Description
Network Health partners with high-quality health systems and local healthcare providers to provide care for your whole family right around the corner. No matter your age or stage of life, Network Health is your partner in health and wellness. For more than 40 years Wisconsinites have trusted us with their healthcare needs and we continue to offer innovative health insurance solutions that put our members first.
We are the only plan to have Froedtert and the Medical College of Wisconsin, Ascension Wisconsin, and Children’s Wisconsin hospital and clinic locations all in our network, to help ensure the best care possible is available to you – right around the corner.
Network Health’s mission is to create healthy and strong Wisconsin communities. Our employees are from your hometowns. You are our neighbors, friends, and family, so we make sure to get things right, the first time. We take the extra steps to make insurance understandable so you can make the most of your coverage. We’re honest and hardworking – just like you. Network Health is one of the top-rated plans for quality in the Group Health Insurance Program, and scored #1 in the ratings for health plans, comprehensive diabetes care, and hospitalization follow-up care for mental health.
What’s New for 2024
Network Health provides you access to convenient, affordable care close to home. You can receive medical services from our network of high-quality local health care providers or use one of our many digital and telehealth options to connect with care providers from the comfort of your home.
As of January 1, 2024:
- Members no longer need referrals for bariatric surgery and low back pain
- A prior authorization requirement has been added for diagnostics and treatment of peripheral vascular disease.
Prevent T2 Condition Management Program
Our Prevent T2 Lifestyle Change Program is a year long program designed for people with prediabetes and who are at high risk for type 2 diabetes and want to lower their risk. The program follows the Centers for Disease Control and Prevention (CDC) Guidelines.
Prevent T2 empowers individuals by focusing on the following lifestyle and risk-mitigation strategies:
- Dietary changes – You’ll learn the foods that can help you avoid diabetes Type 2 as well as get great recipes and enjoy community discussion around such foods.
- Physical activity – Find an exercise or exercises that works with your schedule and desired activity types.
- Behavior change strategies – Certain behaviors put us at greater risk of developing diabetes Type 2. Similarly, adopting other behaviors can help us in our quest to prevent the condition. Learn the difference and the most efficient ways to change or implement these behaviors.
To be eligible for Prevent T2, you must have a fasting glucose of 100 – 125 mg/dL and a body mass index (BMI) greater than 25.
If you’d like to learn more about Prevent T2, please email NHpreventT2@networkhealth.com.
Provider Directory
Visit our Find a Doctor, Facility or Clinic webpage to access an easy-to-use provider and facility search. Choose State of Wisconsin employees/members as your plan. Or view a PDF of the Provider Directory. To request a printed directory be mailed to you, call 844-625-2208.
Please note – Both provider and the provider facility must be in-network and located in Network Health’s service area for medical services to be covered by your Network Health benefits plan.
If you receive services from an out-of-network provider at a facility that is in-network, the services will not be covered. The same is true if you receive services from an in-network provider at a facility that is out-of-network or out of our service area.
Both provider and provider facility must be in-network and located in Network Health’s service area.
Referrals, Authorizations, Out-of-Network
As a State of Wisconsin member of Network Health, you can see most in-network doctors without a referral. Prior authorization (or prior approval) is required for certain services, procedures, and for out-of-network providers before you receive care. A list of services requiring prior authorization is available here. You can also find the list in your member portal after logging in, under My Materials.
If approval is required for your medical services, your in-network provider will request a prior authorization for you. We will provide you and your provider with written notification of its approval or denial. You are responsible for obtaining required prior authorizations for services provided by Out-of-Network providers or you may be financially responsible for the services. To determine if a service, test, or procedure requires prior authorization or a referral, call 844-625-2208 prior to your appointment.
Emergency and Urgent Care
If you require emergency or urgent care when outside the Network Health service area, seek care at the nearest medical facility. Contact your primary care physician if you need help determining the appropriate level of care. Follow-up care must be received from an in-network provider unless otherwise approved by Network Health.
Mental, Behavioral Health and Substance Abuse
Prior authorization is required for all inpatient services for mental health, behavioral health, or substance abuse services with participating providers. Prior authorizations are not required for outpatient mental health services. For assistance accessing mental health or behavioral health services, please contact Network Health’s Care Management Behavioral Health Department at 866-709-0019. After hours, call your personal doctor.
As a Network Health member, you also have access to telehealth services through MDLIVE®. MDLIVE licensed therapists and board-certified psychiatrists can help you get back to feeling your best if you’re feeling overwhelmed, stuck, or not like yourself – in the privacy of your own home. Common reasons to seek care include the following:
- New relationships
- Divorce or separation
- Parenting challenges
- New job or stress at work
- Job loss or retirement
- Loss of a loved one
- Experiencing a traumatic event
- LGBTQ+ support
- And more
See the Virtual Visits section below for instructions about setting up your MDLIVE account.
24-Hour Nurseline
If you have health care questions during normal business hours, you can contact your personal doctor's office. Health care questions that arise outside normal business hours can be directed to one of our provider nurse lines that can be found on the Getting Care Quickly page of our website.
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. Virtual Visits through MDLIVE give you access to nurses, doctors, dermatologists, and behavioral health practitioners from the comfort of your own home.
You can activate your Network Health MDLIVE account one of three ways.
- Text NETWORK to 635483 or visit our MDLIVE page.
- Download the MDLIVE app on your smartphone or tablet. Open the application and follow the instructions to create an account.
- Call 877-958-5455 and an MDLIVE customer service representative will walk you through the process of setting up an account.
Member Portal
Your member portal is the gateway to secure information about your Network Health plan. In it, you’ll find links that are unique to you. Tools, tips, and important information to help you enhance your life, health, and wellness are also available here.
When you sign in, you’ll see a customized dashboard specific to you and your plan. You can view benefit information, view out-of-pocket expenses, reorder an ID card, access plan materials, and more.
Dedicated Customer Service Line
You will have access to our member experience team through a dedicated phone line. By calling 1-844-625-2208 or 920-720-1811, you'll be connected with Network Health representatives who are specially trained to answer State of Wisconsin and Wisconsin Public Employer Group Health Insurance Program questions. The member experience team can be reached Monday - Friday from 8 a.m. to 4:30 p.m.
Major Health Systems
- Froedtert & the Medical College of Wisconsin Health System
- Children’s Hospital of Wisconsin - with locations in Milwaukee, Green Bay and Neenah
- Ascension Wisconsin
- Prevea Health
- Bellin Health
- SSM Health
- Holy Family Memorial