Traveling? You've got coverage
Traveling and find you need health care? Members of WellFirst Health — Provided by SSM Health Plan — are covered for urgent and emergency care worldwide. Regardless of where you travel, you don’t need to take health care coverage worries with you on vacation. We have you covered.
You do not need a referral or prior authorization for urgent or emergency services — no matter where you travel:
- We cover urgent and emergency services while you are outside of our service area (subject to policy copays, coinsurance, deductibles and maximum allowable fees).
- The amount charged for these services received from an out-of-network provider may exceed the maximum allowable fee, in which case you will be responsible for paying the difference between the amount charged and the maximum allowable fee.
- If you require urgent or emergency care outside the service area and are unable to get to a plan provider, go to the nearest urgent care or emergency center for treatment. It is important to notify us as soon as possible by calling the Customer Care Center.
- All follow-up care should be done by a plan provider. If you are out of the area and unable to see a plan provider, call your primary care practitioner for a referral to an out-of-area provider. These services require our approval.
In most cases, claims are submitted directly to us by the providers or clinics. On occasion, if you’re traveling out of the area or have a college-age dependent, for example, it may be necessary for you to submit a claim for reimbursement. When submitting the claim, be sure to follow these guidelines:
- Send an itemized bill from the provider of service. If services were received outside of the U.S., you will need to submit the original bill along with an itemized bill that has been translated into English and indicate the appropriate currency exchange rate at the time the services were received.
- Send the bill within 60 days after the services are received to: WellFirst Health — Provided by SSM Health Plan, Attn: Claims Department, P.O. Box 56099, Madison, WI 53705.
If you have other health coverage that is the primary payer, you will need to send the EOB to us or your health care provider.