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

The EHP offers a two-tier provider network to choose from for members in Florida.  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.  Following is a description of each Tier and a link to the Summary Plan Description (SPD).

 

Provider Network

For our members in Florida 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 1TIER 2 
NetworkCleveland Clinic Quality Alliance (QA)UMR (United Healthcare Choice Plus Network )
Deductible0$500 Single / $1,500 Family
Coverage100% after applicable co-pay or co-insurance70% 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 copayment will be applied.

Pediatrics, Obstetrics, Ophthalmology, Nutrition and Behavioral Health Services are not available at Cleveland Clinic Florida.  As a result, special network arrangements have been made.  Only these services, when obtained at/by UMR UnitedHealthcare Choice Plus providers/facilities will be covered at the Tier 1 benefit level.   Cleveland Clinic employees should go directly to the third-party administrator (TPA) to resolve any claims payment issues.  The Cleveland Clinic EHP TPA is UMR.  The UMR customer service department can be reached by calling 800.826.9781.   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).

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.