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Information Specific to Commercial and Individual and Family Plan Members
Below you will find useful information about the virus specifc to commercial members.
If you have any questions feel free to reach out using the contact information listed throughout this page. You can also contact our customer service team.
Individual and Family Plan Members
Coronavirus Relief Benefit Enhancements
As your health and wellness partner, Network Health is launching new, safe ways for you to improve or maintain your health. If you purchase insurance on your own, you have access to these benefits in 2020.
Health Insurance Exchange members receive a Benefits card to use for qualified health care expenses in 2020. Cards will mail in August 2020.
Here are some ways to use your card.
- Pay your office visit copayments
- Pay your coinsurance expense
- Pay for prescription medications
- Purchase over-the-counter products (For a list of eligible products click here)
- Out-of-pocket dental expenses
- Dental x-rays, exams/teeth cleanings, gum treatments, fillings, crowns, bridges, oral surgery, extractions, dentures
- Out-of-pocket vision expenses
- Contact lens solution and cleaners
- When purchased through a vision provider: contact lenses, eye examinations, eyeglasses, reading glasses, prescription sunglasses
These items cannot be purchased with your Benefits Card.
- Vitamins
- Spa treatments
- Dinner at a restaurant
- Any other items not on the list
Health Insurance Exchange (Marketplace) Plans with Supplemental Benefits
If your plan was purchased on the Health Insurance Exchange, you may have supplemental benefits available through yoru Network Health plan. To determine if your Network Health plan offers these benefits, review your plan documents. Below you will find each benefit and the updates we've received from our partners.
Argus Dental Contact Info
- Argus Dental can be reached at 844-296-1850, Monday–Friday from 7 a.m. to 7 p.m. CST.
Many vision providers are beginning to offer routine services again. We recommend calling your provider directly to verify business hours and service availability.
EyeMed Contact Info
- 866-939-3633 (TTY 711), Monday–Saturday from 6:30 a.m. to 10 p.m. and Sunday from 10 a.m. to 7 p.m. CST.
Many fitness centers are reopening with restrictions. If your Network Health plan has a fitness benefit and you don't feel comfortable using a fitness center, you have access to other resources so you can continue to exercise from the comfort of your home.
Active&Fit offers the follow options for members.
- Members can order up to two home fitness kits per year. Each kit is unique and focuses on a specific style of fitness. Depending on the kit(s) the member chooses, it may include items such as DVDs, guides, a FitBit® activity tracker and/or other items.
- The Active&Fit ConnectedTM tool allows members to track their exercise and activity from a wearable device—this is also available through Active&Fit's ASHConnectTM mobile app.
- Visit networkhealth.com/individual/additional-benefits for more information on how to select and order home fitness kits.
Health Insurance Exchange (Marketplace) Members
Information for Employer Groups
Network Health is here to help. We are here to support you even though our physical offices are closed. We will be handling business a little differently to ensure we’re continuing to provide you with the same superior service you’ve come to expect. 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 December 31, 2020, 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.
Medical Plan Information About the Coronavirus
In addition, if you are outside the Network Health service area and you receive the lab test, we are not requiring a prior authorization (prior approval) for the lab test.
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.
Yes, all Network Health members can get a 90-day supply of their medications if the following conditions are met.
- The prescription order has sufficient refills remaining. If needed, ask the pharmacist to request additional refills from your prescriber.
- The requirements for taking these medications imposed by the medication prescriber are met.
- This applies to our entire pharmacy network, including states outside Wisconsin.
Commercial members can get their refills via retail location or mail order.
Health Insurance Exchange members must use mail order to get a 90-day supply of medication.
During the coronavirus health crisis, members may reach out to their pharmacy to ask about delivery options. Many pharmacies are delivering free of charge while Wisconsin is under the safer at home order.
At this time, no changes are anticipated to member medical or pharmacy benefits. We are monitoring the situation closely and will update our information and policy if the situation changes.
Telehealth Services
To give our members access to the care they need, effective 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.
In addition to coronavirus telehealth services, telehealth services performed by primary care, behavioral health and OBGYN providers are covered with no member cost share. 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 December 31, 2020, 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 December 31, 2020.
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. 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. This list will continue to grow as we get more information.
- 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, this list will continue to grow as we get more information.
- 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.
This depends on the pharmacy, so the member will want to call the pharmacy to confirm. During the coronavirus health crisis, many pharmacies are delivering free of charge while Wisconsin is under the safer at home order.
In addition, many pharmacies have drive-up windows that customers can use if they don't want to enter the store.
