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General Questions
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Why should I choose Group Health Cooperative of Eau Claire for my health
insurance?
As you can see by the ratings in the 2007 dual choice handbook, Group Health is
ranked at the highest level of satisfaction by the State and Local Government
employees. Actually, Group Health Cooperative has earned a 3 star rating in the
areas of Overall Health Plan Satisfaction and in Customer Service for the last 5
consecutive years! We believe that these results reflect our commitment
to personalized service. One example of this service is that you will never have
to deal with an automated phone system when you call us! We have real
people who are looking forward to assisting you with your questions. We also
have an expansive network of physicians for you to choose from, just take a
look at our provider
directory. Finally, Group Health Cooperative is offered as a Tier 1
plan, which means that you will get our high quality service and a strong
network of doctors for the lowest cost available to you! Back to Top
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I chose Group Health and have not received my member information yet.
Member information will be mailed by December 15th in most cases. If you have
not received this information within 1 week following this timeframe, please
contact Group Health Cooperative Member Services at (715) 552-4300 or (888)
203-7770 and one of our Member Service Advocates will assist you. Back
to Top
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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 WI nor Group Health requires the Provider Number to be
filled in. You may leave it blank. It is located on the application as an
optional field. Back to Top
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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. Back to Top
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Dependants
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How long will my dependent be covered?
For medical and preventative 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 dependant children through the age of 18. Back to Top
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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 dependant 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 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. Back to Top
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I am switching from another plan to Group Health Cooperative for the 2007
plan year. Will you be sending us a new dependency form?
Your prior health carrier was responsible for sending the dependency forms for
2007. They will forward the information to the State of WI who, in turn, will
forward it to Group Health. Back to Top
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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 finger tips, just click
here! Back to Top
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If a doctor from Mayo Clinic sees me at Midelfort Clinic, is the visit
covered?
This service will be covered as long as you receive prior authorization from
Group Health Cooperative. Back to Top
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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 Group Health Cooperative of Eau Claire. Back to
Top
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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, but 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 1-800-256-3808 and they will assist you in finding
the most appropriate provider. Providers in the Group Health Cooperative
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 Group Health Cooperative
Member Services at (715) 552-4300 or (888) 203-7770. Back to Top
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Coverage Termination
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My coverage was terminated with Group Health 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. Back to Top
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My coverage will be terminated with the State of WI - 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, 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. Back to Top
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