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.
 

The Details

As of Janury 1, 2018, EHP offers a three-tier network of providers. Cleveland Clinic and regional hospitals, including participating physicians, comprise the Tier 1 Provider Network.  The Midwest Health Collaborative is the new Tier 2.  Medical Mutual and First Health comprise the Tier 3 Provider Networks.
 
As a Cleveland Clinic EHP member, you can use any provider tier at any time throughout the benefit year and may see providers in multiple 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 ProvidersIt is your responsibility to verify and obtain the most current Tier participation each time services are obtained.
 
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 consist of the Midwest Health Collaborative (MHC).  MHC is a group of health systems and their employed physicians across the state of Ohio.  Provider Directory:  https://directory.mhcol.com   or website: https://www.midwesthealthcollaborative.org
 
Tier 3 consists of two provider networks:
All Emergency/Urgent Care services are covered at 100% after co-payment ($50 Urgent Care and $250 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 (option 2).