Employee Health Plan – The Plan
The following information primarily addresses health plan provisions for Cleveland Clinic Employee Health Plan. Current employees have the opportunity each year to re-enroll for coverage through the BeneFlex Open Enrollment process. Through this process, you can choose to keep the same coverage you have or make changes to it for the upcoming calendar year.
EHP offers a two-tier network of providers. Cleveland Clinic and regional hospitals, including participating physicians, comprise the Tier 1 Provider Network. Medical Mutual and USAMCO comprise the Tier 2 Provider Networks.
As a Cleveland Clinic EHP member, you can use either provider tier at any time throughout the benefit year and may see providers in both tiers if you choose. The tier you select, however, determines the amount of coverage you will receive. To receive maximum coverage, you must use Tier 1 Providers.
Tier 1 providers consist of the Cleveland Clinic Quality Alliance (QA) network. The QA is comprised of Cleveland Clinic and regional hospitals, including participating physicians credentialed by the Cleveland Clinic Community Physician Partnership (CPP). The Tier 1 Network of Providers includes Primary Care Providers (PCP), Specialist Providers (SP), Behavioral Health Providers, and Ancillary Services Providers. Ancillary Services are services such as dialysis, ambulance transportation, durable medical equipment (DME), home health, skilled nursing facilities, hospice and others.
Tier 2 consists of two provider networks:
All Emergency/Urgent Care services are covered at 100% after co-payment ($50 Urgent Care and $150 Emergency),
Third-Party Administrator (TPA)
Cleveland Clinic employees should go directly to the third-party administrator (TPA) to resolve any claims payment issues.
- The Cleveland Clinic EHP TPA is Mutual Health Services (MHS). The MHS customer service department can be reached by calling 1-800-451-7929.
If your problem is not resolved to your satisfaction after calling the TPA directly, please call the Cleveland Clinic EHP Customer Service Unit at 216-448-2247 or toll-free at 1-877-688-2247.