Mercy Hospital

Find the latest information here regarding new plan offerings in 2023 for Mercy Hospital caregivers.

Preview your medical benefits options now; enrollment begins soon

During this year’s open enrollment beginning Oct. 20 through Nov. 4, you will have the opportunity to select from two medical insurance options — EHP and EHP Plus. 

The EHP Website is your hub to learn all about your medical benefit options ahead of open enrollment. New information this week includes:

  • Search for doctors and providers with the links below
  • View a video tutorial for navigating the Provider lookup tool
  • New and updated frequently asked questions by caregivers
  • Compare EHP and EHP Plus Plans

EHP provider search

EHP Plus provider search

Note, Aultman Hospital and affiliates may appear in network in 2022.  As of 1/1/2023, Aultman Hospital and all affiliates will be out-of-network for EHP, EHP Plus and all EHP plans.  

Remember, in 2023 there will no longer be out-of-network coverage for the EHP and EHP Plus plans except for urgent or emergency care. 

Continue to check this site as we work on completing the network for 2023. 


Simply Healthy Choice

If you participated in the Simply Healthy Choice program, your discount level earned will be available in Workday on Thursday, Oct. 20. Your Simply Healthy Choice discount will apply to your 2023 medical plan election — EHP or EHP Plus. The Healthy Choice program will replace Simply Healthy Choice in 2023 and can provide caregivers the opportunity to earn premium discounts towards their 2024 premiums.  You will be able to enroll in the Healthy Choice program in Jan. 2023. 

Want to learn more about 2023 benefits? Join us for a Benefits Fair on Tuesday, Oct. 18 and Wednesday, Oct. 19, from 7:30 a.m. to 4 p.m. in the Medical Office Building, ACC Ground Floor. Learn more about open enrollment, Healthy Choice, pharmacy options, and speak with Employee Health Plan representatives who will be available to answer questions.   


Cleveland Clinic is invested in your health and well-being, and we look forward to continuing to offer comprehensive healthcare benefits and a competitive My Pay + Benefits package.


Mercy Hospital FAQs

Yes, if you want healthcare benefits through Cleveland Clinic in 2023.

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 Cleveland Clinic providers, in addition to Quality Alliance providers.

Please note:  Akron Children's Hospital is 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.  

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 the EHP or EHP Plus plan. More details on the health plans, the enrollment process and the Mercy Hospital Benefits/Wellness Fair will be made available as we get closer to open enrollment, Oct 20 - Nov. 4.
 

Yes. 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 providers 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. For members of both plans, Cleveland Clinic will continue to provide comprehensive medical and prescription drug coverage. Premiums are currently in the process of being determined and will be available when open enrollment begins Oct. 20.

A provider search will be available online for each network in October for you to see whether current providers will be covered for you in 2023.  

When deciding on which plan to select for 2023, you are strongly encouraged to check all of your current providers to see if they are listed in your new network choice. You are expected to receive all your care from the providers in the network you choose. 

As the 2023 plan year begins, there may be certain situations in which you are finishing a treatment that is already started and need more time to switch to an in-network provider. In this instance, a brief and temporary transition-of-care coverage for the out-of-network provider may be available. Restrictions apply and situations are limited. Find the most current Transition of Care form at https://employeehealthplan.clevelandclinic.org/. Bookmark this site to find current information on eligibility and the process of requesting temporary transition-of-care coverage in 2023.

Yes, you need to ask for a TOC waiver if your OB provider is not in your network and you are experiencing a high-risk pregnancy, or if you are having a routine pregnancy and are at 20 weeks or more gestation as of Jan. 1, 2023. 

If your provider(s) is a Cleveland Clinic or Cleveland Clinic Quality Alliance provider, they will be in network for both EHP and EHP Plus in 2023. It is your responsibility to verify the participation of your provider in the networks. Please reference the Aetna provider search tools to identify physicians and facilities covered in each of the plans.


Having trouble finding your provider?  Contact the Aetna Concierge Customer Service Unit at 833.414.2331.   

Note, Aultman Hospital and affiliates may appear in network in 2022.  As of 2023, Aultman Hospital and all affiliates will be out of EHP, EHP Plus and all EHP plans. 
 

No. Services provided by these medical institutions and their affiliates are not covered by either the EHP or EHP Plus health plan in 2023. In case of an emergency, services will be covered and if admitted, will be subject to the notification and transfer requirements outlined in the Summary Plan Description (SPD).

In 2023, Akron Children’s Hospital will be available to any caregiver who elects EHP Plus during open enrollment. If you would like to maintain your coverage for Akron Children’s Hospital, you must elect EHP Plus. There will be no coverage for Akron Children’s Hospital under the EHP plan in 2023.

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 plan will serve 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 lower 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. As long as 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 plan 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.

The EHP plan has a large network of Behavioral Health providers who are aligned to the Quality Alliance and 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. Before open enrollment, you will be able to search providers for each plan using the links in the “How do I know if my provider is in the network?” FAQ above. There is no out-of-network coverage in either plan, except emergency or urgent care. 
 

Although the cost of the EHP Plus plan is more than the EHP plan, it is competitively priced and has low out-of-pocket expenses for an open access network. Under the EHP Plus option, 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. EHP and EHP Plus are rich plans, meaning their benefit designs do not have any deductibles, and they have minimal copays and co-insurance. In addition, your Healthy Choice participation helps lower your premium costs. As a reminder, active caregivers are able to offset the cost of their health, dental, vision and supplemental life elections by trading in their PTO.

Yes. Participation in the Simply Healthy Choice program will close on Sept. 30, 2022. Beginning in 2023, Mercy caregivers and their spouses will be able to join the Healthy Choice premium discount program provided by the EHP. 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 2023. Note: The Healthy Choice information on the EHP website now is subject to change and may not reflect the complete program requirements for 2023.

Yes.  Any discount you earned during the 2022 Simply Healthy Choice program year will apply to your health plan premium in 2023.  Your Simply Healthy Choice discount will be visible in Workday when you elect benefits during open enrollment. 

As an EHP or EHP Plus member, you will have access to a comprehensive drug benefit program that utilizes a custom EHP formulary and multiple utilization management strategies to drive value, thereby keeping your out-of-pocket health care expenses as low as possible.  

The EHP Prescription Drug Benefit Program is managed by the EHP Pharmacy Management Department and administered by CVS/Caremark. The EHP Prescription Drug Formulary can be found on the EHP website along with other information related to the EHP Prescription Drug Benefit Program. Medications may be added to the EHP Prescription Drug Formulary four times a year and removed from the EHP Prescription Drug 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 EHP 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. 
 

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 Mercy Professional Pharmacy or any of the other Cleveland Clinic pharmacies, including the Cleveland Clinic Home Delivery and Specialty pharmacies, to obtain their medications.  You will also 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 your prescription is filled with a generic medication.

Unfortunately, no, it will not.  You will need to have your provider 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.

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.  Starting in 2023, your vision exams are covered under the EHP and EHP Plus health plans.  You also have the option to enroll in our vision plans, which provide discounts on glasses and contacts.  More information about vision plan coverage will be provided closer to the open enrollment period.

Yes, please look for new medical and pharmacy ID cards in the mail prior to January 2023.  You will also receive new Cigna Dental and EyeMed Vision ID cards in the mail in January 2023.  Please be sure your address is up-to-date in Workday prior to open enrollment. 

In 2023, Mercy Hospital members will still 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, 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.

If you are currently on COBRA, you can continue coverage under your current plan for the rest of 2022. You will receive an open enrollment notification from Payflex in the fall, and at that time, you will have the opportunity to elect coverage for 2023 and choose between EHP and EHP Plus.
 

Eligible dependents who are away at school, like college students, are covered no matter which plan option is selected, EHP or EHP Plus, as long as 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 the EHP Customer Service for resolution at 216.986.1050 or 888.246.6648.
 

We are building the details of the plan offerings and additional information will be coming soon.  Please bookmark this site for the most current information.  You can also reach out to the following departments with general questions:

  • Workday question:  Contact the ONE HR Service Center at 216.448.2247 or 877.688.2247.
  • Employee Health Plan medical or benefit questions:  Contact an EHP Specialist at 216.986.1050 (option 1) or 888.246.6648 (option 1).
  • EHP 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. 

Provider Lookup Video Tutorial

Tutorial video on how to search for your providers and facilities