Frequently Asked Questions

Below find answers to the most frequently asked questions and links to important information.

Member Offerings

Your Health Plan ID number is either an EHP number or a UMR number.  Both of these numbers can be found at the top of your medical insurance card.

You may have received a bill because you owe a copay/coinsurance.  Specialist visits carry a co-pay with them for every appointment.  Also some scans and tests, such as an MRI, have a co-pay.  You may have also received a bill because the provider or service you received is in the tier II network, which has a co-pay and a deductible.  For more information please refer to your Summary Plan Description.  

If you have additional questions, please feel free to Contact Us.  Please be sure to have the bill available when you call. 

The Cleveland Clinic offers several ways to pay your bill.  This link will walk you through paying your bill online through MyChart or MyAccount.   You can also Contact Us.

Willis Towers Watson is a company that we contract with to conduct our dependent audit.  You must respond or your dependents will be terminated from our plan.  If you are enrolling dependents onto your plan you will need to provide dependent verification after you have elected coverage to ensure that the dependents you are adding are eligible for coverage. Eligible dependents include your lawfully married spouse and dependent children under the age of 26. After you have elected coverage in Workday, Willis Towers Watson, our Third Party Administrator (TPA) for dependent verification, will send a letter to your home address asking you to provide dependent verification documentation. See the Summary Plan Description (SPD) for more detailed information

Foreign Country Claims:
Emergency services received while in a foreign country are covered, however, payment up front is typically required by the provider. To obtain reimbursement, the member must provide an itemized receipt from the provider which includes a description of services and codes (in English). A claim form then needs to be submitted to the Third Party Administrator along with the receipts.

Emergency Care:
Emergency and Urgent Care are covered at 100% regardless of the provider as long as the visit meets Emergency or Urgent Care criteria as defined in the Definitions of Terms in your Summary Plan Description.  A co-payment is required for any emergency department visit. Observation stays in the hospital are not considered admissions and are subject to the ER copayment.
If the ER visit results in an admission, the ER co-payment will be waived and the admission co-payment will apply. 

The Employee Health Plan requires members to contact the Cleveland Clinic Transfer Center at 866.721.9803 or EHP Medical Management at 216.986.1050 or toll free 888.246.6648 if the member requires admission (including unplanned admissions). These numbers are also on the back of your Health Plan ID card. 
 

Due to privacy laws we are not able to provide protected health information without a release form for anyone 18 or older.  See the Summary Plan Description or our privacy policy for more information.

For coverage related questions, please refer to the My Plan and Benefits page or the Summary Plan Description.  If you have additional questions, you can Contact Us.  Please have the CPT Code (Current Procedural Terminology) and Diagnosis Code available when you call.  This code can be obtained through your provider’s office.

Certain changes that affect you and/or your dependents – such as a marriage, birth, divorce, or qualifying for Medicare – and may result in the need to make changes to your benefit elections

If you experience a qualifying life event and wish to change your coverage, you must do so within 31 days of the event and provide the necessary supporting documentation. Any adjustment to coverage must be consistent with the change resulting from the qualifying life event. To initiate a life event change, visit the ONE HR Workday and Portal and click on the “Benefits” worklet. If you need additional assistance, please feel free to contact the ONE HR Service Center at 216.448.2247, option 1.
 

Please call ONE HR at 216.448.2247 or (877) 688.2247 and select the option for Human Resources.

No, the Employee Health Plan will cover one routine exam per calendar year.

Coordinated Care

The health plan offers over 20 programs for these conditions including:
Coordinated Care Programs

·    Asthma (for adults and children) 
·    Chronic Kidney Disease (CKD) 
·    Congestive Heart Failure (CHF)
·    Depression (adults and children)
·    Diabetes *
·    Hyperlipidemia (high cholesterol)
·    Hypertension (high blood pressure)
·    Migraine (adults and children)
·    Nicotine Cessation (offered by EHP Wellness tobacco/nicotine )
·    Weight Management (nonsurgical and surgical)

  * The Summary Plan Description contains information about the Diabetes program and copay reimbursement incentives for members under 18 years of age.


Rare or complex condition management programs (managed by AccordantCare):
·    Amyotrophic lateral sclerosis (ALS) 
·    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) 
·    Crohn’s disease 
·    Cystic Fibrosis 
·    Dermatomyositis 
·    Gaucher disease 
·    Hemophilia 
·    Hereditary angioedema 
·    Lupus 
·    Multiple Sclerosis 
·    Myasthenia Gravis
.    Myositis (includes Inclusion Body Myositis - IBM) 
·    Parkinson’s disease 
·    Polymyositis 
·    Rheumatoid Arthritis (includes Juvenile Idiopathic Arthritis)
·    Scleroderma 
·    Seizure disorders 
·    Sickle Cell Anemia 
·    Ulcerative Colitis

To join Coordinated Care programs, please call the health plan’s Medical Management Department at 216.986.1050 or 1.888.246.6648.   

Studies have shown that those who participate in Coordinated Care programs are healthier and manage their conditions more effectively.  Additionally, you may qualify for money saving discounts and reimbursements. The Coordinated Care Incentive FAQ page has a comprehensive list of the incentives and reimbursements that the Coordinated Care program offers.

Yes, you can ask to be assigned to a specific EHP Care Coordinator when you call to join. We will do our best accommodate your request, but we cannot promise that all requests can be met.

Documentation needs to be sent to Cleveland Clinic / Akron General EHP Medical Management.  Please remember to include on your cover sheet: the patient’s name and one other individual identifier such as date of birth, and/or the Member ID number or EHP number. 
You have three submission options:

Attn: Reimbursements
3050 Science Park Drive / AC332B
Beachwood, Ohio 44122


You will find all of the information regarding reimbursement on the Coordinated Care Incentive FAQ page.

Acceptable forms of documentation required include:
1. Office copay receipts should include the Date of Service. The patient name on the receipts and the Tier 1 provider’s name and are preferred but not required. Receipts such as (but not limited to) Epic and Core receipts are acceptable as proof of payment or an itemized statement showing proof of payment.
No hand written receipts will be accepted. The Date of Service must be included on the documentation submitted if the member paid after the visit.

2. Individual tax receipts/bar code receipts, along with the register receipts from the Cleveland Clinic/Akron General pharmacies or Cleveland Clinic Home Delivery. Both must be submitted in order to request reimbursement. We do not accept the pharmacy printouts. 

3. For DME qualifying medical supplies related to a program, purchased through Tier 1 providers Edgepark, Health Aid of Ohio, or JMR Medical Inc., a Solara Healthcare company, you must submit the shipping ticket, invoice, or itemized statement from the DME provider that shows the patient name, date of service, and amount paid along with proof of the type of payment (canceled check or payment receipt for a credit card statement). Both must be present to request reimbursement.

 WE CANNOT ACCEPT THE FOLLOWING AS PROOF OF PAYMENT: 
a. Explanation of benefits received from Mutual Health Services or UMR (Florida members).
b. Cash register receipts by themselves with no identifying information (date of service, and patient name). You must submit the individual tax receipt with the cash register receipt.
c. We do not accept hand written receipts or pharmacy printouts.

We encourage you to keep a copy of all documentation submitted for your records.

You will find the information regarding what documentation is needed on the Coordinated Care Incentive FAQ page.

Yes, for more detailed information review the "When am I eligible for reimbursements and incentives? " area of the Coordinated Care Incentive FAQ page.

  • Receipts must be submitted within six (6) months of the date of service. 
  • You will find information on when you may submit receipts for reimbursement  on the Coordinated Care Incentive FAQ page.

Reimbursement checks will be mailed to the policy holder’s address as listed in Workday from Mutual Health Services (MHS), or UMR if you belong to the Florida or Out of State group.  Please review any mailings received from MHS or UMR.  Your reimbursement check will be on the bottom of a form that looks very similar to the Explanation of Benefits.

You will find information regarding your reimbursement check on the Coordinated Care Incentive FAQ page.

The EHP Medical Management department will process member requests to replace never received, lost or misplaced reimbursement checks totaling $20.00 or larger. For checks that are reissued, a replacement fee of $10.00 will be deducted for the original reimbursement.
Checks totaling less than $20.00 will not be re-issued. 
Lost, misplaced or never received checks will not be replaced if it has been more than 180 days* from the date of the original check being issued. 
The member is responsible for ensuring that their correct mailing address is on file with the Human Resources Department in Workday.

* Note: Requests for check reissue that are over 180 days from the date the original check was issued will be declined due to the amount of time that has passed, regardless of the original check amount.

You will find information about what happens if you lost or didn’t receive your reimbursement check on the Coordinated Care Incentive FAQ page.

  1. Members must utilize their EHP Medical and Pharmacy benefit for the supplies and medications in order for these items to be eligible for Coordinated Care program copay reimbursement.
  2. The Employee Health Plan (EHP) must be the member’s primary insurance.
  3. The EHP card holder (insured), spouse and all eligible dependents on the plan must be actively employed at CCHS, or active on the policy, or be on COBRA at the time receipts are submitted for payment to receive any copay reimbursement.
  4. Once you enroll in a specific program, the copays for some screening supplies required for you to manage the chronic condition can be reimbursed. These items may include:
    • Diabetic testing supplies and Glucagon, if enrolled in the Diabetes program. (This does not include alcohol wipes or calibrator/control solution.) Not all items are reimbursable. This applies to adults (18 and up).
    • Peak flow meter and aero chamber (up to $20.00 for each) and Epinephrine pen if enrolled in the Asthma program. (The disposable mouthpiece for the peak flow meter and the coinsurance for a nebulizer are not reimbursable).
    • One (1) upper arm blood pressure monitor if enrolled in the Hypertension program, up to $55.00. No finger or wrist blood pressure monitors will be reimbursed.
    • One (1) Bathroom scale (up to $40.00) and one (1) upper arm blood pressure monitor (up to $55.00) if enrolled in the Congestive Heart Failure program. No finger or wrist blood pressure monitors will be reimbursed.
    • Reimbursement for peak flow meters, bathroom scales and blood pressure monitors occurs once every 5 years.
  5. If you are enrolled in the Diabetes program and you have received prior-authorization approval, your insulin pump will be covered at 100%.
  6. Up to five (5) Tier 1 physician or Tier 1 physician assistant condition related office visit copayments per calendar year are reimbursable AFTER you have met all the program goals. The member becomes eligible from the date you meet all goals forward and must keep meeting all goals to continue to be eligible for the copay reimbursement.
    • EHP Members enrolled in the Diabetes program who have met all the program goals are also eligible for reimbursement of additional copayments for one (1) dilated eye exam and one (1) foot exam from a Tier 1 provider per year.
    • EHP Members enrolled in the Depression program who have met all the program goals are also eligible for copayment reimbursement for up to 15 office visits with a Tier 1 licensed clinical counselor, licensed independent social worker, and/or psychologist.
    • Receipts must be submitted within six (6) months of the date of service. The receipt should include the patient name and date of service. No hand written receipts will be accepted. Release of reimbursement funds is dependent on confirmation that a claim has been paid by the Third Party Administrator, Mutual Health Services or UMR.
  7.  Medication copays for qualifying condition-related prescriptions, syringes, pen tips and needles can be reimbursed 6 months from the date all program goals have been met. This incentive can only be extended if you continue to meet the goals. Your annual EHP Pharmacy deductible must be met each year prior to any reimbursement being released. Drug manufacturer coupons used to pay deductible will not be applicable for this reimbursement program; if you used one, the first $200.00 of your medication actually paid by you will be considered non-reimbursable. Receipts must be submitted within six (6) months of the fill date.

Only testing supplies (i.e. test strips and lancets) purchased from Cleveland Clinic/Akron General pharmacies, Cleveland Clinic Home Delivery, Edgepark, Health Aid of Ohio, or JMR Medical Inc., a Solara Healthcare company, will be reimbursed. No receipts will be processed for any supplies filled by other pharmacies or providers. CVS Caremark mail order approved medications or testing supplies are NOT reimbursable unless the policy holder resides in a state that is not serviced by Cleveland Clinic Home Delivery Pharmacy. Receipts must be submitted within six (6) months of the date of purchase.  
 

Supplies for Insulin Pumps and Continuous Glucose Monitors
  • Insulin pumps and continuous glucose monitors require prior-authorization according to the EHP Summary Plan Description.
  • These items must be obtained through a Tier 1 provider, such as Edgepark, Health Aid of Ohio, or JMR Medical Inc., a Solara Healthcare company.
  • Copays for continuous glucose monitors, transmitter and/or receivers are reimbursable upon meeting all the goals of the Diabetes program.
  • Copays for some of your insulin pump supplies and continuous glucose monitor (device and parts) are reimbursable if you have met all the program goals.
  • The coinsurance is NOT reimbursable for glucometers.
  • The member becomes eligible for copay reimbursement from the date they meet all the goals and going forward. You must continue to meet all the goals to continue to be eligible for the copay reimbursement.
  • Not all supplies are reimbursable (e.g. batteries).

Receipts must be submitted within six (6) months of the medication or DME prescription fill date.

NOTE: If you do not stay active and participate in the Diabetes Coordinated Care program, you will no longer be
eligible for copay reimbursement

No, only medications that are related to the program that you are enrolled in may be eligible for reimbursement. Please be aware that not all medications are on the reimbursable medication list. Your Care Coordinator can discuss which medications are eligible or you may check the pharmacy benefit resources that tell you which are eligible.

You will receive a letter from your EHP Care Coordinator when you are meeting all the goals of the program that will tell you which medications you are currently taking that can be reimbursed. If new medications are ordered or if you have questions about whether a medication is eligible for reimbursement, please review with your EHP Care Coordinator to find out if that medication can also be reimbursed.

Your annual pharmacy deductible is waived for generic prescriptions only if they are filled by Cleveland Clinic / Akron General Pharmacies and/or Cleveland Clinic Home Delivery. Brand name medications are subject to the annual deductible. If a generic medication is available, only the generic medication will be eligible for copay/coinsurance reimbursement, unless you have a prior authorization from the EHP Pharmacy Management department on file.
Please refer to your current Prescription Drug Benefit and Formulary Handbook for lists of brand name and generic
medications.

Receipts must be submitted within 6 months of the prescription fill date.

Qualifying receipts may take up to 60 days for processing. The claim must be submitted by your provider and paid by MHS or UMR before any copay reimbursement can be processed. Please contact your EHP Care Coordinator if you have any questions. If your receipt does not qualify for reimbursement, you will be notified

Reimbursement check is made out to the policy holder of the health plan coverage.

The EHP Medical Management department will process member requests to replace never received, lost or misplaced reimbursement checks totaling $20.00 or larger. For checks that are reissued, a replacement fee of $10.00 will be deducted for the original reimbursement.

 Checks totaling less than $20.00 will not be re-issued.

 Lost, misplaced or never received checks will not be replaced if it has been more than 180 days* from the date of the original check being issued. 

 The member is responsible for ensuring that their correct mailing address is on file with the Human Resources
Department in Workday.

* Note: Requests for check reissue that are over 180 days from the date the original check was issued will be declined due to the amount of time that has passed, regardless of the original check amount

EHP Healthy Choice

Both employees and their spouse have an opportunity to earn a discount towards their premium. There are 5 discount levels based on what the employee (and spouse if applicable) earn: 
Bronze – Bronze is our standard premium rate 
Silver – 7.5% off the bronze premium rate
Gold – 15% off the bronze premium rate
Platinum – 22.5% off the bronze premium rate
Diamond- Is the best discount at 30% off the bronze premium rate

Additional information is available on the Healthy Choice page of the website.

Eligible employees and spouses can start the program by creating a Healthy Choice Portal account and reviewing their health status and requirements.  Please review the instructions on how to create a HC portal account and program requirements to earn a discount based on your health status.

Only the employee and their spouse are eligible to participate in Healthy Choice.  Dependent children, retirees, Cobra members, and PRN employees are not eligible to participate.

Please note, if you are a resident or fellow, contact EHP customer service for more information regarding Health Choice participation.  A specialist can be reached by email at EHPwellness@ccf.org or by phone at 216.448.2247, option 2 or 877.688.2247 option 2.

No, the Healthy Choice Program is only available to those employees and spouses currently on the health plan.  

No, we cannot accept participation from another employer or insurance company.

The health plan works alongside your health provider to support your wellness.  For consistency, we have a standard data collection process for those identified with one of the six chronic conditions, as well as those identified as “healthy”.  

Pregnancy changes your program requirements.  If you are enrolled in Coordinated Care, contact your Care Coordinator for information and updates.  If you are not enrolled in Coordinated Care, contact EHP Customer Service by email at EHPwellness@ccf.org or by phone at 216.448.2247, option 2 or 877.688.2247 option 2.

New Employees/New Members

Yes, every member of a family has their own health plan ID number and their own health plan ID card.  

Once you have your health plan ID card with your EHP ID or UMR ID number you can join a Healthy Choice or Coordinated Care program.

The two most common reasons that a new member is told they do not have coverage are:

The prescription drug benefit is included in your Employee Health Plan coverage, so when you enroll in the Employee Health Plan you are automatically covered. CVS/Caremark administers this plan and will mail you a CVS/Caremark prescription ID card about 4 weeks after you have elected coverage under the Employee Health Plan in Workday. If you need to have a prescription filled prior to your CVS/Caremark ID card arriving you will need to pay for the prescription out of pocket, then you can apply for a reimbursement after your card has arrived. 

Is the prescription for a medication you take every day?  Maintenance medications like that maybe filled one time at a retail pharmacy such as CVS.  All other refills must be filled at Cleveland Clinic MyRefills, a Cleveland Clinic pharmacy, or CVS mail order. 

No, a referral is not needed to see a specialist.

Please visit our Find a Provider page on our website under your applicable plan.  

The Health Plan does not have out of network coverage except in case of emergency.  If you see a provider or go to a hospital that is not in network except in the case of an emergency you will be responsible for all charges and fees.

Please note:  Staff plan information is located on Doc.com

The Tier refers to the network that your provider or facility is in under the Health Plan service network.  The plan will always pay the most for services provided within the tier I network.  If you choose a doctor or hospital in tier 2 there will be a co-insurance and a deductible that may apply.  See the Summary Plan Description for more information.  

Health Plan ID cards can be viewed and printed prior to their arrival in the mail once benefits have been processed by the TPA. Click here and follow instructions below to view your MHS card: (you must be on a Cleveland Clinic network computer to access this page)

  • Login into the MHS portal using your MHS credentials.  If you have not registered on the portal you can do so by clicking on "Register" within the login box.
  • Click on “ID Card” to the left of your name or any dependents on the health plan to view the EHP card.
  • Select “Click to Print” to print the specific ID card.

Your coverage effective date will be retroactive to your date of hire, or the date of a qualified life event – however it takes about 4 weeks for your health plan ID cards to arrive in the mail after you have elected coverage in Workday.

If you have questions regarding your eligibility effective date, please Contact Us.

We have one health plan which is known as the Cleveland Clinic Employee Health Plan and bronze is our standard premium.  All caregivers start at the bronze “standard” premium level.  You can only earn a different premium by participating in our Healthy Choice program.

You can learn more by navigating to Workday and click on the inbox icon located in the upper right-hand corner by your picture. Electing benefits in Workday is a two-step process. The first step is learning more about the Cleveland Clinic benefit plans on the ONE HR Portal and selecting your plans. The second step is to elect your benefits in Workday by clicking on your benefits task located in your inbox and following the on-screen prompts. 

Durable Medical Equipment

Custom-made orthotics are covered at 80% of allowed amount after $50 co-payment in Tier 1.  If the contracted rate is less than the amount of the co-payment, the member is still responsible for the corresponding copayment/co-insurance. 

General orthotics are not a covered benefit.  

Orthopedic shoes and diabetic shoes are not considered orthotics.  

This information is also available in the Summary Plan Description.

Hearing aids are covered at 50% of billed amount up to $3,500 per ear; one aid per ear every three years within the Tier 1 Network of Providers. Evaluation, consulting, and dispensing fees are covered at 100% within the Tier 1 Network of Providers. Repair of hearing aids ARE NOT covered. There is NO coverage of the hearing aids, evaluation, consultation, or dispensing fees OUTSIDE of the Tier 1 Network of Providers.  This information is also available in the Summary Plan Description.

No, these must be purchased through an in network provider with a prescription.  Compression stockings are covered at 50% and are limited to six pairs per year.

The pump should be under warranty.  Please contact the manufacturer for a repair/replacement.

 

A breast pump can be obtained within 4 months after the birth of the infant.  You can purchase a breast pump at Cleveland Clinic pharmacies with a prescription, but you can also use another in network durable medical equipment (DME) provider.  See the Summary Plan Description for more information.

A CPAP/BIPAP machine can be obtained by going through a durable medical equipment (DME) provider.  You can go to Find a Provider and search by Facility and then Service Type.  You may also Contact Us.

You can go to Find a Provider and search by Facility and then Service Type.  You may also Contact Us.

The Health Plan benefit for durable medical equipment (DME) is 80/20.  Which means we pay 80% of the cost and you pay 20% as long as you use an in network provider.  Some equipment does require prior authorization. For exceptions and more information please review the Summary Plan Description.

Prescription Drug Coverage

You can view your CVS Rx card on the CVS website.  Once on the site and logged in, click on Plan & Benefits on the navigation bar and then Print Member ID Card.  An image of your card will then be displayed. 

You can view your CVS Rx card on the CVS website.  Once on the site and logged in, click on Plan & Benefits on the navigation bar and then Print Member ID Card.  Within this area, you can also request a  new card.

You can view your CVS Rx card on the CVS website.  Once on the site and logged in, click on Plan & Benefits on the navigation bar and then Print Member ID Card.  Within this area, you can also request a  new card.

EHP Wellness Programs

All cancelations are handled by the provider of the program; contact them to cancel. Make note that the provider may charge you a cancellation fee.  

Your next steps are dependent on different factors. Please contact us for further assistance by sending a message to us through the help section of your Healthy Choice Portal. You can also send an email to EHPWellness@ccf.org or call 216.448.2247, option 2 or toll free 877.688.2247, option 2.

Some of our programs do have participation requirements for the Health Plan to continue paying for the benefit for you or a dependent.  You can find more information on the EHP website under Member Offerings.

That is not a charge, the Health Plan is required by the IRS to add the cost of some EHP Wellness programs to your check as income so that the IRS can tax you on the benefit.  This is similar to the Tuition Reimbursement program or the Caregiver Celebrations program.  If you have further questions please contact the Cleveland Clinic Tax Department by calling 216.448.2247, option 3 or 877.688.2247.

No, we are not able to offer wellness programs to the retirees or through any other 3rd party program.

No.  Some of the programs, for example WW, require the member to pay part of the program cost.

No, we do not reimburse for programs that are not part of our plan offerings.

Members of the Employee Health Plan and their dependents, who are not on the retiree plan or PRN.  Also please keep in mind that some programs may have restrictions for minors that are not imposed by EHP.  Please contact the individual program staff directly for information on those policies. 

The EHP wellness programs are programs designed to help you meet your goals for healthy living. The Healthy Choice Program is our premium discount program and although some of the EHP Wellness programs can be used to meet your Healthy Choice goals they are not the same.

Related Links