Balance summer2014

A PUBLICATION OF

S U M M E R

2 0 1 4

You wouldn’t have known it, but inside

I was miserable.

How Network Health helped Kelly Neumann put her mind at ease.

L I F E , H E A LT H & W E L L N E S S

life

3

Leave Your Worries at Home Coverage while on vacation

4

We ensure you get medical care in a timely manner

E DITORIAL STAFF

President Sheila Jenkins

Preventive Guidelines Now Available Online

Chief Administrative Penny Ransom

Officer

Access and Care After Hours

03

4

How to access our preventive care guidelines on networkhealth.com

he alth Understanding Asthma Meds

Explaining the different types of asthma medications and their uses

6

Making Your Medications Work

Peggy Huss, Dawn Rady, Deborah Anderson, Renee Corral, Barb Gore, Chuck Rynearson, Teri Koepke, Darren Brzozowski

Tips to make sure you take medicines exactly as your doctor prescribes

7 Three Things to Look for When Shopping for Shades

Picking out the perfect shades for style and eye protection S T O C O V E R Y

wellness

08

her

How Network Health paved the way for Kelly Neumann to erase her cancer fears

Organic vs. Conventional Foods

Explaining organic food and how it differs from conventional options

Tips for surviving the summer heat

14

Do you Have a Primary Care Doctor?

What a primary care doctor can do for you

15 How Claims Work

Balance is published quarterly by Network Health. The health information contained in Balance is meant to supplement, not replace, the advice of health care professionals. © 2014 Network Health. No portion of this newsletter may be reproduced without written permission from Network Health.

Network Health will sponsor the Health and Wellness Expo at this year’s Fox Cities Marathon (Sept. 19-21), and we encourage all of our members to participate in the weekend’s festivities. If you would like to walk or run with Team Network Health,

register at foxcitiesmarathon.org.

Members who register with Team Network Health will receive a T-shirt as a thank you for committing to good health and wellness.

If you plan on participating in either the full or half marathon, Network Health would like to share your experience in an upcoming issue of Balance. If interested, email us at balance@networkhealth.com.

Five Ways to Keep Cool When Working Outside

05

Clearing mind

12 13

Graphic Designer Gary Vossekuil

DITORIAL BOARD E

5

Publications Sam Darcy

Coordinator

13

Understanding how Network Health processes your claims

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networkhealth.com

life

Information to help you get the most out of your coverage

Leave Your Worries at Home Y

oudon’t don’tplan planonongetting getting injured while ou injured while onyou’re a trip, but because traveling,sometimes but because sometimes turn intoNetwork vacations turnvacations into unexpected adventures, unexpected adventures, Network has you Health has you covered when you’reHealth away from home. covered when you’re away from home.

In Case of Emergency – If you have a medical emergency when you’re out of the service area, call 911 or get to the nearest emergency room. You have health care benefits for emergency situations such as heart attacks, excessive bleeding, head traumas, broken bones or seizures.

If you are outside of Network Health’s service area and you need to see a doctor but it isn’t an emergency, you can still visit a hospital or an urgent care clinic. However, if the doctor or facility is not in our network, you’ll need to notify us within 48 hours of receiving care. To do so, simply contact our customer service department at 800-826-0940 or 920-720-1300 to request an authorization. Our call center is open from 8 a.m. to 5 p.m.

Monday, Wednesday, Thursday and Friday, and from 8 a.m. to 4 p.m. on Tuesday.

When out of the network area, you’re covered for an emergency hospitalization until you can be moved to a participating Network Health facility, as long as you let us know about your emergency within 48 hours of entering the hospital. Just be sure to show your Network Health ID card when you check in.

Follow-Up Care – Your primary doctor, or other in-network providers,

Urgent Care – If you can’t travel safely to get care from your primary

Network Health’s service area) may require you to pay for your care when it is provided. To get reimbursed, send itemized bills and proof of payment within 90 days of receiving care. Send to Network Health, Attn: Claims at 1570 Midway Pl., Menasha, WI 54952.

doctor, you’re covered for urgent care situations like a minor injury, stitches, possible strep throat or an ear infection.

n e t w o r k h e a l t h . c o m

must be seen for your follow-up care. If this is not possible, and you visit a doctor or hospital not in our network, you’ll need to call us for approval within 48 hours of treatment.

Payment for Care – Some out-of-area medical facilities (not in

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life { YOUR CARE }

Access and Care After Hours

Network Health’s Quality Improvement Department wants to make sure you’re able to get medical care in a timely manner.

We work with doctors and hospitals to ensure you have access to medical and behavioral health care during business days and after hours. You should always be able to get the timely care you need, so we require primary care providers to offer access to health care services without excessive scheduling delays. We also have standards for office wait times and appointment scheduling and communicate these standards to all of our doctors and hospitals.

If you ever feel that your medical care isn’t being scheduled in a timely manner, call us at 920-720-1300.

We’re here to help.

DID YOU KNOW? Network Health evaluates new technology and new applications of existing technologies on a regular basis. This includes the evaluation of medical procedures, drugs and devices.

New technologies are reviewed by a group of participating physicians and health plan staff who make recommendations for inclusion as a covered benefit. The review process also includes evaluation of information from government regulatory bodies and published scientific evidence.

T Preventive Guidelines Now Available Online

o help you prevent health problems, Network Health offers certain services at no cost to you.

Go to networkhealth.com/members to see a list of these preventive services.

Select the Preventive Care to Stay Healthy tab on the right side of the page, then click the Learn More button.

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networkhealth.com

health

News and tips to help you maintain a healthy and happy life

Understanding Asthma Meds If you or someone in your family has asthma, you know how serious an attack can be.

Fortunately, with proper treatment, you can live comfortably.

One of the best ways to control asthma is to understand and follow your doctor’s guidelines for medication. Asthma medications play an important role in managing the severity of symptoms, so it’s important to understand how they work.

Types of Asthma Medication Controller Medications – These long-term medications are taken on a daily basis, even when you don’t have symptoms. Controller medications prevent an asthma attack by controlling mucus and swelling in asthma airways.

Rescue Medications – These provide quick relief by opening your lungs and relaxing airway muscles. They can ease worsening symptoms or stop an asthma attack, and usually provide relief in about 10 minutes.

To keep your asthma under control, make sure you have an updated action plan, record your symptoms and make note of any side effects. This will help your doctor adjust your treatment and develop a detailed plan for managing your asthma and medications over a long period of time.

To learn more about asthma, visit the Condition Management section of networkhealth.com, found under Health and Wellness.

If you have questions about medications for your asthma, talk to your doctor about different options available. If you’d like to talk to a nurse at Network Health, call 920-720-1651 or 800-769-3186 ext. 1651, Monday – Friday, 8 a.m. to 4 p.m.

44,000 Americans have an asthma attack every day, and asthma accounts for one quarter of all emergency room visits in the U.S. each year, according to the Asthma and Allergy Foundation of America.

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health

Making Your Medications Work What’s one of the biggest reasons treatments fail?

Not taking medications exactly as a doctor prescribes.

This simple concept can lead to higher health care costs, worsening symptoms and more time spent in the hospital. In fact, the American College of Preventive Medicine reports that not following a doctor’s medication instructions accounts for 30 to 50 percent of all treatment failures.

When you take a medication, how much and how often can have a big impact on whether or not it works. It may seem OK to change your medicine, but you should never do so without talking to your doctor first.

How can you make sure you’re doing things right?

Start with this list of questions and tips.

Understand If you don’t know the answers to these questions, ask your doctor or pharmacist for instructions.

>> >> >> >>

Why am I taking this drug?

How and when should I take it?

How should I store it?

What are the possible side effects?

Organize >> If you take multiple medications, create a list to help remember the instructions for each.

>> Use a pill box or organizer to keep your meds in order. >> Make a list of any questions you have about your medications and bring the list along to your next doctor’s appointment.

Avoid >> Don’t take more or less of a medication unless your doctor says so. >> Don’t take your medication for any symptoms it wasn’t prescribed for. >> Don’t take someone else’s medications and don’t give your medication away. Prescriptions are specific for each person’s health and wellness.

Almost 70 percent of Americans take at least one prescription medication, and more than half take at least two, according to a study by researchers at the Mayo Clinic.

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networkhealth.com

For a complete list of recent changes to our provider network, go to networkhealth.com/providerchanges.

Three Things to Look for When Shopping for Shades

W

hen you reach for the sunscreen this summer, remember to keep your sunglasses on too. Many people know about the danger the sun can cause to your skin, but not everyone is aware that it’s just as important to protect your eyes.

When you’re picking out that perfect pair of shades this summer, make sure they’ll keep your eyes protected. Long-term exposure to UV radiation can cause damage to your retinas and increase your odds for developing cataracts. Keep an eye out for these three details.

FULL UV-PROTECTION

A PROPER HUE

Choose sunglasses that block 99 to 100 percent of UV rays. If the sunglasses don’t list details on UV protection, you should probably choose a different pair. Also, remember that your eyes need to be covered at every angle, so close-fitting or wrap-around sunglasses with wide lens offer the best protection.

When trying on sunglasses off of the rack, you would think darker lenses offer more protection. That’s not true. The color and darkness of the lenses have nothing to do with UV protection, but keep in mind that it does affect color perception. Yellow or rose-tinted lenses can make it hard to see changes in traffic lights.

Gray, brown and green tints minimize color distortion, and they’re a better choice for driving.

THE RIGHT LENSES

Besides the style and UV protection of your shades, consider the type of lenses in the sunglasses. Lenses come in a variety of types that work better in certain situations.

HERE ARE SOME OPTIONS.

n e t w o r k h e a l t h . c o m

POLYCARBONATE

POLARIZED

PHOTOCHROMIC

Offers protection from impact. Useful for sporting activities.

Reduces glare from sunlight that is reflected off of other objects, such as water or windows. A good option if you’ll be on the water fishing, boating or waterskiing.

Adjusts to available light by gradually lightening or darkening.

BLUE-BLOCKING

MIRROR-COATED

GRADIENT

Blocks all blue light by tinting it amber. Helps make distant objects easier to see.

Reduces visible light.

Reduces glare because lenses are darker on the top and lighter on the bottom.

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networkhealth.com

S T O C O V E R Y

Clearing mind

her

There are certain things in life you are willing to take a chance on.

Maybe it’s a Powerball ticket, a new job or the last hot dog on the roller at the gas station.

But what about cancer odds? No matter how small the odds, would you feel comfortable risking your health? Would the thought of what cancer could take away from you be too much to bear?

For Network Health member Kelly Neumann, the chance of another breast cancer scare wasn’t just about the threat to her body, it was also about the weight it put on her psyche.

By Sam Darcy

m etworkhealth.com n

|

>>>

P h o t o g r a p h s b y B e t h D e s J a r d i n , Tr ov e P h o t o g r a p hy

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In October 2012, Kelly Neumann was diagnosed with early stage breast cancer. While the news was devastating, she was fortunate in that she didn’t need chemotherapy.

Instead, with the cancer contained to only her right breast, Kelly had a right mastectomy that November.

(A mastectomy is the surgical removal of a breast, usually used to treat breast cancer.)

At the time, Kelly was given the option of having a mastectomy on both breasts, but she decided against it, sparing her body the pain of a longer recovery.

As Kelly’s cancer disappeared, she began to second guess her decision to opt out of the left mastectomy. Her doctor told her that she only had a two-percent chance of developing cancer in her left breast, which would increase to an 18-percent chance only if she lived to be in her 80s.

Unfortunately, those numbers only put Kelly’s mind at ease for a short time. By January 2013, she already found herself thinking about how she would handle another cancer diagnosis.

“When I was busy, I didn’t think about it much,” Kelly said. “But give it a couple of rainy days and it kept popping into my head. It started becoming the last thing I thought about at night and the first thing I thought about in the morning.”

Kelly continued to try to keep her mind off of the unknown, but as a mother of three, her worries began to weigh her down and fill her with constant anxiety.

“It was a really long winter and your thoughts play with your head,” Kelly said. “You wouldn’t have known it, but inside I was miserable.”

Kelly finally decided she needed to look into her options and find out if another mastectomy would be covered by insurance, even without the presence of cancer.

Unsure of what to do, Kelly called the number listed on the back of her Network Health insurance card. After a short conversation with a customer service representative, Kelly was transferred to Network Health Care Management Coordinator Yvonne Murrow.

“I was a hot mess, I was choked up, had tears in my eyes and I didn’t know what to do,” Kelly said.

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‘‘

I was fortunate to have my husband Chuck’s support. If it meant that I’d be happy, he encouraged me to do whatever I needed.

’’

“Then I got this beautiful woman that helped me. I’m so glad Yvonne was on the other end of the phone that day.”

Yvonne pursued second opinions to help Kelly make the best and most-informed decision. Yvonne quickly became Kelly’s source for information about another mastectomy and what her insurance covered.

“We had to talk through everything and look at the options,” Yvonne said. “You don’t know until you’re faced with a health problem. Most people have no idea where to start.”

While Yvonne looked into non-surgical options, she also worked to see if a mastectomy could be covered. She found that, even though statistics said Kelly didn’t need the surgery, Network Health would still cover it because of her personal history with breast cancer.

“I never would have moved a step without Network Health behind me,” Kelly said. “My first call to Network Health was on a Monday, and by Wednesday I had an appointment with a cancer specialist.”

networkhealth.com

S T O C O V E R Y

‘‘

I never would have moved a step without Network Health behind me.

’’

Yvonne continued to call Kelly between appointments to see if she needed any help coordinating her care. This included helping her schedule appointments, answering questions and just checking in to see if there was anything else Kelly needed.

With Yvonne’s help and Network Health’s coverage, Kelly received the OK to undergo the left mastectomy surgery earlier this year. Kelly’s worries were immediately lifted by having the mastectomy, a procedure that benefitted her mind maybe more than her body.

Shortly after her surgery, Yvonne called to check in on Kelly and her progress. She found that Kelly was feeling so good that she was already back to work.

“Kelly did great,” Yvonne said. “That’s why I love what I do.

Wherever our members’ needs are, that’s where we want to meet them.”

Today, Kelly continues to live her life just as she always has, but she no longer has those nagging suspicions of a future cancer scare. Now she can sleep a little better at night, and she appreciates all the help she received from Network Health.

“You’ve got to find the people that have the answers,” Kelly said.

“I’m happy and I’m healthy. In the scheme of life, I’m doing great.”

Kelly’s also grateful that Network Health has a system in place to connect members with people like Yvonne. Now, she just wants anyone out there that needs help to know about Network Health’s Care Management system too.

“There are people behind the scenes that you’ll never meet that have your back the whole time. There’s no reason you need to go through anything alone, there are too many good people out there to help you.”

Kelly with her plastic surgeon, Dr. Todd Van Ye and her cancer surgeon, Dr. Jeffery Burkett

net workhealth.com

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wellness

Tools to empower your personal health

Organic vs.

Conventional Foods

What’s the difference?

W

APPLETON

hen shopping for produce, you may have noticed an increase in organic food the past few years. The organic choice typically costs more than its conventional counterpart, but what are you getting for that extra cost?

AREA FARMERS’ MARKETS

What’s considered organic?

Organic refers to the way farmers process and grow foods like fruits, vegetables, grains, meats and dairy products. Organic farming uses alternative practices for fertilizing, controlling weeds and preventing livestock disease.

Organic labeling

The U.S. Department of Agriculture (USDA) sets standards for what can be labeled organic. Organic foods can be labeled two ways. >> 100 percent organic – This means the product is completely organic or made of all organic ingredients. >> Organic – This means the product is at least 95 percent organic.

Sometimes, you may see the term “natural” labeled on foods.

This doesn’t mean the product is organic. Only foods that meet USDA standards can be labeled organic.

Are organic foods more nutritious?

Organic foods must meet the same quality and safety standards as conventional foods.

According to the Mayo Clinic, a recent study examined the past 50 years’ worth of scientific articles about the nutrient content of organic and conventional foods. The researchers concluded that organically and conventionally-produced foods are comparable in their nutrient content.

Why do people choose organic?

There are many reasons people choose organic foods. Some buy organic to avoid pesticides and additives used on foods. Others prefer organic for environmental reasons, or because they feel it’s fresher.

But remember, just because a food is organic doesn’t mean it’s healthy. No matter what you eat, try to avoid foods high in sugar, fat, salt and calories. Whether you buy organic or conventional foods, check the label.

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College Avenue from Appleton Street to Drew Street Saturdays, June 21 - October 25 8 a.m. - 12:30 p.m.

FOND DU LAC

City/County Parking Lot at Western Avenue and Linden Street Saturdays, May 10 - October 25 7 a.m. - Noon

GREEN BAY

South Washington Street from Walnut to Stuart Saturdays, May 31 - October 25 7 a.m. – Noon

MANITOWOC

Eighth Street and Quay Street Saturdays, May 17 - October 25 8 a.m. – 2 p.m.

OSHKOSH

400 and 500 blocks of North Main Street and 100 block of Church Avenue Saturdays, June - October 8 a.m. – 12:30 p.m.

SHEBOYGAN

Fountain Park, Downtown Sheboygan Saturdays, June - October 7 a.m. – 2 p.m.

STEVENS POINT

Mathias Mitchell Public Square, Downtown Stevens Point Saturdays, May - October 7 a.m. – 2:30 p.m. networkhealth.com

5

Ways to Keep Cool When Working Outside

I

f you work outdoors, finding a shady spot or retreating to air conditioning isn’t always an option.

When you find yourself working hard under the summer sun, make sure to take care of yourself by following these steps.

1 Stay Hydrated

When you’re working and it’s hot, it doesn’t take long to get dehydrated. In fact, if you wait until you’re thirsty, you are already beginning to dehydrate. Try to frequently drink small amounts of water, even when you aren’t thirsty, and avoid beverages high in sugar and caffeine.

2 Dress Right

To stay cool in the heat, make an effort to wear light-colored clothing that is loose-fitting and breathable. Keep in mind that while light-colored clothing will keep you cool, darker colors actually offer more protection from sunburn.

3 Use Sunscreen

Anyone who plans on spending time outdoors should use sunscreen. Try to choose a broad-spectrum sunscreen that offers protection against both UVA and UVB rays.

Remember, an ounce of sunscreen should be applied 30 minutes before you go outside and again every two hours.

4 Look for Heat Illnesses

High temperatures, humidity and physical activity create a recipe for heat stroke and exhaustion. It’s important to know the warning signs of heat illnesses, which include headaches, lightheadedness, confusion, irrational behavior, loss of consciousness, abnormally-high body temperature and hot, dry skin.

If you think someone has had a heat stroke, call 911 or take the person to a hospital immediately. While waiting for help to arrive, get the person into an air-conditioned or shady area and remove any unnecessary clothing.

5 Watch Out for Coworkers

It’s important to take care of yourself in the heat, but keep an eye on your coworkers too. Be aware of anyone wearing bulky, protective clothing or equipment. They might be at a higher risk of overheating. And if you get a chance, brush up on your first aid so you can be ready if a coworker needs immediate help from a heat stroke.

net workhealth.com

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wellness Network Health’s Self-Management Workshops

For more information or to sign up for a workshop, call us at 920-720-1655 or 800-769-3186, extension 01655. Or visit us at networkhealth.com/workshops.

Click Learn More for details, dates and times about each workshop.

Living Well with Chronic Conditions

Do you Have a Primary Care Doctor?

H

ave you ever wondered why Network Health always asks who your primary care provider is?

There are a number of reasons why we ask, but we just want to make sure you have one main doctor to coordinate your health care.

Even if you consider yourself healthy, you should have one main doctor to coordinate your care.

Having a primary doctor is an important way to make sure you’re getting the best care possible.

What can a primary care provider do for you? >> Be a primary contact when health concerns arise. >> Make recommendations about the best specialist for you. >> Supervise your medications and make sure there are no harmful interactions. >> Keep your health records in a single, central location.

If you don’t have a primary care provider, you can search for a doctor online using the Find a Doctor tool at networkhealth.com.

1. Go to networkhealth.com and click the Find a Doctor button.

2. Select your type of plan. a. Choose HMO/POS if you receive health insurance through your employer. b. Choose Individual/Family Plan if you don’t get insurance through an employer. c. Choose State of Wisconsin Employees if your employer is the state of Wisconsin.

3. Complete any other information to narrow your search results. For example, you can limit your search to doctors near you.

4. Check the I’m looking for a Primary Care Provider box and click the orange Search button for your results.

5. Don’t forget to call our customer service department to let us know who you choose, so we can update our records. Call us at 800-826-0940 or 920-720-1300, Monday, Wednesday, Thursday and Friday from 8 a.m. to 5 p.m., and Tuesdays from 8 a.m. to 4 p.m.

S AY W H AT ?

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Primary Care Provider – The medical professional whom

Designed specifically for anyone with a chronic condition such as arthritis, high blood pressure, heart disease, chronic pain or anxiety, this workshop teaches self-management skills and develops a step-by-step plan to achieve specific goals.

The six-week class meets once a week for two and a half hours.

Healthy Living with Diabetes This workshop is designed to help adults living with type 2 diabetes better manage their condition. Classes cover topics like healthy eating choices and habits, the benefits of exercise, techniques for dealing with symptoms and how to work with health care providers. This six-week workshop meets once a week for two and a half hours.

Stepping On A program for older adults who may have fallen, have a fear of falling or are at risk for falling. This program empowers older adults to step outside of their homes with the confidence to improve their quality of life. This seven-week workshop meets once a week for two hours.

Additional Local Support Groups C.O.P.E. with COPD Education and support to help those with chronic lung disease. For more information, call 920-203-8821 or 920-235-2542.

Better Breathers A community-wide support group for people with COPD and other chronic lung diseases.

For more information call 920-738-2558 or 920-738-5364.

Fox Valley Diabetic Education and Support Group Open to people with type 1 or type 2 diabetes and/or their loved ones. Classes are free and no registration is needed.

you routinely visit. This person coordinates your health care.

networkhealth.com

H

How Claims Work

ave you ever wondered why it takes so long to process insurance claims?

Each claim has its own lifecycle, where specific measures and steps are taken to ensure accuracy.

STEP

2

STEP

4

STEP

1

It all begins with your doctor. Your doctor’s office files a claim for the service they provided you.

Each service has a procedure and diagnosis code.

The procedure code tells us what was done during the visit, and the diagnosis code tells us why.

Filing Next, your claim gets filed with us electronically or by paper. Your claim is dated when we receive it, then entered into our system. Paper claims are manually entered into our claims processing system, while electronic claims are loaded directly.

STEP

3

STEP

Verification When your claim is processed, we verify that your insurance coverage was effective on the date you received the service.

Our processing system automatically checks that the service is covered, and we will check that the doctor you saw is in our network.

STEP

6

5

Review

We then review your claim against your benefits.

This determines if you have out-of-pocket costs, like a deductible. If your doctor is in our network, we pass on discounts to you and you’ll owe less.

Our system will then apply your deductible to your claim and notify your doctor what you owe.

Explanation of Benefits If you’ve already reached your deductible for the year, we pay the amount directly to the provider. You’ll get an explanation of benefits document showing how your claim was processed.

The explanation of benefits is not a bill.

Your Doctor

Processing To ensure accuracy, your claim then goes through auditing. Our claims processing system is set up to correspond with your benefits.

This allows your claim to process without anyone manually looking at it. Claims not automatically processed are reviewed by a claims analyst.

STEP

7

Billing

Once payment is made by your doctor, it’s posted to your account. Your doctor’s office then sends you a statement indicating any remaining amount you owe.

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1570 Midway Pl. Menasha, WI 54952

MAILED ON 7/14/14

COMMUNICATION IS KEY TO ANY GOOD RELATIONSHIP

AT NETWORK HEALTH, WE LISTEN TO THE PEOPLE OF WISCONSIN. We recently teamed up with people all over our state to share ideas and improve the health insurance industry. We heard ideas for better products and services from people from Racine to Green Bay and Milwaukee to Madison. We listened, and today Network Health is tailoring products and services for your unique needs.

cocreatewi.com 800-826-0940 足 MO plans underwritten by Network Health Plan. POS plans underwritten by Network Health Insurance Corporation, or Network H Health Insurance Corporation and Network Health Plan. Self-funded HMO and POS plans administered by Network Health Plan.

SAL-196-01-6/14