Provider Lookup Video Tutorial
Tutorial video on how to search for your providers and facilities
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:
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.
As we welcome new members to Cleveland Clinic Employee Health Plan (CC EHP) for 2023, we want to make sure that there are no lapses in your care.
If you currently have an approval in place for which care will continue or is scheduled in 2023, you should check the Cleveland Clinic EHP Plan or EHP Plus Plan Summary Plan Description and / or Prescription Drug Formulary Handbook to see if the service will require precertification in 2023. To initiate Medical precertification, please ask your provider to complete this form EHP Medical Management Precertification Request and submit it to the Medical Management department by fax at 216.442.5791.
As a reminder, certain medications also require pre-certifications. Prescription precertification will also end on December 31, 2022. To obtain an updated Pharmacy precertification, please ask your provider to complete this form Pharmacy Management Prior Authorization Form and submit by fax to 216.442.5790. Once completed and submitted, the Medical Management and/ or Pharmacy Management team will review the request within 10 days. Please note that submission of either precertification form is no guarantee that the request for precertification will be approved. Requests will be reviewed based on the EHP’s criteria for coverage; those requests meeting precertification criteria will be approved. If, after referencing the form/s, you have further questions, you can reach out to Medical Management by calling 216.986.1050, and selecting option 2 or Pharmacy Management by selecting option 4.
Mercy Hospital caregivers will be transitioning from the Simply Healthy Choice program to the Healthy Choice program in January 2023. The Healthy Choice Program is a voluntary discount program from the Employee Health Plan that rewards you for taking action to manage your health. The program also provides resources to help you save on health care costs and support your overall wellbeing. When you participate and meet your goals, you’ll become eligible to save 30% on your health plan premiums. Have a spouse on your health plan? They can participate too, and together you could achieve your best discount.
Want to learn more about the Healthy Choice Program? Join us for a Healthy Choice Fair on Wednesday, January 18 and Thursday, January 19, from 7:30 a.m. to 4:30 p.m. in Conference Room C next to the cafeteria. Learn more about the Healthy Choice program, sign up for your personal Healthy Choice portal account, download the app and much more!
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.
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:
Provider search links are available above for each network 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.
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.
*Due to the religious exemption in place at Mercy Hospital, caregivers cannot fill contraceptive prescriptions at the Mercy Hospital Outpatient Pharmacy. Caregivers wishing to fill contraceptive prescriptions should refer to the CVS/Caremark member packet which will be mailed after enrollment.
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: