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
29050 Aurora Road
Solon, OH 44139

Mail code for internal mailings: SCC13

New fax numbers:

EHP Main Fax: 216.448.9053
Eligibility (New Hire Audit): 216.448.9054
EHP Wellness: 216.448.9055

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.

The Employee Health Plan (EHP) provides support to the employees for all aspects of health benefit administration. The staff of the Cleveland Clinic Employee Health Plan Total Care Customer Service Unit works with Cleveland Clinic employees on a variety of administrative issues related to their Health Plan and strives to provide outstanding customer service to their fellow Cleveland Clinic employees. Some of the issues the Cleveland Clinic Employee Health Plan Total Care will work on with the employee include:

• Explaining details of the Cleveland Clinic Employee Health Plan benefit coverage and the CPP provider network.
• Claims management and resolution.
• Facilitating the timely review of special benefit or waiver cases.

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 Network

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:

• Cleveland Health Network (CHN) - a regional network of hospitals, physicians, and other healthcare providers in northern Ohio and western Pennsylvania.
  Web site: www.chnetwork.com
• Medical Mutual Traditional Network - a network of providers within the state of Ohio.
  Web site: www.supermednetwork.com and click on “Traditional".
• USA Managed Care Organization (USAMCO) - a network of providers outside the state of Ohio.
  Web site: www.usamco.com.

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:

• No deductibles or co-insurance
• Flat co-payments for office visits ($15 for both primary care and specialists)
• Prescription drug coverage through the Cleveland Clinic Employee Health Plan Program (CVS Caremark is the Prescription Benefit Manager)
• Approximately 5,000 Providers complemented by a network of hospitals in 13 counties

The Kaiser Permanente HMO (Health Maintenance Organization) requires your Primary Care Provider (PCP) to authorize all healthcare services before services are rendered, or there is no benefit coverage. Services must be received at a Kaiser Permanente facility.

Following is a summary of the benefits Cleveland Clinic employees can receive from the Kaiser Permanente HMO health plan:

• No deductibles or coinsurance
• Flat co-payments for office visits ($15 for both primary care and specialists)
• Urgent Care - $35 Emergency - $50
• Flat co-payments for prescriptions (generic $15; brand $30)
• Ten Kaiser Permanente medical offices throughout Northeast Ohio
• Affiliated community physicians practicing in their own offices throughout Northeast Ohio

Third-Party Administrator (TPA)

• The Cleveland Clinic EHP TPA is Mutual Health Services.  The MHS customer service department can be reached by calling 1-800-451-7929.
• The SummaCare Health Plan EPO customer service department can be reached by calling 330-996-8515 or toll-free at 1-800-753-8429.
• The Kaiser Permanente HMO customer service department can be reached by calling 1-800-686-7100.

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.