Provider Network
For our retirees, the EHP offers a two-tier provider network. 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. To locate a provider, click here or on the "Find a Provider/Facility" button above.
| TIER 1 | TIER 2 | |
| Network | Cleveland Clinic Quality Alliance (QA) | MMO SuperMed network (within the state of Ohio) Aetna® Open Choice® PPO network (outside the state of Ohio) |
| Deductible | 0 | $500 Single / $1,500 Family |
| Coverage | 100% after applicable co-pay or co-insurance | 70% after deductible and applicable co-pay or co-insurance |
| 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 visit co-payment will be waived and the inpatient admission co-payment will be applied. (This applies to retirees under 65 only).
Retirees who have Medicare Part B as their primary health plan (age 65 and older) are not subject to the co-payment when the EHP pays as secondary. However, for services not covered by Medicare and the service is a covered benefit by the EHP, the EHP then pays as primary. In this instance, you could be responsible for the applicable co-payment.
Cleveland Clinic employees should go directly to the third-party administrator (TPA) to resolve any claims payment issues. The Cleveland Clinic EHP TPA is Mutual Health Services (MHS). The MHS customer service department can be reached by calling 1.800.451.7929. If your issue is not resolved to your satisfaction after calling the TPA directly, please call the Cleveland Clinic EHP Customer Service Unit at 216.448.2247 (Option 2).
