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

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 the EHP Summary Plan Description (SPD) and the EHP Plus Summary Plan Description (SPD) with specific plan details.

Provider Network

The EHP network includes Cleveland Clinic employed physicians and facilities as well as other local contracted providers. The EHP Plus network includes the Cleveland Clinic Quality Alliance (QA) and the Florida clinically integrated (CIN) networks in addition to the Aetna Select Open Access network (a national network). No matter which plan you selected, 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.

	EHP	EHP Plus	Out-of-Network
Network	Cleveland Clinic Quality Alliance (QA) Florida clinically integrated (CIN)	Cleveland Clinic Quality Alliance (QA) Florida clinically integrated (CIN) Aetna Select Open Access (National Network)	No coverage
Deductible	None	None	No coverage
Coverage	100% after applicable co-pay or co-insurance	100% after applicable co-pay or co-insurance	No 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*)	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.

**Florida Region Network Additions:

The EHP plan is supplemented with Aetna providers in the following specialties within the seven counties surrounding our Florida hospitals: Allergy, Behavioral Health, Chiropractic, Dermatology, Endocrinology, 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

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.