Cleveland Clinic Employee Healthplan
EHP Total Care Customer Service Unit
The EHP Total Care Customer Service Unit is open Monday through Friday from 7:30am to 3:30pm. Trained representatives are available to answer health plan benefit questions, including medical, behavioral health, and prescription drug questions and issues.
EHP Customer Service 216.448.0800
Toll-free number: 866.811.4352
Employee Health Plan address:
EHP Total Care
Mail code for internal mailings: SCC13
New fax numbers:
EHP Main Fax: 216.448.9053
Cleveland Clinic offers their employees a comprehensive health plan that includes access to the entire Community Physicians Partnership (CPP) network of providers (formerly the CCHS Physicians' Organization). Cleveland Clinic Employee Health Plan Total Care is committed to consistently providing the employee with timely and accurate information regarding their health plan benefits. Through medical management programs, the Cleveland Clinic Employee Health Plan Total Care Customer Service Unit strives to ensure that quality-oriented, culturally sensitive healthcare services are provided to the employee at the appropriate level, in the proper setting, and in a timely manner.
Finally, the Cleveland Clinic Employee Health Plan Total Care Customer Service Unit strives to offer Cleveland Clinic employees the opportunity to select health plan coverage that meets the needs of the employee and their family while controlling the expense to the employee.
The following information primarily addresses health plan provisions for Cleveland Clinic Employee Health Plan Total Care. Summaries of the SummaCare Health Plan EPO (Exclusive Provider Organization) and Kaiser Permanente HMO (Health Maintenance Organization) offerings for the 2011 calendar year are provided as well. Current employees have the opportunity each year to re-enroll for their coverage through the BeneFlex Open Enrollment process. Through this process, you can choose to keep the same coverage you have or make changes to it for the coming calendar year.
Two-Tier NetworkCleveland Clinic Employee Health Plan Total Care (EHP) offers a two-tier Network of Providers. Cleveland Clinic and Regional hospitals, including participating physicians, comprise the Tier 1 Provider Network. Cleveland Health Network (CHN), Medical Mutual and USAMCO comprise the Tier 2 Provider Networks. As a Cleveland Clinic EHP member, you can use either provider tier at anytime throughout the benefit year and may see providers in both tiers if you choose. The tier you select, however, determines the amount of coverage you will receive. To receive maximum coverage, you must use Tier 1 Providers.
Tier 1 includes all Cleveland Clinic and Regional hospital providers in the CPP and are, for the most part, located in Cuyahoga County. The Tier 1 Cleveland Clinic EHP Network of Providers includes Primary Care Providers (PCP), Specialist Providers (SP), Behavioral Health Providers, and Ancillary Services Providers. Ancillary Services are services such as dialysis, ambulance transportation, durable medical equipment (DME), home health, skilled nursing facilities, hospice and others.
Tier 2 consists of three provider networks:
All Emergency/Urgent Care services are covered at 100% after a $50 co-payment (depending on the tier).
The SummaCare Health Plan EPO (Exclusive Provider Organization) requires you to select one Primary Care Provider (PCP) listed in the Network Provider Directory to be your personal Physician. This is the Physician you will visit for most of your healthcare needs. If your PCP determines that you require care from a specialist, need surgery, or should be admitted to the Hospital or some other facility, he will refer you to an appropriate source for that care and obtain any necessary pre-authorization. Please remember that in order to receive benefits under the Plan, you MUST select a PCP.
Following is a summary of the benefits Cleveland Clinic employees can receive from the SummaCare Health Plan EPO:
Third-Party Administrator (TPA)Cleveland Clinic employees should go directly to the third-party administrator (TPA) for the plan they are enrolled in to resolve any claims payment issues.
If your problem is not resolved to your satisfaction after calling the TPA directly, please call the Cleveland Clinic Employee Health Plan Total Care Customer Service Unit at 216-448-0800 or toll-free at 1-866-811-4352.