Frequently Asked Questions

In the EHP plan, there are approximately 100 additional Behavioral Health providers aligned to the Quality Alliance who are in-network providers. The EHP Plus wide access plan includes the Cleveland Clinic Quality Alliance and all the national Aetna Select Open Access network providers. There is no out-of-network coverage in either plan except emergency or urgent care.

 

A referral is not required to see a specialist in any EHP plan including EHP or EHP Plus.

If your provider(s) is a Cleveland Clinic or Cleveland Clinic Quality Alliance provider, they will continue to be in both EHP and EHP Plus in 2024. You can access your plan provider search tools by registering at Aetna.com or download the free Aetna mobile app for more convenient access to your benefits. Click here for detailed instructions.

Having trouble finding your provider? Contact the Employee Health Plan for assistance at 216.986.1050, select option 1. 
 

The EHP plan consists of Cleveland Clinic and Quality Alliance* providers. EHP Plus option features the EHP network plus Aetna’s Select Open Access national network of providers.  EHP Plus offers a choice for caregivers (and their dependents) who may not reside in the immediate Cleveland Clinic regions in Ohio.

*Wooster Community Hospital is not part of the Quality Alliance and is only available in the EHP Plus plan.  Emergency and urgent care services will be covered out of network for both plans after the applicable copay.

When an employee becomes eligible for COBRA they have the opportunity to continue the coverage that they were covered under immediately prior to the COBRA qualifying event. This means that if they were enrolled in the EHP plan at the time they become eligible for COBRA, their only option to continue coverage is the EHP plan (not EHP Plus). However – they would have the opportunity to switch to EHP Plus during open enrollment (Payflex sends COBRA open enrollment notifications to COBRA participants in the fall).

There is no impact to your retiree medical benefit if you choose to elect that coverage as part of your retirement process. The same two EHP and EHP Plus options will be offered to you. If you plan on retiring, report your retirement date to ONE HR to start the retirement process.

Yes. If an in-patient admission occurs following an out-of-network emergency room or urgent care visit, the EHP plan will cover the hospitalization. There is an ER transfer line phone number located on the back of your medical ID card. When possible, the member will be transported to a CC facility. If transport is not feasible, EHP covers the hospitalization at maximum coverage. 

Eligible dependents who are away at school, like college students, are covered no matter which plan option you have, including EHP or EHP Plus, as long as they use in-network providers for that plan.

The Employee Health Plan allows college students to visit their student health center for non-routine, non-preventive services. These services will be covered as a specialty visit with a $35 copay. Services may include, flu shots, tetanus shots, allergy therapy, and PT/OT/Speech Therapy, if these are provided at the student health center. It is your responsibility to ensure the service you need can be performed at the college’s student health center for coverage.

There is no out-of-network coverage in either plan except for Emergency and Urgent Care visits. Urgent visits to the college student health centers for an acute illness are treated as such, but may initially be denied as not all college student health centers are contracted with Aetna or UMR. If you receive a bill, contact EHP Customer Service for resolution.
 

EHP
The EHP offering will be made up of the Cleveland Clinic Quality Alliance network. Note: The EHP offering will not include Akron Children’s Hospital.  

EHP Plus
The new EHP Plus offering will give members access to the providers available in the EHP plan, plus the Aetna Select Open Access network, offering providers nationwide. This plan may be best for those who are not close to the Cleveland Clinic/Quality Alliance or who have dependents out of state. The EHP Plus offering will include Akron Children’s Hospital.

EHP will continue to offer a comprehensive benefit plan with low out of pocket costs no matter which plan you elect, while premium and network size will differ. The choice is up to you, when you make your health plan elections during Open Enrollment.

If you are currently enrolled in the health plan and do not take action during open enrollment, your health plan coverage will default to the Employee Health Plan (EHP). More details on these health plans and the enrollment process will be made available as we get closer to open enrollment.   
 

Your Health Plan ID can be found on the front of your insurance ID card.  Navigating your health plan ID card through Aetna is easy with this guide.  
 

The EHP and EHP Plus plans do not require members to select a PCP. You can see a mid-level provider in either plan as long as they are in network. We are working with Aetna to modify this statement, as it doesn’t apply for EHP or EHP Plus.

PLEASE NOTE: Not all mid-level providers, like CNPs and PAs, are listed in the provider directory. This is because they sometimes bill under their associated physician’s office, and not as an individual provider.
 

You may have received a bill because you owe a copay/coinsurance.  Specialist visits carry a co-pay with them for every appointment.  Also some scans and tests, such as an MRI, have a co-pay.  You may have also received a bill because the provider or service you received is not in the network, which has a co-pay and a deductible.  For more information please refer to your Summary Plan Description.  

If you have additional questions, please feel free to Contact Us.  Please be sure to have the bill available when you call. 

The Cleveland Clinic offers several ways to pay your bill.  This link will walk you through paying your bill online through MyChart or MyAccount.   You can also Contact Us.

Willis Towers Watson is a company that we contract with to conduct our dependent audit.  You must respond or your dependents will be terminated from our plan.  If you are enrolling dependents onto your plan you will need to provide dependent verification after you have elected coverage to ensure that the dependents you are adding are eligible for coverage. Eligible dependents include your lawfully married spouse and dependent children under the age of 26. After you have elected coverage in Workday, Willis Towers Watson, our Third Party Administrator (TPA) for dependent verification, will send a letter to your home address asking you to provide dependent verification documentation. See the Summary Plan Description (SPD) for more detailed information

Foreign Country Claims:
Emergency services received while in a foreign country are covered, however, payment up front is typically required by the provider. To obtain reimbursement, the member must provide an itemized receipt from the provider which includes a description of services and codes (in English). A claim form then needs to be submitted to the Third Party Administrator along with the receipts.

Emergency Care:
Emergency and Urgent Care are covered at 100% regardless of the provider as long as the visit meets Emergency or Urgent Care criteria as defined in the Definitions of Terms in your Summary Plan Description.  A co-payment is required for any emergency department visit. Observation stays in the hospital are not considered admissions and are subject to the ER copayment.
If the ER visit results in an admission, the ER co-payment will be waived and the admission co-payment will apply. 

The Employee Health Plan requires members to contact the Cleveland Clinic Transfer Center at 866.721.9803 or EHP Medical Management at 216.986.1050 or toll free 888.246.6648 if the member requires admission (including unplanned admissions). These numbers are also on the back of your Health Plan ID card. 
 

Due to privacy laws we are not able to provide protected health information without a release form for anyone 18 or older.  See the Summary Plan Description or our privacy policy for more information.

For coverage related questions, please refer to the My Plan and Benefits page or the Summary Plan Description.  If you have additional questions, you can Contact Us.  Please have the CPT Code (Current Procedural Terminology) and Diagnosis Code available when you call.  This code can be obtained through your provider’s office.

Certain changes that affect you and/or your dependents – such as a marriage, birth, divorce, or qualifying for Medicare – and may result in the need to make changes to your benefit elections

If you experience a qualifying life event and wish to change your coverage, you must do so within 31 days of the event and provide the necessary supporting documentation. Any adjustment to coverage must be consistent with the change resulting from the qualifying life event. To initiate a life event change, visit the HR Workday and Portal and click on the “Benefits” worklet. If you need additional assistance, please feel free to contact the HR Service Center at 216.448.2247, option 1.
 

Please call the HR Service Center at 216.448.2247 or (877) 688.2247 and select the option for Human Resources.

No, the Employee Health Plan will cover one routine exam per calendar year.

Under the EHP Plus option, you receive access to two networks - the Cleveland Clinic Quality Alliance (local) and the Aetna Select Open Access (national) network. This gives more flexibility to those who need to go outside of the Quality Alliance or those living outside of the northeast Ohio area. Because the EHP Plus option has access to nationwide providers, the cost will be higher.  This is the standard in any insurance offering. The benefit coverage is the same for both EHP and EHP Plus. Cleveland Clinic will continue to provide comprehensive medical and prescription drug coverage for our caregivers.  

With the geographic expansion and growth of Cleveland Clinic, it is necessary to change to a third party administrator who can provide a comprehensive provider network to accommodate the needs of our caregivers in these areas.  With the transition to Aetna, the EHP Plus plan will serve this purpose as we continue to grow. That is why Akron Children’s providers will be in the EHP Plus network. The benefit coverage is not changing, meaning still no deductible and lower copays.

Qualifying receipts may take up to 60 days for processing. The claim must be submitted by your provider and paid by Aetna before any copay reimbursement can be processed. Please contact your EHP Care Coordinator if you have any questions. If your receipt does not qualify for reimbursement, you will be notified.

The health plan offers over 20 programs for these conditions including:
Coordinated Care Programs
·    Asthma (for adults and children) ·   
·    Congestive Heart Failure (CHF)
·    Depression (adults and children)
·    Diabetes *
·    Hyperlipidemia (high cholesterol)
·    Hypertension (high blood pressure)
·    Migraine (adults and children)
·    Nicotine Cessation (offered by EHP Wellness tobacco/nicotine )
·    Weight Management (nonsurgical and surgical)

  * The Summary Plan Description contains information about the Diabetes program and copay reimbursement incentives for members under 18 years of age.


Rare or complex condition management programs (managed by AccordantCare):

• Amyotrophic lateral sclerosis (ALS) 
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) 
• Crohn’s disease ​
• Chronic Kidney Disease (CKD)
• Cystic Fibrosis 
• Dermatomyositis 
• Gaucher disease 
• Hemophilia 
• Hereditary angioedema 
• Lupus 
• Multiple Sclerosis 
• Myasthenia Gravis
• Myositis (includes Inclusion Body Myositis - IBM) 
• Parkinson’s disease 
• Polymyositis 
• Rheumatoid Arthritis (includes Juvenile Idiopathic Arthritis)
• Scleroderma 
• Seizure disorders 
• Sickle Cell Anemia 
• Ulcerative Colitis
• Pulmonary Arterial Hypertension (PAH)

To join Coordinated Care programs, please call the health plan’s Medical Management Department at 216.986.1050 or 1.888.246.6648, option 2.

• To join Coordinated Care programs, please call the health plan’s Medical Management Department at 216.986.1050 or 1.888.246.6648, option 2.
• For Rare or Complex Disease Management please visit our website.    
• For nicotine use visit our website for program options.

Studies have shown that those who participate in Coordinated Care programs are healthier and manage their conditions more effectively.  Additionally, you may qualify for money saving discounts and reimbursements. The Coordinated Care Incentive FAQ page has a comprehensive list of the incentives and reimbursements that the Coordinated Care program offers.

1. Members must utilize their EHP Medical and Pharmacy benefit for the supplies and medications in order for these items to be eligible for Coordinated Care program copay reimbursement.
2. The Employee Health Plan (EHP) must be the member’s primary insurance.
3. The EHP card holder (insured), spouse and all eligible dependents on the plan must be actively employed at CCHS, or active on the policy, or be on COBRA at the time receipts are submitted for payment to receive any copay reimbursement.
4. Once you enroll in a specific program, the copays for some screening supplies required for you to manage the chronic condition can be reimbursed. These items may include:
   • Diabetic testing supplies and Glucagon, if enrolled in the Diabetes program. (This does not include alcohol wipes or calibrator/control solution.) Not all items are reimbursable. This applies to adults (18 and up).
   • Peak flow meter and aero chamber (up to $20.00 for each) and Epinephrine pen if enrolled in the Asthma program. (The disposable mouthpiece for the peak flow meter and the coinsurance for a nebulizer are not reimbursable).
   • Hypertension program:  One (1) Upper ArmBlood Pressure Monitor (up to $55) OR One (1) Upper Arm Manual Blood pressure monitor with Stethoscope (up to $55 combined total) once every five (5) years.
   • One (1) Bathroom scale (up to $40.00) and One (1) Upper Arm Blood Pressure Monitor (up to $55) OR One (1) Upper Arm Manual Blood pressure monitor with Stethoscope (up to $55 combined total) once every five (5) years if enrolled in the Congestive Heart Failure program. No finger or wrist blood pressure monitors will be reimbursed.
   • Reimbursement for peak flow meters, bathroom scales and blood pressure monitors occurs once every 5 years.
5. If you are enrolled in the Diabetes program and you have received prior-authorization approval, your insulin pump will be covered at 100%.
6. Up to five (5) in network for EHP or EHP Plus plan members or Tier 1 Cleveland Clinic Martin Hospital Under 65 Retirees, Main Campus Residents and Fellows and Florida Residents and Fellows physician or physician assistant condition related office visit copayments per calendar year are reimbursable AFTER you have met all the program goals. The member becomes eligible from the date you meet all goals forward and must keep meeting all goals to continue to be eligible for the copay reimbursement.
   • EHP Members enrolled in the Diabetes program who have met all the program goals are also eligible for reimbursement of additional copayments for one (1) dilated eye exam and one (1) foot exam from an in network for EHP or EHP Plus members or Tier 1 Cleveland Clinic Martin Hospital Under 65 Retirees, Main Campus Residents and Fellows and Florida Weston Residents and Fellows provider per year.
   • EHP Members enrolled in the Depression program who have met all the program goals are also eligible for copayment reimbursement for up to 15 office visits with an in network for EHP or EHP Plus members or Tier 1 Cleveland Clinic Martin Hospital Under 65 Retirees, Main Campus Residents and Fellows and Florida Weston Residents and Fellows licensed clinical counselor, licensed independent social worker, and/or psychologist.
   • Receipts must be submitted within six (6) months of the date of service. The receipt should include the patient name and date of service. No hand written receipts will be accepted. Release of reimbursement funds is dependent on confirmation that a claim has been paid by the Third Party Administrator, Aetna or UMR (2023).
7.  Medication copays for qualifying condition-related prescriptions, syringes, pen tips and needles can be reimbursed 6 months from the date all program goals have been met. This incentive can only be extended if you continue to meet the goals. Your annual EHP Pharmacy deductible must be met each year prior to any reimbursement being released. Drug manufacturer coupons used to pay deductible will not be applicable for this reimbursement program; if you used one, the first $200.00 of your medication actually paid by you will be considered non-reimbursable. Receipts must be submitted within six (6) months of the fill date.

Documentation needs to be sent to Cleveland Clinic EHP Medical Management.  You must  include the member's name and one other individual identifier such as date of birth, and/or the Member ID number.   
You have three submission options:

• Scan and Email:  EHPpharmacyreimbursement@ccf.org
• Fax:  216-442-5795 to the Attention of Reimbursements
• Mail to: Cleveland Clinic Employee Health Plan

Attn: Coordinated Care Reimbursements
25900 Science Park Drive / AC242
Beachwood, Ohio 44122

Acceptable forms of documentation required include:
1. Office copay receipts should include the Date of Service. The patient name on the receipts and the in network provider name for EHP or EHP Plus members or Tier 1 provider name for Main Campus Residents/Fellows and Weston Residents/Fellows are preferred but not required. Receipts such as (but not limited to) Epic and Core receipts are acceptable as proof of payment or an itemized statement showing proof of payment.
No hand written receipts will be accepted. The Date of Service must be included on the documentation submitted if the member paid after the visit.

2. Individual tax receipts/bar code receipts, along with the register receipts from the Cleveland Clinic/Akron General pharmacies or Cleveland Clinic Home Delivery. Both must be submitted in order to request reimbursement. We do not accept the pharmacy printouts. 

3. For DME qualifying medical supplies related to a program, purchased through an in network provider for EHP or EHP Plus members or Tier 1 providers for Main Campus Resident/Fellows and Weston Resident/Fellows plan.  You must submit the shipping ticket, invoice, or itemized statement from the DME provider that shows the patient name, date of service, and amount paid along with proof of the type of payment (canceled check or payment receipt for a credit card statement). Both must be present to request reimbursement.

 WE CANNOT ACCEPT THE FOLLOWING AS PROOF OF PAYMENT: 
a. Explanation of benefits received from Aetna.
b. Cash register receipts by themselves with no identifying information (date of service, and patient name). You must submit the individual tax receipt with the cash register receipt.
c. We do not accept hand written receipts or pharmacy printouts.

We encourage you to keep a copy of all documentation submitted for your records.

You will find the information regarding what documentation is needed on the Coordinated Care Incentive FAQ page.

Reimbursement checks will be mailed to the policy holder’s address as listed in Workday from Aetna.  Please review any mailings received from Aetna.  Your reimbursement check will be on the bottom of a form that looks very similar to the Explanation of Benefits.

You will find information regarding your reimbursement check on the Coordinated Care Incentive FAQ page.

Yes, for more detailed information review the "When am I eligible for reimbursements and incentives? " area of the Coordinated Care Incentive FAQ page.

• Receipts must be submitted within six (6) months of the date of service. 
• You will find information on when you may submit receipts for reimbursement  on the Coordinated Care Incentive FAQ page.
• NOTE:  If you plan on retiring, you must submit all receipts before you retire.

Reimbursement check is made out to the policy holder of the health plan coverage.

EHP, EHP Plus, Main Campus Residents/Fellows and Weston Residents/Fellows: Aetna will process member requests to replace never received, lost or misplaced reimbursement checks. It must be over 30 days since issued. The member will need to contact Aetna directly by phone at 833.414.2331.

Lost, misplaced or never received checks will not be replaced if it has been more than 180 days* from the date of the original check being issued. 
The member is responsible for ensuring that their correct mailing address is on file with the Human Resources Department in Workday.

* Note: Requests for check reissue that are over 180 days from the date the original check was issued will be declined due to the amount of time that has passed, regardless of the original check amount.

The EHP Medical Management department will process member requests to replace never received, lost or misplaced reimbursement checks totaling $20.00 or larger. For checks that are reissued, a replacement fee of $10.00 will be deducted for the original reimbursement.

 Checks totaling less than $20.00 will not be re-issued.

 Lost, misplaced or never received checks will not be replaced if it has been more than 180 days* from the date of the original check being issued. 

 The member is responsible for ensuring that their correct mailing address is on file with the Human Resources
Department in Workday.

* Note: Requests for check reissue that are over 180 days from the date the original check was issued will be declined due to the amount of time that has passed, regardless of the original check amount

Yes, you can ask to be assigned to a specific EHP Care Coordinator when you call to join. We will do our best accommodate your request, but we cannot promise that all requests can be met.

No, only medications that are related to the program that you are enrolled in may be eligible for reimbursement. Please be aware that not all medications are on the reimbursable medication list. Your Care Coordinator can discuss which medications are eligible or you may check the pharmacy benefit resources that tell you which are eligible.

You will receive a letter from your EHP Care Coordinator when you are meeting all the goals of the program that will tell you which medications you are currently taking that can be reimbursed. If new medications are ordered or if you have questions about whether a medication is eligible for reimbursement, please review with your EHP Care Coordinator to find out if that medication can also be reimbursed.

Your annual pharmacy deductible is waived for generic prescriptions only if they are filled by Cleveland Clinic / Akron General Pharmacies and/or Cleveland Clinic Home Delivery. Brand name medications are subject to the annual deductible. If a generic medication is available, only the generic medication will be eligible for copay/coinsurance reimbursement, unless you have a prior authorization from the EHP Pharmacy Management department on file.
Please refer to your current Prescription Drug Benefit and Formulary Handbook for lists of brand name and generic medications.

Receipts must be submitted within 6 months of the prescription fill date.

NOTE:  If you plan on retiring, you must submit all receipts before you retire.

Only testing supplies (i.e. test strips and lancets) purchased from Cleveland Clinic pharmacies, Cleveland Clinic Home Delivery, or an in network provider for EHP or EHP Plus members or Tier 1 provider for  Main Campus Residents/Fellows and Weston Residents/Fellows will be reimbursed. No receipts will be processed for any supplies filled by other pharmacies or providers. CVS Caremark mail order approved medications or testing supplies are NOT reimbursable unless the policy holder resides in a state that is not serviced by Cleveland Clinic Home Delivery Pharmacy. Receipts must be submitted within six (6) months of the date of purchase.   
 

• Insulin pumps and continuous glucose monitors require prior-authorization according to the EHP Summary Plan Description.
• These items must be obtained through an in network provider for EHP or EHP Plus members or Tier 1 provider for Main Campus Residents/Fellows and Weston Residents/Fellows.
• Copays for continuous glucose monitors, transmitter and/or receivers are reimbursable upon meeting all the goals of the Diabetes program.
• Copays for some of your insulin pump supplies and continuous glucose monitor (device and parts) are reimbursable if you have met all the program goals.
• The coinsurance is NOT reimbursable for glucometers.
• The member becomes eligible for copay reimbursement from the date they meet all the goals and going forward. You must continue to meet all the goals to continue to be eligible for the copay reimbursement.
• Not all supplies are reimbursable (e.g. batteries).

Receipts must be submitted within six (6) months of the medication or DME prescription fill date.

The health plan works alongside your health provider to support your wellness.  For consistency, we have a standard data collection process for those identified with one of the six chronic conditions, as well as those identified as “healthy”.  

No, we cannot accept participation from another employer or insurance company.

Both employees and their spouse have an opportunity to earn a discount towards their premium. There are 5 discount levels based on what the employee (and spouse if applicable) earn: 
Bronze – Bronze is our standard premium rate 
Silver – 7.5% off the bronze premium rate
Gold – 15% off the bronze premium rate
Platinum – 22.5% off the bronze premium rate
Diamond- Is the best discount at 30% off the bronze premium rate

Additional information is available on the Healthy Choice page of the website.

Only the employee and their spouse are eligible to participate in Healthy Choice.  Dependent children, retirees, Cobra members, and PRN employees are not eligible to participate.

Please note, if you are a resident or fellow, contact EHP customer service for more information regarding Health Choice participation.  A specialist can be reached by email at EHPwellness@ccf.org or by phone at 216.986.1050, option 3 or 888.246.6648 option 3.

No, the Healthy Choice Program is only available to those employees and spouses currently on the health plan.  

Pregnancy changes your program requirements.  If you are enrolled in Coordinated Care, contact your Care Coordinator for information and updates.  If you are not enrolled in Coordinated Care, contact EHP Customer Service by email at EHPwellness@ccf.org or by phone at 216.986.1050, option 3 or 888.246.6648 option 3.

Health coaching takes a client centered approach to enhancing well-being through creating and
sustaining behavior change. Health coaching honors the fact that each of us is an expert on our own
lives. Health coaches partner with clients to help them discover their needs, tap into their internal
strengths, environment, and external resources to make sustainable, life-long behavior change.

What makes health coaching different from ‘traditional’ coaching is that it is self-directed. Meaning,
that in your interpersonal relationship with a health coach you will decide your own goals, engage in
self-discovery, and learn how to self-monitor your behaviors to promote personal accountability
toward your own version of health & wellness. The wellness eCoaching team incorporates the
foundations of health coaching into our programs. 

Wellness is personal and the steps you take to reach your wellness goals should be personal too.
Coaching is designed around YOU – your schedule, your lifestyle, and your goals. We pair you with a
coach who provides you with guidance and education to reach your individual goals. Your coach is
there to keep you motivated, build your self-confidence, help you solve problems, and keep you
accountable.

Frequent communication is key. Participants who are most successful typically email at least 1-2
times per week. The ideal number of emails per week can vary from person to person, so talk with
your coach about a schedule that works for you.

If you signing up as a member of Healthy Choice, you will need to send a minimum of one email a week
for 16 weeks.

In your emails, you can send basic information like updates on weight loss and your habits, or
more complex thoughts like desires for your physical health and emotional wellbeing. The more you
invest in our partnership, the more personalized your conversations become and that leads to more
meaningful change.

Those check-in emails are what we call a nudge. If your coach hasn't heard from you in a few
days they'll send a nudge to see how you're doing and remind you to continue sending emails to stay
active and engaged in the program. We still need emails from you, so keep in mind that these nudge
emails are not replacing your messages to your coach.

We can provide suggestions for general exercise and healthy eating guidelines. However, our team does not provide individualized workout or diet plans as it does not align with the scope of health coaching. EHP does offer options for receiving nutrition and fitness services. You can find more information on the Member Offerings page.

You will have until September 30th each year to complete all of the program requirements.

 Your coach will reach out to you using the email address you used during registration.

If you plan to file an appeal, you must contact EHP by March 31st.  To contact EHP, please call 216.986.1050 option 3 or toll free at 888.246.6648 Monday - Friday 8am to 4:30pm EST.

If you have additional questions, please email us at eCoaching@ccf.org
 

All active Cleveland Clinic Employee Health Plan members with any of the 19 conditions are eligible to participate free of charge.
(Retirees are not eligible to participate in the program)

Participation is voluntary and members can opt out at any time.  A variety of service options are available to meet the unique needs of all its members.  Members continue in the program if they are eligible and can participate in a variety of ways.

During the first quarter of the new year EHP and AccordantCare will be analyzing the previous year's data to determine eligibility for an incentive.  Once the analysis is complete, AccordantCare will be advised of those participants receiving an incentive. 

Incentives will be disbursed during the first quarter of a new year and mailed to homes.

If you feel you met all of the incentive requirements and did not receive a check, you may email EHP at EHPAccordantAppeals@ccf.org to open an appeal.  Your information will again be reviewed by both EHP and AccordantCare.  An answer will be provided to you within 14 days.  Please provide the following information when emailing EHP:

• Full Name
• EHP health plan ID found on the front of your medical ID card
• Date of birth
• AccordantCare Member ID if available

If your primary health insurance is not Employee Health Plan, you do not qualify for an incentive.

If you feel you met all of the incentive requirements and did not receive a check, you may email EHP at EHPAccordantAppeals@ccf.org to open an appeal.  Your information will again be reviewed by both EHP and AccordantCare.  An answer will be provided to you within 14 days.  Please provide the following information when emailing EHP:

• Full Name
• EHP health plan ID found on the front of your medical ID card
• Date of birth
• AccordantCare Member ID if available

Yes, every member of a family has their own health plan ID number and their own health plan ID card.  

Once you have your health plan ID card with your EHP ID or UMR ID number you can join a Healthy Choice or Coordinated Care program.

The two most common reasons that a new member is told they do not have coverage are:

The prescription drug benefit is included in your Employee Health Plan coverage, so when you enroll in the Employee Health Plan you are automatically covered. CVS/Caremark administers this plan and will mail you a CVS/Caremark prescription ID card about 4 weeks after you have elected coverage under the Employee Health Plan in Workday. If you need to have a prescription filled prior to your CVS/Caremark ID card arriving you will need to pay for the prescription out of pocket, then you can apply for a reimbursement after your card has arrived. 

Is the prescription for a medication you take every day?  Maintenance medications like that maybe filled one time at a retail pharmacy such as CVS.  All other refills must be filled at Cleveland Clinic MyRefills, a Cleveland Clinic pharmacy, or CVS mail order. 

No, a referral is not needed to see a specialist.

Please visit our Find a Provider page on our website under your applicable plan.  

The Health Plan does not have out-of-network coverage except in case of emergency.  If you see a provider or go to a hospital that is not in network, except in the case of an emergency, you will be responsible for all charges and fees.
 

Tier levels only apply to ONA, Main Campus Residents and Fellow and Florida Region members. The Tier refers to the network that your provider or facility is in, under the Health Plan service network.  The plan will always pay the most for services provided within the tier I network.  If you choose a doctor or hospital in tier 2 there will be a co-insurance and a deductible that may apply.  See the Summary Plan Description for more information.
 

Once you have submitted your health plan coverage elections, it takes up to 4-6 weeks to receive your ID cards in the mail. To access your cards before they arrive, view the instructions on this page. 

Your coverage effective date will be retroactive to your date of hire, or the date of a qualified life event – however it takes about 4 weeks for your health plan ID cards to arrive in the mail after you have elected coverage in Workday.

If you have questions regarding your eligibility effective date, please Contact Us.

All caregivers start at the bronze “standard” premium level. You can only earn a different premium by participating in our Healthy Choice program.

You can learn more by navigating to the Caregiver Workday and Portal and click on the inbox icon located in the upper right-hand corner by your picture. Electing benefits in the Caregiver Workday and Portal is a two-step process. The first step is learning more about the Cleveland Clinic benefit plans on the Caregiver Workday and Portal and selecting your plans. The second step is to elect your benefits in the Caregiver Workday and Portal by clicking on your benefits task located in your inbox and following the on-screen prompts. 

If your provider(s) is a Cleveland Clinic or Cleveland Clinic Quality Alliance provider, they will continue to be in both EHP and EHP Plus plans. Please reference the Aetna provider search tools to identify physicians and facilities covered in each of the plans.

EHP provider search
EHP Plus provider search
EHP Main Campus Residents and Fellows provider search
EHP Akron ONA provider search

Having trouble finding your provider? Contact the Employee Health Plan for assistance at 216.986.1050, select option 1. 
 

EHP
The EHP offering will be made up of the Cleveland Clinic Quality Alliance network. Note: The EHP offering will not include Akron Children’s Hospital.  

EHP Plus
The new EHP Plus offering will give members access to the providers available in the EHP plan, plus the Aetna Select Open Access network, offering providers nationwide. This plan may be best for those who are not close to the Cleveland Clinic/Quality Alliance or who have dependents out of state. The EHP Plus offering will include Akron Children’s Hospital.

EHP will continue to offer a comprehensive benefit plan with low out of pocket costs no matter which plan you elect, while premium and network size will differ. The choice is up to you, when you make your health plan elections during Open Enrollment.

If you are currently enrolled in the health plan and do not take action during open enrollment, your health plan coverage will default to the Employee Health Plan (EHP). More details on these health plans and the enrollment process will be made available as we get closer to open enrollment.   

 

Mercy Hospital and Marymount Hospital members will have a religious accommodation with respect to the health plan.  Mercy members will be contacted directly by Aetna and Caremark regarding female contraceptive coverage, as required under the Affordable Care Act.  If coverage is needed, members must take action at that time.  Additional questions can be directed to the Aetna Concierge Customer Service Unit at 1.833.414.2331.

Due to the religious exemption in place at Mercy Hospital and Marymount Hospital, infertility treatments as well as other services are excluded.  If you have specific questions regarding the religious exemption, please contact the Aetna Concierge Customer Service Unit at 1.833.414.2331.

No, these must be purchased through an in network provider with a prescription.  Compression stockings are covered at 50% and are limited to six pairs per year.

Hearing aids are covered at 50% of the billed amount up to $3,500 per ear; one aid per ear every three years. Evaluation, consulting, and dispensing fees are covered at 100%. Repair of hearing aids ARE NOT covered. There is NO coverage of the hearing aids, evaluation, consultation, or dispensing fees obtained outside of the network. This information is also available in the Summary Plan Description.

Custom-made orthotics are covered at 80% of the allowed amount after your $50 co-payment. If the contracted rate is less than the amount of the co-payment, the member is still responsible for the corresponding co-payment/co-insurance. 

General orthotics are not a covered benefit.  

Orthopedic shoes and diabetic shoes are not considered orthotics.  

This information is also available in the Summary Plan Description.

You can go to Find a Provider and search by your specific plan.  You may also Contact Us.

The Health Plan benefit for durable medical equipment (DME) is 80/20.  Which means we pay 80% of the cost and you pay 20% as long as you use an in network provider.  Some equipment does require prior authorization. For exceptions and more information please review the Summary Plan Description.

The pump should be under warranty.  Please contact the manufacturer for a repair/replacement.

 

A breast pump can be obtained within 4 months after the birth of the infant.  You can purchase a breast pump at Cleveland Clinic pharmacies with a prescription, but you can also use another in network durable medical equipment (DME) provider.  See the Summary Plan Description for more information.

A CPAP/BIPAP machine can be obtained by going through a durable medical equipment (DME) provider.  You can go to Find a Provider and search by your specific plan.  You may also Contact Us.

You can view your CVS Rx card on the CVS/caremark website.  Once on the site and logged in, click on Plan & Benefits on the navigation bar and then Print Member ID Card.  Within this area, you can also request a new card.

You can view your CVS Rx card on the CVS/caremark website.  Once on the site and logged in, click on Plan & Benefits on the navigation bar and then Print Member ID Card.  An image of your card will then be displayed. 

You can view your CVS Rx card on the CVS/caremark website.  Once on the site and logged in, click on Plan & Benefits on the navigation bar and then Print Member ID Card.  Within this area, you can also request a  new card.

No.  Some of the programs, for example Weight Watchers, require the member to pay part of the program cost.

Some of our programs do have participation requirements for the Health Plan to continue paying for the benefit for you or a dependent.  You can find more information on the EHP website under Member Offerings.

No, we do not reimburse for programs that are not part of our plan offerings.

No, we are not able to offer wellness programs to the retirees or through any other 3rd party program.

All cancelations are handled by the provider of the program; contact them to cancel. Make note that the provider may charge you a cancellation fee.  

Your next steps are dependent on different factors. Please contact us for further assistance by sending a message to us through the help section of your Healthy Choice Portal. You can also send an email to EHPWellness@ccf.org or call 216.986.1050, option 3 or toll free 888.246.6648, option 3.

The EHP wellness programs are programs designed to help you meet your goals for healthy living. The Healthy Choice Program is our premium discount program and although some of the EHP Wellness programs can be used to meet your Healthy Choice goals they are not the same.

We offer:
Gym Memberships
Weight Loss Programs
Nutrition Visits
Nicotine Cessation 

Members of the Employee Health Plan and their dependents, who are not on the retiree plan or PRN.  Also please keep in mind that some programs may have restrictions for minors that are not imposed by EHP.  Please contact the individual program staff directly for information on those policies. 

That is not a charge, the Health Plan is required by the IRS to add the cost of some EHP Wellness programs to your check as income so that the IRS can tax you on the benefit.  This is similar to the Tuition Reimbursement program or the Caregiver Celebrations program.  

The value of your fitness center membership and other wellness programs such as Weight Watchers are generally taxable income and reportable on your Form W-2.  This applies to contracted vendors, such as Medina County Recreation Center.

If you have further questions please contact the Cleveland Clinic Tax Department by calling 216.448.2247, option 3 or 877.688.2247.