Retirees

 

You are eligible to participate in the Cleveland Clinic Retiree Health Plan (RHP) if at the time of retirement you are at least age 55 with a minimum of ten years of continuous service OR age 65 with a minimum of five years of continuous service. In addition, you must be a current participant in one of the Cleveland Clinic Employee Health Plan offerings immediately prior to retirement and begin your pension benefit immediately. (Deferred vested participants of the Cleveland Clinic Retirement Plan are not eligible for Retiree Medical Benefits.)

Coordination of Benefits (COB) is the procedure used to pay healthcare expenses when you or an eligible dependent is covered by more than one health plan. The COB procedure follows the rules established by the laws of the state of Ohio.

At the time you and/or your covered dependent become 65 years of age, it is your/their responsibility to actively enroll in Medicare Part B. The amount that the Cleveland Clinic Retiree Health Plan (RHP) will pay of the balance not covered by Medicare depends on the type of health service provided and the provisions of the Cleveland Clinic RHP. For example, if a retiree seeks care from a primary care provider, the Cleveland Clinic RHP will cover 100% of the balance not covered by Medicare Part B. However, if the retiree requires durable medical equipment, the Cleveland Clinic RHP will cover 80% of the balance not covered by Medicare Part B.

In order for this claims payment process to work correctly, it is EXTREMELY IMPORTANT that you bring both your Medicare and Cleveland Clinic RHP cards to all visits and inform the registrar that you are covered by two health plans. If you have more than these two plans, bring ALL the health plan cards you have to the visit so that coordination of benefits can be done correctly.

Medical plan benefits provided are also subject to the following non-duplication provision:

The combined payments of all healthcare plans will not exceed the actual amount of your bills. In other words, you cannot expect to receive benefits in excess of 100% of the cost you incur and receive reimbursement on claims through both the Cleveland Clinic RHP and any other company sponsored plan where you have coverage.

 
Medicare Part B "Carve Out" – if a retiree is eligible for Medicare Part B but is NOT enrolled, the Cleveland Clinic RHP will pay claims for covered services as if the retiree were enrolled in the Medicare Part B coverage. Whether you are enrolled in Medicare Part B or not, if you are eligible for Medicare Part B, the Cleveland Clinic RHP will only pay as a secondary coverage.

 

View and print the Retiree Summary Plan Description

View or print the SilverScript Drug Formulary

(for Medicare primary retirees)

 

 

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