It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

Group Health Cooperative of Eau Claire
(888) 203-7770 or (715) 552-4300
group-health.com
Overall Quality Rating
See Report Card section
What’s New for 2013
Group Health Cooperative of Eau Claire
has added new online applications which
include Wiser Health. This tool contains
detailed health information on more than
200 health conditions including examples of
what doctors who have those conditions do
for diagnosis and treatment.
New in 2013, Group Health Cooperative
of Eau Claire will have health promotion
coaches available at work sites in our
coverage area for biometric screenings
and coaching sessions. All members who
complete this voluntary process will be
entered into a prize drawing. Details will be
available online at group-health.com.
Provider Directory
Refer to our website group-health.com and
choose Find a Provider to access the 2013
State of WI provider listing.
Referrals and Prior Authorizations
Referrals are not required for in-network
providers. Prior to receiving care from an outof-network
provider, you must get a referral
event authorization. Event authorization
is required for all admissions, selected
outpatient services and all out-of-network
care. For certain procedures, members
will be required to participate in a patient
decision aid program to review information
on options, outcomes and to clarify personal
values. Group Health Cooperative will send
written notification to you and the ordering
physician of approval or denial of the event
authorization request. For further information
regarding authorization guidelines, please
visit group-health.com or call (888) 203-7770
to speak with a member services advocate.
Care Outside Service
Area
Emergency and urgent
care do not require a
referral. The FirstCare
Nurseline, listed on
your ID card, can help
you determine the
appropriate level of
care. Group Health
Cooperative has the
Qualified Plan
Non-Qualified Plan
right to review for
See Glossary for definitions
medical necessity.
Follow-up care must be
received by an in-network provider.
Mental and Behavioral Health Services
No referral is needed to see a provider in
Group Health Cooperative’s network. Please
refer to the Provider Directory for a listing
of mental health providers in Group Health
Cooperative’s network.
Dental Benefits
No routine dental coverage provided.
Health Risk Assessment Information for Enrolled Members:
Contact a member services advocate at (888) 203-7770
Decision Guide Page 36