It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
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Group Health Cooperative of South Central Wisconsin<br />
(608) 828-4853 or (800) 605-4327, ext. 4504<br />
ghcscw.com<br />
Overall Quality Rating<br />
See Report Card section<br />
GHC-SCW (GSC)<br />
What’s New for <strong>20<strong>13</strong></strong><br />
• New wellness reimbursements for<br />
Madison School and Community<br />
Recreation (MSCR) fitness classes.<br />
• Check out our new complementary<br />
medicine classes and services including<br />
aromatherapy sessions and Walking Thai<br />
Massage.<br />
• GHCNurseConnect, 24 hour nurse advice<br />
line.<br />
Provider Directory<br />
Visit https://ghcscw.com/Advanced_<br />
Search.asp to search for providers and<br />
to view their professional qualifications.<br />
Members may request a provider directory<br />
from GHC-SCW member services at (800)<br />
605-4327, ext. 4504.<br />
Referrals and Prior Authorizations<br />
<strong>Your</strong> primary care physician will submit a<br />
referral request to a certified GHC-SCW<br />
case manager when you need to receive<br />
services outside of a GHC-SCW clinic or<br />
through a specialty care area. You will<br />
receive a letter from GHC-SCW, as well as<br />
notification in your GHCMyChart online<br />
account, letting you know if the referral<br />
request has been approved.<br />
Care Outside Service Area<br />
Call GHC-SCW at (800) 605-4327, ext. 4504<br />
within 48 hours after receiving emergency<br />
or urgent care outside the GHC-SCW<br />
network. All other care requires a referral as<br />
described above. This phone number is also<br />
located on the member ID card.<br />
Mental and Behavioral<br />
Health Services<br />
When you need<br />
mental health services,<br />
contact a GHC-SCW<br />
staff outpatient mental<br />
health provider directly.<br />
Please refer to the<br />
GHC-SCW Provider<br />
Directory. A referral is<br />
not required for services<br />
provided in a GHC-SCW<br />
clinic. A referral is<br />
needed for transitional<br />
and/or inpatient care.<br />
Dental Benefits (See plan for full details.)<br />
Preventive Services: Covered at 100%:<br />
Exams, X-rays, cleanings, every six months.<br />
Restorative Services: Covered at 100%:<br />
Amalgam fillings, composite fillings for<br />
anterior teeth, stainless steel crowns for<br />
primary teeth and simple and surgical<br />
extractions.<br />
Annual Benefit Maximum: None.<br />
Qualified Plan<br />
Non-Qualified Plan<br />
See Glossary for definitions<br />
Orthodontics: 50% of the first $3,500 in billed<br />
charges for dependent children through<br />
age 18.<br />
Dental Network: All dental services must be<br />
obtained from Dental Health Associates in<br />
Madison.<br />
Health Risk Assessment Information for Enrolled Members at:<br />
ghcscw.com<br />
<strong>Decision</strong> <strong>Guide</strong> Page 37
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