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).
 

Provider Network 

For our members in Ohio, 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)
MMO SuperMed network (within the state of Ohio)  
Aetna® Open Choice®  PPO network (outside the state of Ohio)  
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 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 Mutual Health Services (MHS). The MHS customer service department can be reached by calling 1.800.451.7929. You can access your health benefit information by registering at Mutual Health Servicesor download the free MHS 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 216.448.2247 (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.