Employee Health Plan – The Plan
The following information primarily addresses health plan provisions for the Cleveland Clinic Employee Health Plan. Current employees have the opportunity each year to re-enroll for coverage through the 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.
As of January 1, 2020, EHP offers a two-tier provider network to choose from for members in Ohio. The Tier you select determines the amount of coverage you will receive. To receive maximum coverage, you must use Tier 1 Providers. It is your responsibility to verify and obtain the most current Tier participation each time services are obtained.
Following is a description of each Tier.
Tier 1 Provider Network:
Consists 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 Provider Network:
Consists of providers in the MMO SuperMed network (within the state of ohio) and Aetna® Open Choice® PPO network (outside the state of Ohio)
Tier 2 benefits benefits include an annual deductible of $500 for single coverage and $1,500 for family coverage. After the deductible is met, all inpatient, outpatient services and laboratory/diagnostic services will reimburse at 70% after any applicable co-payment with the exception of emergency services. Tier 2 providers can be accessed by visiting MutualHealthServices.com/CCHS and choosing the applicable network you would like to search.
All Emergency/Urgent Care services are covered at 100% after a 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 (Option 2).