It's Your Choice 2016
State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)
Gundersen Health Plan1-800-897-1923 or 608-775-8007
What’s New for 2016
The Gundersen Health Plan service area will no longer include Barron, Sawyer and Washburn counties.
We encourage members to visit our web portal regularly at gundersenhealthplan.org/etf. As in prior years, the web portal includes important information on the 2016 Wellness Incentive Program as well as links to the Provider Directory and our Member Portal.
Members who register for the Member Portal have access to: claims history, explanation of benefits (EOB) search, member materials, eligibility information, customer service, and more.
Go to gundersenhealthplan.org/etf to access a printable or the searchable Online Provider Directory. To request a printed directory be mailed to you, call 1-800-897-1923.
Referrals, Prior Authorizations, Out-of-Network Care
Referrals are not needed when receiving care from in-network providers. Prior authorization is required for certain services, procedures and for out-of-network providers before you receive care. You will receive written notification of the approval or denial for the prior authorization. If you are unsure if a service, test or procedure requires prior authorization or a referral, contact 1-800-897-1923 prior to the appointment.
Chippewa, Clark, Crawford, Eau Claire, Grant, Jackson, Juneau, La Crosse, Monroe, Richland, Sauk, Trempealeau and Vernon counties.
Emergency and Urgent Care Outside Service Area
If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact your primary care physician or the Telephone Nurse Advisors at 1-800-858-1050, 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 Gundersen Health Plan.
Mental, Behavioral Health and Substance Abuse
No prior authorization or referral is required for inpatient or outpatient services from an in-network provider. Prior authorization is required for transitional care. For other services, contact 1-800-897-1923 between the hours of 8 a.m. and 5 p.m.
Telephone Nurse Advisor: 1-800-858-1050 or 608-775-4454
This page was last modified on: 9/11/2015 6:53:05 PM