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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2019 Local Health Plan Insurance Program
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2019 It's Your Choice - Local Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2019


Local Health Plan
Insurance for Employees
and Retirees
(PO6, PO16)


Network Health

844-625-2208
networkhealth.com/employer/state

Open Enrollment October 1 – 26, 2018

If you are currently enrolled in Network Health and do not wish to change health plans during open enrollment, you will automatically be enrolled in the Network Health offering.

You do not need to take action during open enrollment unless you would like to select a health plan other than Network Health for 2019.

What’s New for 2019

You'll have access to a new member portal with a simplified look and enhanced functionality at login.networkhealth.com. Based on real member testing and feedback, we’ve completely redesigned the experience. The first time you visit the new portal, you'll need to create a new account.

Once signed in, you can get benefit information, find a doctor, view out-of-pocket expenses and claims, reorder an ID card, access plan materials and more. You'll also be able to select communication preferences, so you can choose to receive Explanation of Benefits statements by email instead of mail.

Plus, the new portal will be mobile responsive, so you can access everything below 24/7 from any device.

  • Benefits and coverage overview
  • Out-of-pocket expenses tracker
  • Claims detail and status
  • Explanation of Benefits statements
  • Authorization information and status
  • Mobile access to view or order an ID card
  • Plan-related materials and forms
  • Secure messaging with our local customer service team
  • Wellness tools
  • Find a Doctor, Find a Pharmacy, Look Up Medications searches and more

In addition, our provider network continues to grow and will remain combined across northeast and southeast Wisconsin. In 2019, our network will continue to include the following high-quality health systems, including several systems that have rebranded.  

  • Ascension Wisconsin (Affinity Health System, Ministry Health Care, Columbia St. Mary’s and Wheaton Franciscan Healthcare have rebranded as Ascension Wisconsin. What does this mean? The same access to the quality doctors and hospitals you've come to know and trust, supported by the largest not-for-profit health system in the U.S.)
  • Froedtert & the Medical College of Wisconsin (Froedtert, Community Memorial, St. Joseph’s Hospital – West Bend)
  • Children’s Hospital of Wisconsin
  • Prevea Health
  • Bellin Health

Fox Valley Hematology and Oncology in northeast Wisconsin was acquired by ThedaCare in 2018. Effective January 1, 2019, Fox Valley Hematology and Oncology will no longer be a participating provider with Network Health. Our care management team has already been working with impacted members and will be available to assist with any needed transitions of care. In addition, Network Health will follow standard continuity of care guidelines to ensure that the care for impacted members is not disrupted.

Dedicated Customer Service Line

You'll continue to have a dedicated customer service line. By calling 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. Representatives can be reached Monday-Thursday from 7:30 a.m. to 6 p.m. and Friday from 7:30 a.m. to 5 p.m.

Provider Directory

Go to networkhealth.com to access a provider directory. Click Find a Doctor and choose "2019 State of Wisconsin employees/members" as your plan, enter your location and search for a provider. Or, click on Printable Directory. To request a printed directory be mailed to you, call 844-625-2208.

Referrals and Prior Authorizations

You don’t need a referral to see a provider that’s in our network. Prior authorization (or prior approval) is required for certain services, procedures and for out-of-network providers before you receive care. For a list of Services Requiring Prior Authorization, log in to your member portal account at login.networkhealth.com and go to My Materials.You will receive written notification of the approval or denial for a prior authorization. If you are unsure if a service, test or procedure requires prior authorization or a referral, call 844-625-2208 prior to your appointment.

Service Area

Brown, Calumet, Dodge, Door, Fond du Lac, Green Lake, Kenosha, Kewaunee, Manitowoc, Milwaukee, Oconto, Outagamie, Ozaukee, Portage, Racine, Shawano, Sheboygan, Washington, Waukesha, Waupaca, and Winnebago counties.
Limited provider availability in: Marquette, Menominee, and Waushara counties.

Care Outside the Service Area

If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact Network Health at 844-625-2208 or your primary care physician 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 Network Health.

Virtual Visits

For non-emergent care, use virtual visits to access board-certified doctors by phone, secure video or the App. To access, visit MDLIVE.com/networkhealth.

Mental and Behavioral Health Treatment

We require prior authorization for 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 provider or the Network Health Nurse Line.

24-Hour Nurse Line

Our nurse line is available when you have health care questions—any time of the day or night. This free 24-hour phone service is available 365 days a year. The nurse advice line can be accessed by calling 888-879-8960 (TTY 888-833-4271). You will be connected with a registered nurse who will help answer medical questions specific to you. Some examples of when to call include the following:

  • When you have a symptom like a sore throat, muscle pain or a fever
  • When you have questions about your medications or are prescribed a new medicine and want to know more about it
  • When you want more information on a health issue
  • When you need help determining where to go for care and it's not an emergency

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 9/7/2018 9:47:56 AM