Provider Network, Medical Benefits & Summary Plan Description (SPD)

Below is an explanation of the provider networks available to you as well as a link to the EHP Summary Plan Description (SPD) and the EHP Plus Summary Plan Description (SPD) with specific plan details. 


Provider Network

The EHP network includes Cleveland Clinic employed physicians and facilities as well as other local contracted providers.  The EHP Plus network includes the Cleveland Clinic Quality Alliance in addition to the Aetna Select Open Access network (a national network). No matter which plan you selected, it is your responsibility to verify your provider's participation each time services are obtained.  To locate a provider, click here.  Note:  You must first register with Aetna to view your plan specific network.

EHPEHP PlusOut-of-Network
NetworkCleveland Clinic Quality Alliance (QA)Cleveland Clinic Quality Alliance (QA)
Aetna Select Open Access (National Network)
No coverage
DeductibleNoneNoneNo coverage
Coverage100% after applicable co-pay or co-insurance100% after applicable co-pay or co-insurance
No Coverage
Urgent Care
100% coverage after applicable co-pay
($50 for Urgent Care / $250 for Emergency*)
100% coverage after applicable co-pay
($50 for Urgent Care / $250 for Emergency*)
100% coverage after applicable co-pay
($50 for Urgent Care / $250 for Emergency*)
* If the emergency visit results in an admission, the emergency visit co-payment will be waived and the inpatient admission co-payment will be applied.  (This applies to retirees under 65 only).  

Retirees who have Medicare Part B as their primary health plan (age 65 and older) are not subject to the co-payment when the EHP pays as secondary.  However, for services not covered by Medicare and the service is a covered benefit by the EHP, the EHP then pays as primary.  In this instance, you could be responsible for the applicable co-payment.

Cleveland Clinic employees should go directly to the third-party administrator (TPA) to resolve any claims payment issues.  The Cleveland Clinic EHP  Third Party Administrator (TPA) is Aetna. The Aetna concierge customer service department can be reached by calling 1.833.414.2331. You can access your health benefit information by registering at Aetna.comor download the free Aetna mobile app for more convenient access to your benefits. Click here for detailed instructions.  If your issue is not resolved to your satisfaction after calling the TPA directly, please call the Cleveland Clinic Customer Service Unit at 216.986.1050 (Option 1).