Coordinated Care Program Overview

Living with a chronic condition can be challenging, however you have the opportunity to receive help managing your condition, so you don’t have to do it alone. Employee Health Plan (EHP) offers Coordinated Care programs at no extra charge. 

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How the Program Works

Members have regularly scheduled contacts with their Care Coordinator. Care Coordinators help you and your health care providers optimize your health care benefits to meet your health- related needs. 

Their goal is to educate you, discuss lifestyle changes necessary to meet your goals, review your progress, and refer you back to your provider as needed for your care needs related to your health condition and reduce your risk for serious complications.

This program does not replace your provider's care. It is designed to work with your provider, reinforcing your provider's recommendations so you can stay healthier between provider visits. 

Advantages of Joining the Program

Plan members who join Coordinated Care can be reimbursed for some of their copayments for medically necessary screenings and monitoring equipment. Once all of your clinical goals are successfully met, you may be eligible for reimbursement of some of your provider visit copayments, along with qualifying condition-related prescriptions and equipment supplies. Reimbursements only apply when services are provided by an in-network provider for EHP and EHP Plus plans. The Coordinated Care Copay Reimbursement FAQ document will provide you with more detailed information on these and other advantages of joining the program. Upon retirement, members are no longer eligible to participate in Coordinated Care. 

EHP members may enroll in any of the Coordinated Care programs listed below:

  • Asthma (adults and children)
  • Congestive Heart Failure (CHF)
  • Depression (adults and children)
  • Diabetes *
  • Hyperlipidemia (high cholesterol) 
  • Hypertension (high blood pressure)
  • Migraine (adults and children)
  • Nicotine Program (offered by Health Coaching)
  • Weight Management 
  • Bariatric Surgery Copay Reimbursement Program

*See SPD for more information on the Diabetes program incentives regarding children

Coordinated Care Medication Reimbursement:

EHP CC Asthma Medication Reimbursement List EHP CC Congestive Heart Failure Medication Reimbursement List EHP CC Depression Medication Reimbursement List EHP CC Diabetes Medication Reimbursement List EHP CC Hyperlipidemia Medication Reimbursement List EHP CC Hypertension Medication Reimbursement List EHP CC Migraine Medication Reimbursement List

At this time, anti-obesity medications are not reimbursable under the medical reimbursement program. For more information, see the Prescription Drug Coverage section of our FAQs.

Getting Started is Easy

You can join the Coordinated Care Program by calling EHP Medical Management at 216.986.1050 or 888.246.6648, option 2.

Coordinated Care Incentive FAQ

AccordantCare

The Employee Health Plan is partnered with AccordantCare, a CVS Caremark company, to provide members with a Rare or Complex Condition Program that specializes in the uncommon conditions to provide rare or complex care programs.

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