Description
Group Health Cooperative of South Central Wisconsin (GHC-SCW) is a non-profit, member-owned health plan providing high-quality health care services, including primary care and specialty care to over 80,000 members living in south central Wisconsin.
When your health care and your health plan work together, the result is the superb care and impeccable service you've come to expect from GHC-SCW.
The GHC-SCW Neighbors Network includes the following health care systems and clinics: Aspirus Health, Family Medical Center (Lancaster), Fort HealthCare, Grant Regional Health Center, High Point Family Medicine, Memorial Hospital of Lafayette County, Mile Bluff Medical Center, Reedsburg Area Medical Center Physicians Group, Sauk Prairie Healthcare, Southwest Health, Three Oaks Health, Upland Hills Health, and UW Health (Fort Atkinson and Portage locations).
If you primarily receive care at one of the health care systems or clinics listed above in Columbia, Grant, Iowa, Jefferson, Juneau, Lafayette, or Sauk County, select the GHC-SCW Neighbors Network.
Please note that there are also clinics outside of these counties in the GHC-SCW Neighbors Network that you may choose from: Sauk Prairie Health Care's Wisconsin Heights Clinic in Mazomanie, Upland Hills Clinic in Mount Horeb, and Aspirus Health Clinic in Oxford.
You will still be able to visit Urgent Care Facilities, Emergency Rooms, and UW-Health Hospitals and Specialists located in Dane County.
What's New for 2024
Network Changes
New for the 2024 plan year, you will enroll in one of two networks, depending on where you want to primarily receive care: the GHC-SCW Dane Choice Network or the GHC-SCW Neighbors Network. The GHC-SCW Neighbors Network includes Primary Care Providers (PCPs) that are located in Columbia, Grant, Iowa, Jefferson, Juneau, Lafayette, and Sauk Counties.
Regardless of where you live or work, you will have the option to select either network.
All dependents on the subscriber's plan will automatically be enrolled within the same network the subscriber selects. Subscribers and their dependents cannot be enrolled in different networks.
Virtual Care
GHC-SCW is introducing a new platform for Virtual Urgent Care visits on demand. These will be powered through KeyCare. Virtual Behavioral Health visits on demand will still be powered through MDLive.
With these changes, the GHC SmartCare app and GHC Care OnDemand app will no longer be available. Members will need to visit our Virtual Care page for virtual care needs.
Podiatry
Associated Podiatrists have relocated from our GHC-SCW clinics to their own dedicated locations. Members can still seek podiatry care from Associated Podiatrists at the Associated Podiatrists Madison West Office and the Associated Podiatrists Madison East Office.
In addition, GHC-SCW has added a new Podiatry Provider to our network, University Podiatry Associates. Members can seek care at the following two locations by contacting them directly at their clinic locations: University Podiatry Associates - West Madison Clinic and University Podiatry Associates - East Madison Clinic.
Provider Directory
Go to our Government Employees page and scroll down to the "Wisconsin Public Employer Group Health Insurance Program Members and State of Wisconsin Group Health Insurance Program Directories" section. The current provider directories are available under the plan year. To request a printed directory to be mailed to you, call Member Services at 1-800-605-4327.
Referrals, Authorizations, Out-of-Network
Your primary care provider will submit a referral request to GHC-SCW Care Management Department when you need to receive services outside of a GHC-SCW clinic or through a specialty care area that requires a prior authorization. Certain procedures or tests also require a prior authorization for medical necessity review. You will receive a letter from GHC-SCW, as well as notification in your GHCMyChartSM account letting you know if the referral/prior authorization has been approved.
Emergency and Urgent Care
If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact GHC-SCW Member Services at 1-800-605-4327 if assistance is needed to determine the appropriate level of care. Follow-up care must be received from an in-network provider unless otherwise approved by GHC-SCW.
Mental, Behavioral Health and Substance Abuse
When seeking Behavioral Health services, please visit the Behavioral Health page. This page will provide helpful information about your options and contact information for securing care. A prior authorization is not required when seeking individual psychotherapy or psychiatry care.
24-Hour Nurseline
GHCNurseConnect: 608-661-7350 or 1-855-661-7350
Virtual Visits
GHCMyChartSM Video Visits
Looking for a video visit? GHC-SCW members can schedule video visit appointments through GHCMyChart for routine visits and select specialty visits (PT/OT, Dermatology, and Behavioral Health). Video visit appointments through an active GHCMyChartSM are a simple option to see your healthcare provider while still getting the exceptional care you expect from GHC-SCW.
Virtual Urgent Care and Virtual Therapy Visits
Members can virtually access a doctor or therapist from their own home or office, on-the-go, 24/7, 365. Licensed providers and therapists are available either by phone or secure video to help treat any non-emergency medical or behavioral health condition. Visits are free for most members. Members with Medicare or HSA-Eligible plans have restrictions or limitations.
Visit our Virtual Care page to learn more.
Major Health Systems
- Aspirus Health
- Fort HealthCare
- Grant Regional Health Center & Southwest Health
- Memorial Hospital of Lafayette County
- Mile Bluff Medical Center
- Reedsburg Area Medical Center
- Sauk Prairie Healthcare