Employee Health Plan – Provider Network
The 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. To find a Tier 1 Provider click here.
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 www.MutualHealthServices.com/CCHS
and choosing the applicable network you would like to search.
Emrgency/Urgent Care services are covered at 100% after a co-payment ($50 Urgent Care and $250 Emergency),
Third-Party Administrator (TPA)
The EHP is partnered with Mutual Health Services (MHS) to administer your medical benefit program. As the TPA, Mutual Health Services manages claims processing, eligibility verification, explanation of benefits (EOB), coordination of benefits (COB) and subrogation processing.
You can access your health benefit information by registering at chn.mutualhealthservices.com
. NEW IN SEPTEMBER!
Download the free MHS mobile app for more convenient access to your benefits. Click here
for detailed instructions.
Members should go directly to MHS to resolve any claim payment issues. MHS can be reached at 1.800.421.7929.