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 Summary Plan Description (SPD) with specific plan details.  The plan summary chart is also available for your reference.
 

Provider Network 

The EHP Plus network includes the Cleveland Clinic Quality Alliance in addition to the Aetna Select Open Access network (a national network).  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 PlusOut-of-Network
NetworkCleveland Clinic Quality Alliance (QA)
Aetna Select Open Access (National Network)
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).

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.