Provider Network, Medical Benefits & Summary Plan Description (SPD)

The EHP offers a two-tier provider network to choose from for ONA members. The Tier you select determines the amount of coverage you will receive. To receive maximum coverage, you must use Tier 1 Providers.  It is your responsibility to verify and obtain the most current Tier participation each time services are obtained. Following is a description of each Tier and a link to the Summary Plan Description (SPD).

 

Provider Network

For our ONA members, EHP offers a two-tier provider network. The tier you select determines the amount of coverage you will receive. To receive maximum coverage, you must use Tier 1 Providers.  It is your responsibility to verify and obtain the most current Tier participation each time services are obtained.    To locate a provider, click here.  You must first register with Aetna to view your plan specific network.  


TIER 1TIER 2 
NetworkCleveland Clinic Quality Alliance (QA)Aetna Select Open Access 
DeductibleNone$500 Single / $1,500 Family
Coverage100% after applicable co-pay or co-insurance70% after deductible and applicable co-pay or co-insurance
Emergency/
Urgent Care
100% coverage after applicable co-pay
($50 for Urgent Care / $150 for Emergency*)
100% coverage after applicable co-pay
($50 for Urgent Care / $150 for Emergency*)
* If the emergency visit results in an admission, the emergency visit co-payment will be waived and the inpatient admission co-payment will be applied.


Cleveland Clinic employees should go directly to the third-party administrator (TPA) to resolve any claims payment issues.  The Cleveland Clinic EHP  Third Party Administrator (TPA) is Aetna.   The Aetna customer service department can be reached by calling 833.414.2331. You can access your health benefit information by registering at Aetna.com or download the free Aetna mobile app for more convenient access to your benefits. Click here for detailed instructions. If your issue is not resolved to your satisfaction after calling the TPA directly, please call the Cleveland Clinic Customer Service Unit at 216.986.1050 (Option 1).

Medical Benefits Information

To the right are documents designed to help navigate the health plan.  The Summary Plan Description (SPD) explains the health plan in great detail and the Summary of Benefits and Coverage (SBC) is a great snapshot of important questions and answers.