If your condition qualifies, your plan pays 100% of eligible costs for most conditions and even covers travel and lodging for you and a companion when using the COE program. You must be enrolled in the Premier, Contribution, Saver plans or a Local plan to be eligible for these benefits. Here are some other important rules and details:

Waiting period—transplants and weight loss surgery have a 12-month waiting period from the date your medical coverage becomes effective before benefits are available.

Coverage for COE programs—Coverage for fertility treatments, spine surgeries, transplants and weight loss surgeries is available only under the COE program; in certain circumstances a network exception may apply for spine surgery and transplants. Hip and knee replacements not performed at a COE program will have a reduced benefit, unless a network exception applies. For more information about network exceptions and coverage levels, please see the Associate Benefits Book.

Weight loss—Weight loss surgeries performed at a COE facility are covered at the regular benefit level of 75% of eligible in-network costs after you meet your annual deductible.

Fertility benefit—Fertility treatments and services, including IVF and IUI, are covered subject to a $20,000 lifetime maximum benefit per person for associates and covered dependents enrolled in the Premier, Saver or Contribution plans or a Local Plan. Coverage may also include travel benefits. Eligible associates also have access to benefits for surrogacy and adoption.

Heart surgery—If you are being considered for heart surgery, you and/or your doctor will be directed to Cleveland Clinic for a cardiac “eReview” to make sure the treatment is appropriate. If they recommend surgery, you’ll be invited to have it done at Cleveland Clinic, where you’ll get 100% coverage instead of 75% of eligible in-network costs at a non-COE (in-network) facility.

Cardiac valve surgery—If you are being considered for heart valve surgery, you and/or your doctor will be directed to set up a cardiac valve “eReview” with Cleveland Clinic to make sure the treatment is appropriate. If they recommend surgery, you’ll be invited to have it done at Cleveland Clinic, where you’ll get 100% coverage instead of 75% of eligible in-network costs at a non-COE (in-network) facility.

Saver Plan—If you’re enrolled in the Saver Plan, you must meet your annual network deductible before the Associates' Medical Plan (AMP) pays any benefit to become eligible for the coverage levels shown here.