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Employer Plans

State of Wisconsin Group Health Insurance Program

It's Your Choice – Choose Network Health

At Network Health, we understand the importance of quality health care and believe it should be convenient. As a member of the State of Wisconsin Group Health Insurance Program, you can choose your plan based on your health insurance needs. We appreciate your choice to be a Network Health member.

Major Health Systems

Network Heath’s provider network is combined across northeast and southeast Wisconsin. Our network includes the following high-quality health systems.

  • Froedtert & the Medical College of Wisconsin (Froedtert, Community Memorial, St. Joseph’s Hospital – West Bend)
  • Children’s Hospital of Wisconsin
  • Ascension Wisconsin (Affinity Health System, Ministry Health Care, Columbia St. Mary’s, Wheaton Franciscan Healthcare)
  • Prevea Health
  • Bellin Health

New for 2020 - Redesigned Find a Doctor Search

Network Health's Find a Doctor search has a new look and functionality that makes it easier to find in-network doctors, hospitals and clinics.

Enhancements include the following.

  • A simplified design—you can choose a plan and enter key words in the "Help Me Find" field.
  • An Advanced Search section providers filters to refine search results.
  • The doctor and facility search are combined.
  • A map displays search results, so you can see where the providers are located.
  • You can View a Printable Map of your results.
  • Mobile responsiveness has been enhanced, so the page is easier to navigate on a mobile device.

Also New in 2020 - Enhanced Dental Benefits and Diabetes Prevention

Network Health members have access to extra dental benefits and a diabetes prevention program. Learn more.

Service Area Map

Member Portal

We gathered and incorporated customer feedback to deliver a redesigned member portal. This portal is easy to navigate and you’ll find tools, tips and important information to help get the most out of your benefits. The portal is also mobile responsive so you can access your important health insurance plan information 24/7 from any device.

Once you are logged in, you'll see a customized dashboard specific to you and your plan. From this dashboard, you can 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

Visit login.networkhealth.com for 24/7 access to your important plan information.

Local Customer Service

The State of Wisconsin Group Health Insurance Program has a dedicated customer service line located in Menasha, WI. To speak with a specially trained Network Health representative call 844-625-2208 or 920-720-1811. Our representatives are available Monday, Wednesday, Thursday and Friday from 8 a.m. to 5 p.m and Tuesday from 8 a.m. to 4 p.m. You can email us a question by using our Contact Us form. We can also provide Language Assistance.

quality ratings

Provider Directory

To find an in-network provider, follow these steps.

  1. Go to our Find a Doctor search tool.
  2. Choose State of Wisconsin employees/members from the Choose a Plan menu. 
  3. Follow the steps and enter in your search criteria then select Search.
  4. You can also view a PDF of the provider directory.
  5. If you would like a printed directory mailed to you, please call 844-625-2208.

Getting Care Quickly

Sometimes, you may have a non-emergency illness or question when your personal doctor is unavailable. When this occurs, Network Health offers two options for non-emergent care that are available 24 hours a day, seven days a week.

MDLIVE® Virtual Visits

Virtual visits, brought to you through MDLIVE, are a convenient and affordable alternative to urgent care or a doctor visit when you experience a non-emergency illness. By using your phone, smartphone, tablet or computer, you can connect with a board-certified physician or pediatrician for the treatment of a wide range of behavioral and physical health conditions.

MDLIVE can assist with these conditions and more.

  • Acne
  • Allergies
  • Behavioral health services
  • Cold and flu
  • Constipation
  • Cough
  • Dermatology
  • Diarrhea
  • Ear problems
  • Fever
  • Nausea and vomiting
  • Pink eye
  • Rash
  • Respiratory problems
  • Sore throats
  • Urinary problems
  • Vaginitis

 

 You can activate your Network Health MDLIVE account one of three ways.

  1. Text NETWORK to 635483 or visit MDLIVE.com/nhcommercial.com.
  2. Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account.
  3. Call 877-958-5455 and an MDLIVE customer service representative will walk you through the process of setting up an account.

Provider Nurse Lines

When you have health care questions, you can get advice by contacting your personal doctor's office or calling one of our provider nurse lines that can be found on the Getting Care Quickly page.

Prior Authorizations and Referrals

At Network Health, we believe in empowering you to control your health care decisions. You can see any in-network doctor without a referral, although select services require prior authorization.

A referral is a written request from your personal doctor (also referred to as a primary care practitioner, or PCP), allowing you to see a specialist or receive specific medical services.
Prior authorization (or prior approval) is the process of getting permission from Network Health to determine if a service, procedure, test or out-of-network provider will be covered by your insurance.
Select services, procedures, tests and out-of-network providers require prior authorization before you receive care. You will receive written notification regarding the approval or denial of the Prior Authorization. If you are unsure if a service, procedure, test or procedure requires prior authorization or a referral, call customer service at 844-625-2208 prior to the appointment.

Care Outside the Service Area

If you are traveling outside the network service area and have a medical emergency that requires a visit to the emergency room or urgent care, get the medical care you need without worrying about your health insurance. Network Health will cover the cost of your visit, excluding any required deductible, coinsurance, or copayment. Follow-up care must be received from an in-network provider unless otherwise approved by Network Health. 

A trip to the emergency room is warranted if you experience an injury, a worsening medical condition or illness, severe pain, and/or you feel that your health is in danger if you do not receive care immediately. Call Network Health at 844-625-2208 or contact your personal doctor if you need help determining the appropriate level of care.

Go to urgent care if your symptoms are moderate, but not severe or life-threatening. You may receive urgent care services from a nonparticipating facility, however you will only receive in-network benefits if one of the following is true:

  • You receive the services in the emergency department of a hospital or in a hospital-based urgent care facility, or
  • You receive the services in a nonhospital-based urgent care facility and you provide Network Health notification within 48 hours of receiving the services. Call the Network Health Care Management Department at 800-236-0208 (TTY 800-947-3529) to provide that notification.
  • Call Network Health at 844-625-2208 or contact your personal doctor if you need help determining the appropriate level of care.

Mental and Behavioral Health Treatment

We require prior authorization for autism treatment and all inpatient services for mental health, behavioral health or substance abuse services. For assistance, please contact Network Health’s Care Management Behavioral Health Department at 800-555-3616. After hours, call your practitioner or the Network Health Nurse Line.

2019 Summary of Benefits and Coverage

2020 Summary of Benefits and Coverage

Other Forms

Frequently Asked Questions

 

There are two ways to choose or verify a primary care practitioner or personal doctor.
  1. Visit login.networkhealth.com Once signed in, select your name in the upper right corner to view your profile. Select Change my Personal Doctor and follow the steps that appear to select or change your doctor.
  2. Call our customer service department at 844-625-2208.
Any prescription medication that must be picked up at a pharmacy is handled through Navitus
Any medication that is used by a provider during a hospital visit or stay is covered under your Network Health medical insurance.
Care management provides personalized coordination of care, access to care, identification of benefits and resources, and condition monitoring to help you get the health care you need, whether you’re dealing with a short-term illness or a more complex diagnosis. Care management begins with a one-on-one conversation with a care manager. If you choose to participate, you will work directly with a care manager to manage your health condition with the ability to opt out at any time by contacting the customer service number on your ID card. Care management is available at no cost to members.
Our condition management team empowers you to take charge of your chronic condition and be the healthiest you can be. Our skilled team of registered nurses engages members in one-on-one health coaching about their ongoing care, provides educational resources and helps build connections to community programs. Condition management is available at no cost to members, and enrollment in the program is voluntary. Individuals who may benefit from condition management services include those who have:
  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • Heart Disease
  • Stroke
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.

Premium- The monthly payment you make for your health plan.

Deductible - The amount you must pay for covered health care services before Network Health begins to pay

Copayment - A set fee you might pay for a type of health care or a prescription drug. For example, your copayment for a doctor visit could be $20. Once your deductible is met, Network Health pays the rest.

Coinsurance - A set percentage you might pay for a type of health care or a prescription drug. For example, 10 percent coinsurance means you pay 10 percent of the cost. Network Health pays the rest.

Medical Drug Exceptions and Member Responsibilities

A medical drug is a drug that is not self-administered. Rather, it is administered by a doctor or physician. 

Network Health's Pharmacy and Therapeutics Committee determines medication tiering and utilization management criteria based on clinical evidence, safety, cost and national recognized therapeutic guidelines. If your prescribed medication is not covered or partially covered, you or your prescriber can ask us to cover it. This is considered an exception.

Medical drug exceptions can be handled both externally and internally. Exceptions usually require a supporting statement from your prescriber explaining why alternative medications are not sufficient.

Common Medical Drug Exception Reasons

  • The requested drug is not on the formulary
  • The requested drug is part of a step therapy
  • A medical condition or drug interaction exists that may require use of the requested drug
  • The requested drug requires a prior authorization

How to Handle a Potential Medical Drug Exception

  • You can contact customer service at the number listed on the back of your member ID card for a list of similar medical drugs covered by Network Health. 
    • You can share this list with your prescriber and ask for a similar medication. 
  • Next, your prescriber must obtain a prior authorization for the exception. This is necessary to determine medical necessity.
    • Your prescriber can complete a prior authorization electronically or via fax and explain why an exception is required. 
    • Electronic requests can be done through portals such as CoverMyMeds® or ExpressPAth®
    • If the prescriber is unable to submit the request electronically, this paper form can be faxed to Express Scripts. 
    • If your prescriber has questions, he or she can call Express Scripts at 800-209-0981.  

A decision will be made regarding your exception within three business days of receiving all the necessary information–including the supporting prescriber statement. You can request an expedited decision if you or your doctor feel your health could be harmed by a three-day waiting period. If your expedited request is granted, a decision will be provided within 24 hours of receiving your doctor’s supporting statement.

  • If a prior authorization is denied, you can request an internal review by contacting customer service at the number listed on the back of your member ID card. 
    • The customer service representative can help you request an exception to cover your drug–he or she can direct you where to send the request.
    • When requesting an exception, a statement from your prescriber is often necessary to support the request for an exception. 
  • Examples of exceptions include the below.
    • You can ask us to cover your drug, even if it is not on our drug list.
    • You can ask us to remove coverage restrictions or limits on your drug.
    • If the internal review upholds the denial for a coverage exception, you will receive a written denial which will contain a form that you can complete and send back to request an external review by an independent review organization.

 

 


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