You have an opportunity to choose between two comprehensive medical plans:
Both plans are administered by Anthem Blue Cross and Blue Shield, and both options are Preferred Provider Organization (PPO) plans, which do not require you to choose a Primary Care Physician. See who’s eligible for UH medical coverage.
Each medical plan option has a different benefit structure for deductibles, copays, coinsurance amounts, out-of-pocket maximums, and employee contributions. Both pay benefits for facility-related charges using three Tiers where the level of benefits depends on where you choose to seek health care treatment.
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| Consists of UH Providers. You receive the highest level of benefits if you choose a facility from Tier 1. Refer to the UH facilities list. |
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Includes all Anthem network facilities in the national Blue Access network, with the exception of the UH Tier 1 facilities and those listed as Tier 3 on the UH facilities list. |
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Providers are non-network providers as shown on the UH facilities list. This Tier provides the lowest level of benefits. The non-network provider listing is customized for the UH plans. |
About Physician and Practitioner Networks
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| All Anthem providers in the national Blue Access Network, with the exception of all Cleveland Clinic Health System employed physicians and practitioners |
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All practitioners who are not contracted with Anthem Blue Access Network, plus all Cleveland Clinic Health System employed physicians and practitioners |
The Anthem standard Blue Access Network has been modified for the UH medical plans. To find a network provider, follow this process:
- Go to Anthem’s web site and select the Online Provider Directory.
- To find a local physician, select Ohio; then, from the top of the drop-down menu, select University Hospitals Active Employees Directory
- To find a physician anywhere in the US, search the National Blue Card Directory
- If you already have a physician, enter his or her name to determine whether your physician is in the Anthem network
- Verify with the provider that he or she is not employed by The Cleveland Clinic. Otherwise, the provider will be considered out-of-network, and payment will be made at the Tier 3 benefit level. All other Anthem network physician services are payable at the highest benefit level.
See the Schedule of Benefits for the Consumer
Select Plan or the Traditional
Plan for more on how the plans pay for covered services.
Use the Health
Care Cost Estimator to compare your cost under the medical
plan options.
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| PPO medical plans give you control over which providers to use – you can use any licensed health care provider without needing a referral. However, your costs are lowest when you choose an in-network provider. |
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