Individual & Family plan kit request form

Request information

WellFirst Health — Provided by SSM Health Plan — offers individual and family health plans to fit your lifestyle and budget. Whether you’re looking for a lower-premium plan – to limit your overall out-of-pocket costs – or for a catastrophic safety net plan, we’re here for you.

We offer individual & family plans to residents of Madison and St. Clair counties in Illinois.

Our plan kit walks you through your options with each type of plan, as well as your enrollment options through the Marketplace. To receive a plan kit in the mail to explore your options, fill out the form:

First Name*

Last Name*

Phone number*

Email*

Address 1*

Address 2

City*

State*

ZIP code*

In what county does the prospective applicant live?*

How did you hear about us?

I consent to receive marketing communications via email and mail from WellFirst Health Plan — Provided by SSM Health Plan. I am aware that I may opt out via unsubscribing from emails or calling Customer Care to be removed from the mailing list.

Please confirm