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General Questions
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Why should I choose Group Health Cooperative of Eau Claire for my health
insurance?
Choosing a health plan is an important decision.
When you choose GHC, you not only get great service from real people in your own backyard, you also get access to our expansive network of providers. Best of all, GHC is a Tier 1 plan, so you get a great price.
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Health Plan Application
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I'm completing the health insurance application and it's asking me for a Provider
Number. Where do I find this information?
Neither the State of Wisconsin nor GHC requires the Provider Number to be
filled in. You may leave it blank. It is located on the application as an
optional field.
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I'm unsure which physician I will be using for care, but I know which
clinic I will be using. What physician should I list under "Selected Physician"?
Group Health Cooperative only tracks your clinic choice; you are not bound to a
physician. Listing the physician along with the clinic where he/she practices
will be helpful to ensure that the correct primary clinic is recorded in your
file. If you prefer not to choose a physician, it is acceptable to only list
the clinic.
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Dependent
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How long will my dependent be covered?
For medical and preventive dental benefits, unmarried children are eligible
for coverage through the end of the calendar year in which they turn age 19 or
until age 25 if they are full-time students and are dependent upon you and/or
their other parent for at least 50% support. Orthodontia benefits cover
unmarried dependent
children through the age of 18.
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How can I get my dependent added back on to the policy, as he or she is now
a full-time student?
A dependent becoming a full-time student is considered a qualifying event and
may mean that he/she is now eligible for coverage under your plan. You have 31
days from the date of a qualifying event to make a change to your coverage. Please
see your Human Resource Representative for information on how to apply for a
change in your coverage. You may be required to submit a transcript or class
schedule with your application.
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I am switching from another plan to GHC for the 2010
plan year. Will you be sending us a new dependency form?
Your prior health carrier was responsible for sending the dependency forms for 2010.
They will forward the information to the State of WI who, in turn, will
forward it to GHC.
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Providers and Benefits
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I would like to see a list of your providers.
Our provider directory is available right at your fingertips.
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If a doctor from Mayo Clinic sees me at Midelfort Clinic, is the visit
covered?
This service will be covered according to your benefits. You do not need prior authorization from GHC to see a doctor from the Mayo Clinic at Midelfort Clinic.
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Can I see a physician at Mayo Clinic in Rochester?
You may see a physician at the Mayo Clinic in Rochester only with prior
authorization from GHC. Please read our Authorization Guidelines
for more information.
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I don't see any psychiatrists listed in your directory. How do I receive
mental health services?
We list behavioral health clinics in our directory, we do not list
individual psychiatrists. This is because, while behavioral health services are
usually a covered benefit, you will need authorization for these services after
6 visits. This authorization is managed by Behavioral Health Consultants of Eau
Claire. You may call them at (800) 256-3808 and they will assist you in finding
the most appropriate provider. Providers in the GHC
network have been educated that authorization is required for services after 6
visits; however, it is ultimately your responsibility as a member to ensure
this authorization has been obtained. If you have benefit questions related to
behavioral health or chemical dependency, please call a GHC
Member Services Advocate at (715) 552-4300 or (888) 203-7770. Back to Top
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Myself or one of my dependents live outside of the GHC service area. Will our health care still be covered?
While emergency and urgent care visits are covered outside of the GHC provider network, any follow-up care resulting from these visits requires you to utilize a provider
within our network.
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Coverage Termination
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My coverage was terminated with GHC and I don't feel it should
have been terminated.
Group Health Cooperative obtains termination information from the State of Wisconsin.
Please see your Human Resource Representative to discuss the reasons
for your policy termination.
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My coverage will be terminated with the State of Wisconsin - what date will my
coverage actually end?
For most plans, coverage will end on the last day of the month in which
coverage is terminated. However, because this criteria is set by your employer, please
see your Human Resources Representative to confirm the date on which your
coverage will end. You may also wish to discuss COBRA options, which may allow
you to purchase continued coverage.
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