Radiation Therapy
YNHHS Facility/Provider
100%, subject to a $50 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Behavioral Health and Substance Abuse
Inpatient Behavioral Health and Substance Abuse Treatment
(facility charges)
YNHHS Facility/Provider
100%, subject to a $1,200 copay
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Outpatient Behavioral Health and Substance Abuse Treatment
NOTE: The Employee and Family Resources (EFR) program provides up to six (6) confidential counseling sessions at no cost .
See Employee Assistance and Work/Life Services
YNHHS Facility/Provider
100%, subject to a $40 copay
Anthem PPO Provider
100%, subject to a $40 copay
Out-of-Network Provider
50% of MAA subject to the deductible
Urgent and Emergency Care and Telehealth
Emergency Department
YNHHS Facility/Provider
$150 copay (copay waived if admitted)
Anthem PPO Provider
$150 copay (copay waived if admitted)
Out-of-Network Provider
$150 copay (copay waived if admitted)
Urgent Care Facility and Walk-In Medical Center
(not Primary Care visit)
YNHHS Facility/Provider
$40 copay (copay waived if admitted)
Anthem PPO Provider
$40 copay (copay waived if admitted)
Out-of-Network Provider
n/a
Ambulance
YNHHS Facility/Provider
n/a
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
80%, subject to the deductible
MDLIVE
YNHHS Facility/Provider
100%, subject to a $20 copay
Anthem PPO Provider
100%, subject to a $20 copay
Out-of-Network Provider
n/a
Non-Acute Care
Skilled Nursing Facility 7
(up to 120 days per calendar year after a hospital stay)
YNHHS Facility/Provider
80%, no deductible
Anthem PPO Provider
70%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Home Health Care
(up to 120 days per calendar year)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Hospice Care
(up to 60 days per calendar year)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Other
Durable Medical Equipment
YNHHS Facility/Provider
n/a
Anthem PPO Provider
80%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Hearing Aids
(two hearing aids per 36 months)
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
Orthotics
YNHHS Facility/Provider
n/a
Anthem PPO Provider
50%, subject to the deductible
Out-of-Network Provider
50% of MAA subject to the deductible
1 All other OB/GYN office visits are covered at the Specialist office visit benefit level.
2 Well visits to the obstetric provider are billed with one global fee which includes: trimester visits, delivery and postpartum care. Any maternity related tests that are needed such as blood work, glucose tolerance tests, stress tests, ultrasounds or, if needed, amniocentesis are billed separately. Inpatient Hospital and Doctor or Surgeon services also apply.
3 Tests (e.g. certain lab work) that are associated with office visits may be subject to a copay or deductible and coinsurance if they are not mandated by the ACA. Check with your provider or call Anthem to determine if a specific test is covered at 100%.
4 List of Preferred Primary Care Providers available at www.ynhhs.org/hrconnect.
5 Diagnostic colonoscopies covered under the outpatient surgery benefit level.
6 Grimes Center, 1354 Chapel Street, New Haven, CT
Benefits for Mastectomy Services
The Yale New Haven Health Advantage Plus Plan and the Yale New Haven Health Advantage Plan provide benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema). In line with medical expenses, the Maximum Allowable Amount is the most the plan will consider paying for mastectomy services. Keep this notice for your records and call the plan administrator for more information.