Medical and Insurance Benefit Highlights
This section highlights the benefits you will receive.
Cleveland Clinic offers a comprehensive health plan that covers residents and fellows as well as your immediate family members (spouse and eligible children) at no cost to you. Trainees are covered as of their actual start date so long as they completed online enrollment within 31 days of their start date.
While the health plan includes a two-tier network of providers, you will receive the maximum level of coverage by using Tier 1 Cleveland Clinic network providers. Tier 1 coverage includes:
- No pre-existing condition clause and 100 percent coverage for primary care office visits.
- No referral is needed for specialist office visits that require a $35 co-payment per visit.
- Pediatrics, Gynecology and Obstetrics are considered primary care. Related services are covered at 100 percent. Maternity care requires a one-time $50 co-payment.
- Inpatient and outpatient hospital services are covered at 100 percent.
- Routine vision exams are covered at 100 percent after a $25 co-payment.
- Emergency care at any Cleveland Clinic or non-Cleveland Clinic hospital is covered 100 percent after a $50 co-payment.
Tier 2 providers include the following three provider networks: Cleveland Health Network (regional), Medical Mutual Traditional Network (within the state of Ohio), and USA Managed Care Organization (outside the state of Ohio). Tier 2 coverage has a $500 individual and $1,500 family annual deductible. After the deductible is met, Tier 2 coverage includes:
- No pre-existing condition clause and 70 percent coverage after a $25 co-payment for primary care office visits (including Pediatrics, Gynecology and Obstetrics).
- No referral is needed for specialist office visits that are covered at 70 percent after a $50 co-payment.
- Maternity care is covered at 70 percent after a one-time $100 co-payment.
- Inpatient and outpatient hospital services are covered at 70 percent.
- Routine vision exams are not covered by Tier 2 providers.
The health plan also includes a prescription drug benefit.
- When purchased through Cleveland Clinic Pharmacies, prescription drugs are covered at 85 percent for generic, 75 percent for preferred brands (formulary), 55 percent for non-preferred brands (non-formulary) and 80 percent for high-technology drugs with prior authorization.
► The minimum co-payment is $3 per month and the maximum is $50 per month for generic and preferred brands. There is no minimum or maximum co-payment for non-preferred brands, and high-technology drugs have a $75 per month maximum co-payment.
► Mail-order prescriptions for up to a 90-day supply are available, with a $15 per 90-day supply minimum and $150 per 90-day supply maximum co-payment ($300 per 90-day supply maximum for high-technology drugs).
► The $100 individual/$300 family annual deductible is waived for generic prescription drugs if they are obtained from a Cleveland Clinic Pharmacy.
- When purchased through a non-Cleveland Clinic retail pharmacy and after the deductible is met, prescription drugs are covered at 80 percent for generic, 70 percent for preferred brand (formulary), 50 percent for non-preferred brands (non-formulary) and 80 percent for high-technology drugs with prior authorization.
► The minimum co-payment is $5 per month and the maximum is $50 per month for generic and preferred brands.
► There is no minimum or maximum for non-preferred brands or high-technology drugs.
Dental insurance is provided to clinical residents and clinical fellows, postdoctoral research fellows and research fellows as well as their eligible dependents after one year of service at no cost to you. The plan takes effect on the first of the month following your anniversary date. You have a choice of the Traditional Dental Plan, the Preventive Dental Plan or the Dental HMO. You may purchase the dental plan during your first year. The cost will be charged to you through payroll deduction. After one year of service, Cleveland Clinic pays for your dental insurance.
Amy Dickenson and Rory Lough are our Group Long Term Disability representatives. They have been independent disability and life insurance advisors to Cleveland Clinic since 1991 and have provided exceptional customer service, education and benefits communication. If you have any questions concerning your disability insurance coverage provided by Cleveland Clinic, please contact a plan representative:
Amy P. Dickenson
Dickenson Group LLC
6001 Cochran Road, Suite 400
Solon, OH 44139
440-505-6007 – Office
440-349-8969 – Fax
Rory Bixel Lough
The Bixel Organization, Inc.
8561 East Avenue
Mentor, OH 44060
Cleveland Clinic offers each resident and fellow a group life insurance policy for $25,000 after 30 days of employment.
Cleveland Clinic provides professional liability coverage for all residents and fellows while working within the confines of Cleveland Clinic’s teaching programs. This includes outside rotations that are part of your training program. Elective rotations outside of Cleveland Clinic are NOT covered by Cleveland Clinic insurance. Upon completion of your training program, this coverage remains in effect for any litigation that may arise from incidents while you were in training. You do not have to purchase “tail” coverage after you leave Cleveland Clinic.
All benefits offered to residents and fellows are developed and implemented by Cleveland Clinic’s Graduate Medical Education Council (GMEC). While every effort is made to ensure the accuracy of the information presented on this website, it is conceivable that there may be mistakes or changes made to benefits since its posting. Cleveland Clinic and GMEC policies take precedence over the content on this website in matters of arbitration. Changes to benefits and/or revisions to them are communicated to residents and fellows in writing as they occur.