Union Hospital

Yes, if you want healthcare benefits through Cleveland Clinic in 2024.

During open enrollment, you will have the choice between two health plans in Workday:

1. Employee Health Plan (EHP)
2. Employee Health Plan Plus (includes a national network of providers)

EHP

The EHP offering includes the Cleveland Clinic Quality Alliance (QA) network and the Florida Clinically Integrated Network (CIN). These networks include Cleveland Clinic facilities and employed physicians as well as contracted facilities and providers in Ohio and Florida.

Please note: University Hospitals Health System, Akron Children’s Hospital, Aultman Hospital, Summa Health System and their affiliates are not included in the EHP network.

EHP Plus

The EHP Plus offering gives members access to the providers available in the EHP plan (above), PLUS Aetna's Open Access Select network, which includes providers nationwide. Akron Children’s Hospital is included in the EHP Plus network.

Please note: University Hospitals Health System, Aultman Hospital, Summa Health System and their affiliates are not included in the EHP Plus network.

 Both plans offer the same benefits and coverage, while premium and network size differ. The choice is up to you when you make your health plan elections during open enrollment.

You must take action during open enrollment by logging into Workday and electing either EHP or EHP Plus. More details on these plans and the enrollment process will be made available as we get closer to open enrollment, Oct. 19 – Nov. 3, 2023.

Cleveland Clinic provides comprehensive health and prescription drug coverage for our caregivers, and the benefit coverage is the same for both EHP and EHP Plus. The difference between the two plans is the network of providers and the benefit cost. Under the EHP Plus option, you receive access to the Aetna Select Open Access (national) network which also includes the Cleveland Clinic Quality Alliance network.  Because EHP Plus includes nationwide providers, the cost will be higher. This is the standard in any insurance offering.  Premiums will be available at open enrollment.
 

Although the cost of EHP Plus is more than the EHP option, for an open access network, it is competitively priced and has low out-of-pocket expenses. With the EHP Plus, you receive access to the Aetna Select Open Access network. Because the EHP Plus option has access to nationwide providers, the cost will be higher. Both plans provide rich coverage, meaning there are no deductibles with minimal copays and co-insurance no matter which option you choose, EHP or EHP Plus. In addition, your Healthy Choice participation helps to lower premium costs. 

As a reminder, active caregivers can further offset the cost of their health, dental, vision and supplemental life elections by trading in their PTO during the PTO trade for benefits period, Nov. 14 – Dec. 1, 2023.
 

A provider search is available to see if your provider is in network.

EHP provider search
EHP Plus provider search

It is your responsibility to verify your provider’s participation in the networks. Please reference the Aetna provider search tools to identify physicians and facilities covered in each plan.

Having trouble finding your provider?  Contact the Aetna Concierge customer service unit at 833.414.2331.  

These medical institutions and their affiliates are excluded from both EHP and EHP Plus unless services provided are for emergency or urgent care.

In case of an emergency, services will be covered by either the EHP or EHP Plus plan at any location as outlined in the Summary Plan description.

In 2024, Akron Children’s Hospital (ACH) will be available to any caregiver who elects EHP Plus during open enrollment. If you would like to maintain your coverage for ACH, you must elect EHP Plus. There is no coverage for ACH under the EHP option.

With the geographic expansion and growth of Cleveland Clinic, it is necessary to offer a plan that accommodates the needs of our caregivers nationwide.  The EHP Plus option serves this purpose as we continue to grow.  EHP Plus includes a wider network of providers in addition to Cleveland Clinic and Quality Alliance providers.  The benefit coverage is the same for both EHP and EHP Plus with no deductible and low copays.

Providers who are included in the Cleveland Clinic Quality Alliance or Aetna Select Open Access networks will be covered if you elect EHP Plus.  If your specialist is participating in either of these networks, they are considered in-network and services will be covered.  You can access the provider search tool for the EHP Plus option to confirm that your specialist participates in the Aetna Select Open Access network. 

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

Both EHP and EHP Plus have large networks of participating Behavioral Health providers. Before open enrollment, you will be able to search providers for each plan. There is no out-of-network coverage in either plan except emergency or urgent care.  

 

Beginning in 2024, Union caregivers and their spouses will be able to join the Healthy Choice premium discount program. For more information on the Healthy Choice program, click here. The Healthy Choice portal and other wellness programs will be available to you to join when you have your new health plan ID number, at the beginning of 2024.

Note: The Healthy Choice information on the Employee Health Plan website is current for the 2023 program year and may not reflect the complete program requirements for 2024. Any updates to the program will be reflected on the website in January 2024.

Yes. Any discount you earned in 2023 will apply to your health plan premium in 2024. Your Direct Primary Care discount will be visible in Workday when you elect benefits during open enrollment.
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As an EHP or EHP Plus member, you will have access to a comprehensive drug benefit program that utilizes a custom formulary and multiple utilization management strategies to drive value, thereby keeping your out-of-pocket health care expenses as low as possible.  

The health plan’s Prescription Drug Benefit Program is managed by the Employee Health Plan Pharmacy Management Department and insured by CVS/Caremark. The Prescription Drug Formulary can be found on the Employee Health Plan website, along with other information related to the Prescription Drug Benefit Program. Medications may be added to the formulary four times a year and removed from the formulary twice a year, once at the start of the benefit year in January and again at mid-year in July. Caregivers should consult the health plan’s Prescription Drug Formulary to determine whether their current medications are included in the formulary, and to discuss alternative options with their healthcare provider if their current medication is not covered.
Note: The pharmacy information on the Employee Health Plan website is subject to change in 2024.  
 

Yes, the Prescription Drug Benefit Program is the same for both EHP and EHP Plus members.

Yes. EHP and EHP Plus members are encouraged to use the Cleveland Clinic Union Hospital Outpatient Pharmacy or any of the other Cleveland Clinic pharmacies, including the Cleveland Clinic Home Delivery and Specialty pharmacies, to obtain their medications. You will receive a lower percentage co-insurance for your prescription medications by using Cleveland Clinic pharmacies, and your annual pharmacy benefit deductible will not be charged if you use a Cleveland Clinic Pharmacy and if your prescription is filled with a generic medication.

No, it will not. Your provider must re-submit a new prior authorization request to EHP Pharmacy Management. This new request will be evaluated against the coverage determination criteria that have been developed by the EHP Pharmacy Management Team and approved by the EHP Pharmacy & Therapeutics Committee. Please note that submission of a new prior authorization request does not guarantee approval of the request. The prior authorization form can be found on the Employee Health Plan Website under Forms.

EHP and EHP Plus members can utilize any of the CVS store pharmacies, including those located inside Target stores, to obtain acute need prescription medications. Please note the charge will apply to your annual pharmacy deductible even if you fill the prescription with a generic medication. 

Yes, look for new health and pharmacy ID cards in the mail prior to January 2024. Please be sure your address is up to date in Workday prior to open enrollment.   You should use your existing health plan ID cards through December 2023 for services.

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

 

Eligible dependents who are away at school, like college students, are covered no matter which plan option is selected, EHP or EHP Plus, if they use in-network providers for that plan. 

Both EHP and EHP Plus plans allow 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. If you receive a bill, contact Employee Health Plan Customer Service for resolution at 216.986.1050 or 888.246.6648.
 

Additional information will be coming soon. Please bookmark this site for the most current information. 

Additional resources:

• Workday or benefits questions: Contact the HR Service Center at 216.448.2247 or 877.688.2247.
• Employee Health Plan questions:  Contact the Employee Health Plan at 216.986.1050 (option 1) or the Aetna Concierge Customer Service team at 833.414.2331.
• Simply Healthy Choice or Healthy Choice:  Contact the Employee Health Plan Wellness team at 216.986.1050 (option 3) or 888.246.6648 (option 3).
• Employee Health Plan Pharmacy Management questions: Contact the Pharmacy Management Department at 216.986.1050 (option 4) or 888.246.6648 (option 4). You can also email the department at EHPRxMgmt@ccf.org.