How to Fill Out the Yale New Haven Settlement Claim Form

To fill out the Yale New Haven settlement claim form, enter the Unique ID and PIN from your notice, provide your name and mailing address, choose either Cash Payment A (up to $5,000 for documented losses) or Cash Payment B (an estimated $100 with no paperwork), optionally check the box for two free years of medical data monitoring, pick how you want to be paid, sign, and submit online at yalenewhavensettlement.com or by mail postmarked no later than February 18, 2026.¹

Before You Start

Gather a few things first so you’re not hunting for them mid-form.

Pull out the postcard or letter you received from Yale New Haven Health. It carries a Unique ID and PIN that link your claim to the system’s records and speed up verification. If you can’t find the notice, you can still file by entering your full legal name and current mailing address.²

If you plan to claim documented losses, collect the receipts, bank statements, invoices, or bills you’ll be attaching. If you want the free medical data monitoring, have a working email address ready, because the activation code is delivered electronically when you provide one.¹

Filling Out Each Field on the Form

The form itself is short. Missing a required field will hold up your payment, so work through it in order.²

Unique ID and PIN. Copy them exactly as printed on your notice.
Name. First name, middle initial, and last name. Required.
Mailing address. Street, apartment number, city, state, and ZIP code. Required, and this is where a paper check would be sent if you choose that payment method.
Phone number. Not required, but useful if the administrator has a question about your claim.
Email address. Required if you want medical data monitoring or plan to receive an electronic payment.
Benefit selection. Check the box for Cash Payment A or Cash Payment B. Not both. You may also check the box for medical data monitoring alongside either cash option.
Supporting documentation. Only needed if you selected Cash Payment A. Attach copies, not originals.
Payment method. Pick one from the options on the form.
Medicare declaration. If you were a Medicare beneficiary at any point from March 8, 2025 to the present and you’re claiming emotional distress benefits, check the additional declaration box.
Signature. Sign, print your name, and date the form.

Choosing Between Cash Payment A and Cash Payment B

This is the one real decision on the form, and you can’t do both.²

Cash Payment A reimburses documented, out-of-pocket losses of up to $5,000 tied to the breach, incurred on or after March 8, 2025. Eligible losses fall into three buckets:

Professional fees to address identity theft or fraud, such as costs for placing a credit freeze or dealing with falsified tax returns, unauthorized account activity, or medical identity theft.
Other fraud-related losses, including bank fees, charges for credit reports, credit monitoring subscriptions, or identity theft insurance purchased because of the breach.
Miscellaneous expenses like notary fees, fax and postage costs, long-distance phone charges, and mileage driven to a police station or IRS office.

Cash Payment B is a flat, estimated $100 with no documentation required. Check the box and you’re done with that section. The final amount can go up or down depending on how many people file.

The practical test: if you can prove more than about $100 in real, breach-related expenses with receipts and statements, Payment A is worth the effort. If you can’t, Payment B is the cleaner path.

What Counts as Documentation for Payment A

This is where claims get rejected. Every expense you list needs supporting proof, and self-prepared documents (handwritten receipts, personal declarations, your own affidavits) are not enough on their own. The administrator treats them only as supplemental context alongside real records.²

What does count:

Receipts showing payment for a credit freeze or other identity-theft professional fees.
Bank or credit card statements with unauthorized charges highlighted.
Invoices for credit monitoring subscriptions or identity theft insurance.
Phone bills for long-distance calls made about the breach.
For mileage, a list of addresses you traveled to along with the reason and miles driven.
Postal receipts for certified mail, notary receipts, and similar official records.

If you spent $40 on certified mail to dispute a fraudulent charge, keep the postal receipt. A note in your own handwriting saying you spent $40 will not carry the claim on its own.

Adding the Free Medical Data Monitoring

Two years of medical data monitoring is available at no cost, regardless of which cash option you pick. Check the box on the form and provide a valid email address, because the activation code is sent electronically. If no email is on the form, the code is mailed to you instead.¹

Picking a Payment Method

The form lets you choose how you want your money delivered. Each option has its own field requirement:²

PayPal, with the email associated with the account.
Venmo, with the mobile number on the account.
Zelle, with either the mobile number or email tied to the account.
Virtual prepaid card, delivered to the email address you provide.
Paper check, mailed to the address on the form.

Double-check the contact detail you enter. A typo in the email or mobile number sends the money to the wrong place, and untangling that after the fact is slow.

Submitting the Form

You can file online or by mail. The deadline is the same either way: February 18, 2026.¹

Filing Online

Go to yalenewhavensettlement.com, enter your Unique ID and PIN, complete the fields, upload your supporting documents as digital files if you selected Payment A, and submit. The system generates a confirmation number. Save it. If any question comes up later about whether your claim was received on time, that number is your proof.

Filing by Mail

Print the claim form from the settlement website, fill it out by hand, and mail it with copies (not originals) of your supporting documents to:

Yale New Haven Health Data Incident Settlement Administrator
P.O. Box 5113
Portland, OR 97208-5113

The envelope must be postmarked no later than February 18, 2026. A late postmark means automatic rejection. Send it certified or with delivery tracking so you have a record, and don’t wait for the final day.

Key Dates To Watch

January 20, 2026. Deadline to exclude yourself from the class or file a written objection. These are separate paths from filing a claim; if you take either action, you’re not using the form covered here.³
February 18, 2026. Deadline to submit the claim form, online or by mail (postmark date for mail).¹
March 3, 2026 at 4:00 p.m. ET. Final Approval Hearing. No payments go out before the court approves the settlement.¹

What Happens After You File

Payments don’t go out until the court grants final approval and any appeals are resolved. The settlement website confirmed that class payments began dispersing on May 27, 2026. Paper checks arrive within about a week of that dispersal; electronic payments follow the method you selected.¹

Your final amount may not match what you wrote on the form. The $18 million fund pays attorneys’ fees, administrative costs, and medical monitoring first. What’s left, the Net Settlement Fund, is divided among approved claims. If total approved claims come in under that number, everyone’s payment goes up proportionally. If claims exceed it, payments are reduced proportionally. Priority order is medical data monitoring first, then Cash Payment A, then Cash Payment B, which means the $100 estimate for Payment B is the number most likely to shift.²

1
Yale New Haven Data Incident Settlement. Yale New Haven Data Incident Settlement
2
ClassAction.org. Yale New Haven Health Services Corp. Data Breach Claim Form
3
Yale New Haven Data Incident Settlement. Frequently Asked Questions