Provider Network, Medical Benefits & Summary Plan Description (SPD)

Below is an explanation of the provider networks available to you as well as a link to your 2024 Summary Plan Description (SPD) with specific plan details.  The plan summary chart is also available for your reference.  

Provider Network 

The EHP network includes Cleveland Clinic employed physicians and facilities as well as other local contracted providers.  It is your responsibility to verify your provider's participation each time services are obtained.  To locate a provider, click here.  Note:  You must first register with Aetna to view your plan specific network.  


EHPOut-of-Network 
NetworkCleveland Clinic Quality Alliance (QA) & Florida Clinically Integrated Network (CIN)**No coverage 
DeductibleNoneNo coverage
Coverage100% after applicable co-pay or co-insuranceNo coverage
Emergency/
Urgent Care
100% coverage after applicable co-pay
($50 for Urgent Care / $250 for Emergency*)
100% coverage after applicable co-pay
($50 for Urgent Care / $250 for Emergency*)

*If the emergency visit results in an admission, the emergency co-payment will be waived and the inpatient admission co-payment will be applied.

Cleveland Clinic employees should go directly to the third-party administrator (TPA) to resolve any claims payment issues.  The Cleveland Clinic EHP  Third Party Administrator (TPA) is Aetna. The Aetna concierge customer service department can be reached by calling 1.833.414.2331. You can access your health benefit information by registering at Aetna.comor download the free Aetna mobile app for more convenient access to your benefits. Click here for detailed instructions.  If your issue is not resolved to your satisfaction after calling the TPA directly, please call the Cleveland Clinic Customer Service Unit at 216.986.1050, option 1.


**Florida Region Network Additions:

The EHP plan is supplemented with Aetna providers in the following specialties within the seven counties surrounding our Florida hospitals: Allergists, Behavioral Health, Chiropractic, Dermatology, Endocrinology, Neurology, Nutritionist, OB-GYN/Obstetrics, Ophthalmology, Otolaryngology (ENT), Oral Surgery, Pain Management, Pediatrics and Podiatry. The seven counties include Brevard, Indian River, St. Lucie, Martin, Palm Beach, Broward and Miami-Dade. We have also supplemented additional non-Cleveland Clinic hospitals in support of the admitting privileges of the above provider specialties. Please note:  Only the above specialties will be covered at these hospitals.  If another specialty is provided at these hospitals, the claim will deny unless it is an emergency visit.  They are:

Baptist Hospital, Broward Health Medical Center, HCA Florida Hospitals (Bayonet Point, Blake, Lawnwood Medical Center, Oakhill and St. Lucie), Holmes Regional Medical Center Aging Services, Holmes Regional Medical Center OP Pain Infusion and Wound, Holmes Regional Medical Center, Jupiter Medical Center, Memorial Hospital, Memorial Regional Hospital, Palm Bay Community Hospital, St. Mary’s Medical Center, University of Miami Hospital and Clinics

It is the member’s responsibility to verify a provider’s network participation prior to receiving services.  You can search providers in the EHP provider directory which can be accessed via our website at employeehealthplan.clevelandclinic.org or log into your Aetna Health account.


Medical Benefits Information

To the right are documents designed to help navigate the health plan. The Summary Plan Description (SPD) explains the health plan in great detail and the Summary of Benefits and Coverage (SBC) is a great snapshot of important questions and answers.