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Employer Plans

Member Resources

At Network Health, our goal is to make managing your health insurance easier. This page contains information and links to ensure you are getting the most out of your plan. 

See our 2023 NCQA rating for employer plans

Member Portal

For plan information that’s specific to your plan, log in to your member portal account at My Login. See our How to Register cheat sheet for first time login instructions.

We’ve gathered and incorporated customer feedback to deliver a member portal that’s centered around you. The portal is easy to navigate to find information regarding your plan, benefits, claims and more. Plus, it's mobile responsive and viewable from any device at any time. The first time you access the new portal, you will need to create a new account.

Once you are logged in, you'll find all this and more.

  • Benefits and coverage overview
  • Out-of-pocket expenses tracker
  • Claims detail and status
  • Your mobile ID card
  • Find a Doctor search and ability to select your personal doctor
  • Secure messaging with our local customer service team

Key Information About How to Use Your Plan

Your Personal Doctor (also referred to as a Primary Care Practitioner or PCP) 

There are two ways to choose or verify a primary care practitioner or personal doctor.

  1. Go to My Login to sign in to your account. Once logged in, click your name in the upper right corner to bring up your profile. Select Change My Personal Doctor and follow the steps that appear to choose or change your personal doctor.
  2. Contact our Network Health member experience department by calling the number on the back of your Network Health ID card.

If you haven’t or don’t wish to choose a personal doctor, the Network Health system will automatically assign a personal doctor based on primary care doctors you have seen recently who are part of your plan and accepting new patients. For those who haven’t seen a personal doctor in two years, Network Health will work with our provider partners to assign you a personal doctor in your area who is accepting new patients. Whether your personal doctor is selected or assigned, you’ll receive the same high-quality care you’ve come to expect.

No Referrals 

You are not required to have a referral to see an in-network specialist. Simply make an appointment with the provider. Some specialty offices may require that you first seek care and evaluation at a personal doctor (also referred to as a primary care practitioner or PCP) before the office will see you. Emergency care is covered 24 hours a day from any emergency facility.

Services That Require Prior Approval

In some cases, Network Health will need to give approval for you to receive coverage for certain services provided by a specialist or other provider. This is called a prior authorization. Once approved, the service is subject to the terms of your policy and summary of responsibility table.

Your Network Health participating provider or his or her office staff will submit a request on your behalf for authorization. Network Health’s Utilization Management Department will review the request and make the decision to approve or deny the service. You will receive a letter from Network Health notifying you of the approval or denial of the service or visit. If you need non-emergent, non-urgent care services from an out-of-network provider, you are responsible for confirming that the service has been approved by Network Health’s Utilization Management Department prior to receiving the service. Please contact the Utilization Management Department at least 14 days prior to receiving care. For pre-service urgent requests, Network Health will make a decision within 72 hours. For concurrent urgent requests (e.g. for a continued stay at a hospital), Network Health will make a decision within 24 hours. 

Your plan provides coverage without authorization, with in-network providers for medically necessary urgent care at a hospital and for emergency health services during an emergency room stay.

If you are admitted to an out-of-network facility after receiving emergency care, or if you receive urgent care from an out-of-network facility, you must notify Network Health within 48 hours or on the next business day of the admission or service. If you are physically or mentally incapable of providing notice within that time, you must provide notice within 48 hours or the next business day of regaining capability. If you are a minor, your parent or guardian must provide notice within 48 hours or the next business day of your admission to an out-of-network facility after receiving emergency care services. If a parent or guardian is not aware of your admission, he or she must notify Network Health within 48 hours or the next business day of becoming aware of the admission. In any case, Network Health must be notified within two business days of discharge from the out-of-network facility or you may be financially responsible for the costs of the services.

If you have questions about which services require authorization, or the status of your authorization request, log in to the member portal at My Login. You can view a list of services that require authorization under My Materials. To see the status of an authorization request, select My Benefits and then My Authorizations.

If you have an authorization request or questions about the prior authorization process, call our Utilization Management Department at 866-236-0208 or TTY 800-947-3529. For mental health and substance abuse services, please contact Network Health’s Care Management Behavioral Health Department at 866-709-0019. You may leave a message 24 hours a day, seven days a week. Calls about routine (non-urgent) authorization requests received after business hours will be returned the next business day. See the Inpatient Hospital Care section below for more information on urgent hospital stay requests received after business hours.

Requesting Prior Approval for Inpatient Hospital Care 

All non-emergency hospitalizations require prior authorization from Network Health. If you are admitted to a non-participating hospital for observation or as an inpatient after a stay in the emergency room, you or your physician must obtain approval from Network Health within 48 hours of the admission or the next business day to receive coverage. If this notification requirement is met, Network Health’s Care Management Department can approve hospital days following that emergency visit up to the time of the notification. Network Health will review any additional days to be sure the stay continues to be medically necessary.

Please call the Utilization Management Department at 866-709-0019 for all prior authorizations and notifications. For mental health and substance abuse services contact Network Health’s Care Management Behavioral Health Department at 866-709-0019. Bilingual language assistance or translation services are available for members. Network Health also offers services for deaf, hard-of-hearing or speech-impaired members (TTY 800-947-3529).

Requesting an Independent Review

We work hard to ensure member satisfaction, but you have the right to have an independent organization examine certain final decisions made by Network Health. Network Health contracts with three nationally-accredited independent review organizations (IRO) to conduct reviews, and the decisions are binding for both Network Health and the member.

Decisions made by Network Health that are eligible for review are those where we determined the requested care or services did not meet our requirements for medical necessity, appropriateness, health-care setting, level of care, effectiveness, experimental treatment, rescission of a policy or a certificate or coverage denial determination based on pre-existing condition exclusion. Requests for services that are not included in your benefits package are ineligible for independent review (including, but not limited to, benefits limitations and direct exclusions).

Typically, you must complete Network Health’s internal complaint process (called a grievance) prior to starting an independent review. However, you do not need to complete the process if you need immediate medical treatment and a delay could jeopardize your life or health, or if we agree with you that it is in everyone’s best interest to proceed with your concern directly to independent review.

For more information on the independent review organization process, call the number on the back of your Network Health ID card.

Evaluating New Technologies 

Network Health evaluates new technologies and new applications of existing technologies on a regular basis. This includes the evaluation of medical procedures, drugs and devices.

New technologies are reviewed by a group of participating physicians and health plan staff who make recommendations for inclusion as a covered benefit. The review process also includes evaluation of information from government regulatory bodies and published scientific evidence.

How Do Health Plans Make Decisions?

Did you know that utilization decisions made about care by Network Health are based on the appropriateness of care and service? Care and service include medical procedures, behavioral health procedures, pharmaceuticals and devices. Decisions are based on written criteria founded on sound clinical evidence and on the benefits outlined in the various Coverage documents. The written criteria are reviewed and approved annually by actively-participating practitioners. Criteria are available to providers, practitioners and/or members/participants upon request. Requests for criteria can be submitted via telephone, fax, electronically, or USPS. Once the request is received, utilization management associates send the requested criteria to the requestor via fax, electronically or USPS.

In addition, treating practitioners may discuss medical necessity denial determinations with the physician review medical director by contacting us at:

Access to our Care Management or Utilization Management teams: call 920-720-1602 or 866-709-0019.

Callers have the option to leave a message 24 hours a day, seven days a week. Messages are retrieved at 8 a.m., Monday through Friday, as well as periodically during the business day. All calls are returned promptly. Calls received after business hours are returned the next business day. Members/Participants, practitioners and/or providers may also send inquiries to the care management department through secure email on the provider portal, fax, and USPS. You can fax the utilization or care management department at 920-720-1916.

Network Health offers TDD/TTY services for deaf, hard of hearing or speech-impaired individuals. Anyone needing these services should call 800-947-3529. Bilingual language assistance or translation services are also available. Callers may leave a message 24 hours a day, seven days a week.


Advance Care Planning/Power of Attorney for Health Care Form 
Use this resource to find for you to give someone permission to make health care decisions on your behalf. For questions about advance directives, contact the Wisconsin Department of Health Services at 608-266-1251 or contact Network Health at 920-720-1300 or 800-826-0940 (TTY 800-947-3529).

Authorized Representative Form
This form names a relative, friend, advocate, doctor or someone else to act on your behalf for an appeal or complaint. Send the completed form to Network Health, Attn: Appeals and Grievance Department, 1570 Midway Pl., Menasha, WI 54952.

Coordination of Benefits (COB)
Fill out this form if you and other members of your household are covered by more than one health insurance plan. Network Health will communicate with the other health insurance company to determine which company pays for each claim.

Member Authorization Request Form
Fill out this form when you, rather than the provider, are required to obtain prior authorization for services provided. 

Member Reimbursement Form
If a provider is unable to send a claim this form can be used to submit charges to Network Health.

Protected Health Information Form 
When completed and signed by both parties, the Protected or Personal Health Information Consent form allows the specified person (a spouse, relative, friend, advocate, attorney, doctor or someone else) to call and discuss your coverage and plan information if it’s ever needed. Completed forms can be mailed to Network Health, P.O. Box 120, Menasha, WI 54952.

Request for Access Form
This form requests a copy of the protected health information Network Health has about you in a designated record set.

Well-Child Resources 

Your personal doctor (also referred to as a primary care practitioner or PCP) is a key resource in managing the health and wellness of yourself and your family. Your doctor may have resources to help you track your child’s next appointment date(s) and upcoming care needs. Your doctor may also be able to provide you with a list containing completed immunizations and medications. Network Health cares about your child’s health and encourages you to work in close partnership with your chosen doctor to meet the physical, social and emotional health needs of your family. For assistance selecting a doctor, contact Network Health at the number on the back of your ID card.

The milestone tracker from the Centers for Disease Control and Prevention (CDC) is a tracking document for recommended immunizations, milestones and growth from birth to six years of age., a website sponsored by the American Academy of Pediatrics, has apps for families that are available for download; these apps give you the ability to track your children’s health information, needs and providers and give guidance on when well-child visits and immunizations are due. They also have apps available for tracking children’s needs with attention deficit hyperactivity disorder (ADHD), car seat safety and safety with physical activity and exercise. Some apps are available for a small fee.

The AAP Schedule of Well-Child Care Visits from can help you organize and prioritize the topics you should to discuss with your provider during well-child visits.

Immunization Resources 

Immunizations help keep us free from various diseases throughout our lifetimes, from infancy to teen years, through adulthood and into our elderly years. Network Health supports member choice when it comes to immunizations. We collected some resources to help you prepare and make the best decision for the health of yourself and your family.

The CDC has a library of information that relates to the health and wellness of you and your family.

A guide for parents on vaccinating your child

Making the vaccine decision

Recommended immunizations for children (birth to 6 years)

Recommended immunizations for children and teens (7 through 18 years)

Recommended immunizations for adults

Pregnancy Resources

If you’re pregnant or have a baby under 1 year, Network Health recommends Text4baby, a free service that helps you feel more prepared for motherhood. Text4baby will send you doctor appointment reminders and personalized information on prenatal care, baby’s development, signs of labor, breastfeeding, nutrition and more, directly to your cell phone. It’s easy to sign up and the text messages are FREE, regardless of how many text messages you have in your cellphone plan or even if you don’t have texting in your cellphone plan. To sign up, text BABY (or BEBE for Spanish) to 511411. You can cancel the service at any time by texting STOP (ALTO for Spanish) to 511411. There is also an app, available for download in the Google Play and iTunes stores, which provides additional information about baby’s development, pregnancy, childcare tips and more. You can also sign up and find more information at or on Text4baby’s Facebook page.

Parenting Resources 

The CDC offers Positive Parenting Tips for children from newborn to 17 years old.

  • Violence prevention. Thorough understanding of adverse childhood experiences is becoming more important in today’s society. The CDC shares resources about various issues and strategies for helping our children grow up happier and healthier.
  • Youth bullying prevention. Resources are available to help understand bullying, identify children at risk for bullying, explain types of bullying and provide strategies for parents, schools and community professionals to come together to stop bullying and its harmful effects on our children.
  • Coping with Stress. Resources to help the whole family, including children, teens and adults as we cope with normal life stressors such as finances, social acceptance and self-care. You can also find information to assist with threatening situations that cause traumatic physical or emotional tension, such as car accidents, domestic violence and alcohol and drug abuse.

Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD is a disorder that makes it difficult to pay attention and control impulsive behaviors. While symptoms generally begin in childhood, ADHD can continue through adolescence and into adulthood. Although the exact cause is unknown, research suggests ADHD may be caused by interactions between genetic and environmental factors. While there is not a cure for ADHD, treatments are available and may help reduce symptoms and improve function. Medications, behavioral therapy, counseling and practical support can help those with ADHD and their families cope with everyday problems.

Your personal doctor, pediatrician or behavioral health specialist are key resources for managing health and wellness for yourself and your family. It is important to schedule follow up visits as recommended to achieve the best outcomes.

Visit Centers for Disease Control and Prevention (CDC) ADHD website to learn more about symptoms of ADHD.

Additional Resources

Surprise Billing Model Notice
All payers must inform their non-Medicare members of their balance billing protections under the No Surprises Act. This notice provides you with what is “balance billing” and “surprise medical claims”, what your rights are under the law, and who to contact if you feel you are being balanced billed.  

Transparency in Coverage
The Transparency in Coverage rule requires health insurers and group health plans to disclose certain pricing information. As of July 1, 2022, group health plans and issuers of group or individual health insurance must post pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care.

The files linked to below are machine readable files. Our pricing tool, per regulations, will be live in 2023.

Preventive Physical vs. Office Visit
Learn the difference between a preventive physical and an office visit.

How Health Plans Make Their Decisions
Find out how decisions are made about your care. You can also view our medical policies for certain treatments here.

Network Health ensures that everyone who handles protected health information within the organization maintains confidentiality at all times.

Notice of Privacy Practices
Our policies to ensure that your privacy and information is protected.

Member Rights and Responsibilities 
As a member, you have certain rights and responsibilities.

Appeals and Grievances
Learn more about how to file a complaint (called a grievance) or an appeal.

Women's Health and Cancer Rights Act of 1998

The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA)

Clinical Practice Guidelines

Frequently Asked Questions

You can only do this in certain situations, called qualifying events. Examples of these include birth, marriage, adoption or when you lose past health coverage. Otherwise, if you don’t select the coverage offered by your employer within a certain time frame, and then you decide you want to sign up, there may be a wait.

Complete a form from your provider’s office requesting the transfer of medical records. You may also contact your previous provider to request the transfer. Sometimes there is a fee for the collection or transfer of medical records.

We work with Express Scripts, Inc.® (ESI) to make your pharmacy and drug coverage straightforward. If you have any questions about your prescription drug coverage, log in to your Network Health member portal, go to My Benfits, then Pharmacy Benefits. You can also call the ESI number on the back of your member ID card.

Yes. While out of our service area, he or she is still covered for emergencies and urgent care. If follow-up care is needed, Network Health must approve it. Some colleges offer basic health care services at no charge, so if you have child(ren) in college(s) located outside of the service area, we recommend exploring that option.

Your deductible is the amount you must pay for health care services before Network Health starts paying. For example, if your plan’s deductible is $500, once you’ve paid the amount, you’ll have met your deductible and we will begin paying for services.

A premium is the set monthly amount you pay to maintain membership in your plan (your employer may help pay for this). When you see a doctor, you may pay a fixed fee called a copayment. Network Health pays the rest. If you have coinsurance, once you’ve met your deductible, you pay a certain percentage of the cost for the care or service. The amount you pay is different depending on the type of plan you have. You can find your plan specific copayment and/or coinsurance amounts by logging into the member portal at It is also available in your Member Handbook.

An emergency is an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm. Seek urgent care for an unexpected injury or illness that is not life threatening, but still needs attention quickly so you don’t develop a serious problem.

Network Health
1570 Midway Place
Menasha, WI 54952
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.

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