Cleveland Clinic Employee Healthplan

MEDICAL

Q: When should I present my Global Care ID card?
A: Use when outside of the United States.

NOTE: Many international providers will not accept insurance cards and will require upfront payment. In these instances, you will need to pay upfront and submit the charges to the EHP for reimbursement.

   
Q: How do I get reimbursed for out-of-pocket medical expenses?
A: E-mail detailed receipts and proof of payment to Patricia Zirm (zirmp@ccf.org). The receipt detail must show the member covered, services or products purchased, the provider, and the date of service/purchase. When purchasing glasses, a breakdown of frames and lenses - including whether a coating has been applied to the lenses - must be provided. Dental claims must provide clear details regarding the services performed. Where insufficient details have been provided, additional supporting documentation will be requested before providing reimbursement.

Reimbursement is processed usually within 72 hours of receipt and is calculated according to coverage guidelines (i.e., deductible, co-insurance, co-payment, current year maximum allowances, etc.) and at the current day's exchange rate as reported on www.ex.com. All reimbursement will be included in the employee's paycheck as a miscellaneous negative deduction (i.e., an addition to the paycheck amount). Depending on when the request is made to Payroll, it could take up to two payroll cycles to receive reimbursement.

   
Q: When should I present my Antares ID card?
A: When you are in the United States, you must utilize your Antares ID card as well as the designated networks as outlined below.
   
Q: What is my coverage under the Tier 1 Network?
A: The Plan pays 100% for covered services received by providers in the Tier 1 Network.

When outside the United States: Global Care is the Tier 1 network When inside the United States: The Tier 1 Networks include Cleveland Clinic and Regional hospitals and participating physicians credentialed by the Cleveland Clinic Community Physician Partnership (CPP), Medical Mutual of Ohio Traditional Network (inside the state of Ohio), and the USA Managed Care Organization (USAMCO) Network (outside the state of Ohio).

   
Q: What is my coverage under the Tier 2 Networks?
A: Cleveland Health Network (CHN) is your Tier 2 provider network. Coverage under the Tier 2 network is subject to an annual deductible of $200 for single coverage and $600 for family coverage. Once the deductible is met, coverage is 80%. The member is responsible for the remaining 20%.

NOTE: If a service is received outside of either the Tier 1 or Tier 2 networks, in addition to the deductible and co-insurance, the plan member is also responsible to pay any charges in excess of the "allowed amount" up to the billed amount.

While EHP has contracted with the Tier 2 networks, we do not have individual contracts with the providers like we do for the Tier 1 network. It is the network that holds the individual contracts. Therefore, EHP cannot resolve discrepancies with claim payment issues when you use a Tier 2 network, nor can we quote the dollar amount of your financial obligation.

   

PHARMACY

Q: How do I obtain my prescriptions while on work assignment in Abu Dhabi?
A: Cleveland Clinic employees working in Abu Dhabi may have their prescriptions filled and reimbursed using one of the following processes:
  1. While you are in the United States, you can either use the Caremark Retail Network or the Cleveland Clinic Pharmacy. Retail allows only for a 30 day supply. Cleveland Clinic Pharmacies allow for a 90 day supply.

    You can take the medication into the country with you as long as the bottles are labeled with your or your dependent's name, drug name and administration instructions. You should also request a letter from your physician indicating the medication has been prescribed under a licensed professional with administration instructions. To purchase medications this way, use the Caremark ID card and the deductible or co-insurance is automatically applied to your account.

  2. Have SKMC pharmacy fill your prescription(s). Although you will pay full price for your prescriptions, the EHP will reimburse you with the submission of the appropriate receipt of purchase.

  3. Request to have your prescription(s) filled by the Cleveland Clinic Mail Order Pharmacy. Fill out the Mail Order form with your prescription information and fax it to (216) 636-5204. The Mail Order form is located on the EHP web site. The address is www.clevelandclinic.org/healthplan. Click on the "Employee Health Plan" link and go to the forms tab. You also can request a Mail Order form by sending an email to mailorderpharmacy@ccf.org. Your order will be processed by debit or credit card. Shipping is free but please allow two weeks to receive your medication. You can request the medications be sent to your home, your work or the SKMC facility. Narcotics, refrigerated items or other sensitive medications are prohibited.

  4. If you know of a colleague who will be in the USA when you need a refill, you may have that person pick up your prescription at one of our pharmacies. The proper documentation, a letter from your doctor authenticating the medication, and a copy of the prescription must accompany this person back to the UAE.

   
Q: How do I get reimbursed for medications when out of the country?
A: E-mail detailed receipts and proof of payment to Patricia Zirm at zirmp@ccf.org. The receipt detail must show the member covered, medication or product purchased, the provider, and the date of service/purchase. Where insufficient details have been provided, additional supporting documentation will be requested before providing reimbursement.

Reimbursement is calculated according to coverage guidelines (i.e. deductible, co-insurance, current year maximum allowances, etc.) and at the current day's exchange rate as reported on www.ex.com. Receipts are usually processed with 72 hours of receipt. All reimbursement will be included in the employee's paycheck as a miscellaneous negative deduction (i.e., an addition to the paycheck amount). Depending on when the request is made to Payroll, it could take up to two payroll cycles to receive reimbursement.

   
Q: Can I take over-the-counter (OTC) drugs with me to Abu Dhabi?
A: No. Abu Dhabi government will confiscate and can be subject to criminal action.
   
Q: What if a provider does not accept my ID cards and wants me to pay up front?
A: Cleveland Clinic has no control if the international provider requires payment up front. You will need to pay with credit card and submit receipts to us and we will apply the appropriate benefit and exchange rate.
   
 

 

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