Description

What’s New for 2020

Group Health Cooperative of Eau Claire is pleased to serve counties throughout Northern and Central Wisconsin.

Members of the Cooperative now benefit from a brand-new website, offering easier access to plan information and an interactive provider directory. These features provide an enhanced user experience to help members navigate the world of health insurance. Members can also connect with Group Health Cooperative of Eau Claire on social media to receive updates on the latest in healthy living—including meal prep and recipes, fitness tips and important reminders regarding your health plan. In addition to the services already provided by our care management app, Valera Health, pregnant members of the Cooperative now have access to this support program. Through Valera’s virtual chat function, members can easily chat with Group Health Cooperative’s case management team, receive support, answers to questions and self-help resources regarding their pregnancy. To learn more about the program, call 1-888-203-7770 to speak with our Member Services department.

Provider Directory

Go to group-health.com to access provider directory. Use group-health.com/directories/providers.aspx as a direct path or visit group-health.com, choose “Members,” then “Provider Directory.” In the drop-down menu under “Select A Plan,” choose State of Wisconsin Employee. To request a printed directory be mailed to you, call Member Services at 1-888-203-7770.

Referrals, Authorizations, Out-of-Network

Referrals are not needed when receiving care from in-network providers. You must get a prior authorization before receiving care from an out-of-network provider, for all admissions and for select outpatient services. You will receive written notification of the approval or denial for the prior authorization. Members with low back pain are required to participate in a shared decision making tool to review information on options, outcomes and to clarify personal values. For further information regarding authorization guidelines, please visit group-health.com or call 1-888-203-7770 to speak with Member Services.

Emergency and Urgent Care

If you require emergency or urgent care while outside the network, seek care at the nearest medical facility. Use the FirstCare Nurseline listed on your ID card if assistance is needed to determine the appropriate level of care. Follow-up care must be received from an in-network provider unless otherwise authorized by the Cooperative.

Mental, Behavioral Health and Substance Abuse

No referral is needed to see a provider in the Cooperative’s network. Prior authorization guidelines may apply for certain services; please contact Member Services at 1-888-203-7770 for additional information. Please refer to the provider directory for a listing of mental health providers in the Cooperative’s network.

24-Hour Nurseline

FirstCare Nurseline: 1-800-586-5473

Virtual Visits

Members of the Cooperative have 24/7/365 access to telehealth services through TelaDoc. Through the convenience of phone or video consult, this service allows you to discuss your medical concerns with a doctor and, if necessary, receive a prescription from the comfort of your home. It is cost-effective and convenient. Visit group-health.com/members/alternative-care-options/teladoc for more information.

Major Health Systems

  • Ascension / Ministry Medical Group
  • Mayo Clinic Health System
  • Essentia Health
  • Marshfield Clinic
  • St. Lukes Health Care System / St. Lukes

Full Service Areas

Ashland County, Bayfield County, Burnett County, Clark County, Douglas County, Iron County, Langlade County, Lincoln County, Marathon County, Oneida County, Price County, Sawyer County, Taylor County, Vilas County, Washburn County

Limited Service Areas

Minnesota, Michigan
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