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Information Specific to Commercial Group and Individual and Family Plan Members
If you have any questions feel free to reach out using the contact information listed throughout this page. You can also contact our member experience team.
For frequently asked questions about the coronavirus vaccine, please visit our coronavirus vaccine page by clicking the link below.
Medical Plan Information About the Coronavirus
Yes, the coronavirus test is covered by your Network Health plan, in accordance with the Families First Coronavirus Response Act.
You will pay $0 out-of-pocket to receive this test at in- and out-of-network facilities.
You can contact your personal doctor, Wisconsin Department of Health Services at dhs.wisconsin.gov/outbreaks/index.htm, Ascension, Froedtert or visit the CDC’s website at cdc.gov/coronavirus/2019-ncov/index.html.
If you are feeling mildly ill, call your doctor before seeking medical treatment.
- He or she may be able to give you advice on how to treat your symptoms at home, which would reduce the number of people you expose.
- If you or someone you’re caring for is short of breath, minimally responsive, looks blue or ashen call 911.
Providers will prioritize who is tested. Here is some of the criteria that will be used.
- Patients with signs and symptoms of the coronavirus (such as fever, cough and difficulty breathing) and no other explanation for symptoms.
- High risk patients (individuals with underlying health conditions such as asthma, diabetes, cancer or heart disease, age = 65, residing in a long-term care facilities, etc.).
- Patients with known or suspected contact (direct contact with a known case of the coronavirus, travel history to a high-risk geographic area or healthcare worker with known exposure) within the past 14 days.
If your provider determines you need a test, they will work with you on what to do next. Typically, that means your doctor will collect a sample via swabbing the nose and throat before sending to a state-regulated lab.
Health Insurance Exchange (Marketplace) Members
Information for Employer Groups
For employer groups that may have unique circumstances, please contact your client manager. Below is an overview of some changes we’re making effective immediately.
Effective immediately, through July 1, 2021, Network Health will have relaxed eligibility guidelines for employer groups. Groups that have reduced hours for staff, have furloughed employees, or have employees that have been laid off will be considered actively at work for eligibility purposes if monthly premiums are paid.
Groups no longer meeting participation requirements due to the public health crisis will not be termed. Groups impacted will be handled on a case by case basis at the time of renewal.
Telehealth Services
To give our members access to the care they need, as of March 20, 2020, Network Health will cover all coronavirus telehealth services for a $0 copayment, including MDLIVE® virtual visits and telephone and virtual face-to-face visits with in-network providers. This $0 coverage will end on July 17, 2022.
In addition to coronavirus telehealth services, telehealth services performed by primary care, behavioral health and OBGYN providers are covered with no member cost share, until July 17, 2022. Other visits are subject to your plan’s deductible, copayment and/or coinsurance. Telehealth services from out-of-network providers for HMO members will not be covered.
Do health savings account (HSA) members have to meet their deductible before coronavirus telehealth visits are covered at $0?
No. To increase access to appropriate care, all coronavirus telehealth visits will be covered at $0 per visit until July 17, 2022, even before members have met their deductible.
Do health savings account (HSA) members have to meet their deductible before non-coronavirus telehealth visits are covered at $0?
No, primary care telehealth services are not subject to your plan’s deductible, copayment and/or coinsurance until July 17, 2022.
Virtual visits limit your exposure to illness from others and limit the spread of any illness you may have. Getting medical advice using a virtual visit provides many benefits if you are experiencing non-emergency symptoms. For more information on MDLIVE, including the illnesses they treat and instructions for logging in, visit our Getting Care Quickly page.
Please note, due to increased activity, MDLIVE wait times are longer than usual. If you prefer not to wait on hold, MDLIVE gives you the option to receive a call back
Yes, all coronavirus and primary care telehealth services are covered for a $0 copayment until July 17, 2022. This applies to all telehealth providers for point-of-service (POS) plans and in-network providers for health maintenance organization (HMO) plans. HMO plans do not cover telehealth services with out-of-network providers.
Below is a list of providers that have telehealth services available online.
- MDLIVE mdlive.com/networkhealth or visit login.networkhealth.com for single sign on login through the member portal
- Ascension getascensioncare.com/onlinecare/
- Froedtert froedtert.com/virtual-clinic
- Agnesian ssmhealth.zipnosis.com/
- Bellin bellin.org/virtualvisits
- Prevea prevea.com/virtualcare
Do any providers have phone numbers to call if a member is experiencing symptoms and wants to discuss it with somebody?
Yes, see the list below.
- Froedtert 414-805-2000
- Ascension 833-978-0649
- Agnesian 844-225-0147
- Bellin Health 888-330-3524
- Bellin Telehealth 920-445-7313
- Holy Family 920-320-3333
- Primary Care Associates of Appleton 920-996-1000
- ProHealth 262-928-4499
Do members have to be an existing patient with a provider/provider office to see him or her virtually?
That is at the discretion of the provider. Typically, providers will only see existing patients virtually.
No, the coronavirus must be diagnosed through a lab test. Telehealth providers can let their patient know whether a lab test is warranted.
Does the $0 copayment include any labs that may be ordered (ex: the provider says you need to come into the office to have a blood test run)?
No, any labs that are ordered by the telehealth provider will be subject to your plan’s deductible, copayment and/or coinsurance. The exception is the coronavirus lab test – that is fully covered by your Network Health plan.
