Coronavirus (COVID-19)

As a community health plan, we’re working to limit the spread of this virus and promote access to testing, vaccination and medically necessary treatment.

COVID-19 vaccine information

WellFirst Health — Provided by SSM Health Plan — strongly encourages all eligible individuals to receive a COVID-19 vaccine and booster.

Our health plan covers FDA-approved COVID-19 vaccines(s) (SARS CoV-2) with no member cost-sharing, consistent with the requirements set forth by the CARES Act. If you are interested in receiving a vaccine or booster, there are several options available to you including, health care providers, pharmacies, federal and community-based vaccine clinics, local and tribal health departments, etc.

For more information on where to find a COVID-19 vaccine or booster near you, please visit SSM Health’s vaccine scheduling website or vaccines.gov.

For more information on COVID-19 vaccine eligibility, please visit the CDC’s COVID-19 vaccine website.

COVID-19 testing

We are doing our part to ensure members have access to the testing they need.

Testing for a current infection

  • Medically appropriate, provider ordered diagnostic testing is provided at no cost to members during the public health emergency.
    • Medically appropriate testing includes tests for members with known or suspected symptoms, a known or suspected exposure, or those entering a medical facility for services (e.g., pre-operative testing).
  • Every household in the US is eligible to order four free OTC COVID-19 tests through the federal government at COVIDTests.gov.
  • Effective Jan. 15, 2022 and for the duration of the national public health emergency, members covered under qualified plans are eligible for coverage of up to 8 FDA-approved over-the-counter COVID-19 antigen tests per member per month. Tests can be obtained through a network pharmacy with no upfront cost when using your member ID card. Alternatively, members may purchase tests directly and request reimbursement from Navitus, WellFirst Health — Provided by SSM Health Plan — pharmacy benefit manager, consistent with the requirements of the Families First Coronavirus Response Act (FFCRA) and CARES Act.
    • Qualified plans include: Individual plans.
  • Tests purchased to fulfill employer directed testing requirements are not eligible for reimbursement.
  • Learn about how to receive your FDA-approved over-the-counter COVID-19 antigen tests and reimbursement for member purchased tests. 


Testing for a past infection

  • When a provider orders COVID-19 antibody testing, member cost sharing is waived.

 

COVID-19 treatment

During the public health emergency, when a provider orders FDA-approved monoclonal antibody treatment (consistent with their respective emergency use authorization (EUA)), member cost sharing is waived.

Information on antiviral therapies may be found on the CDC website.

What to do when you have symptoms of COVID-19

The U.S. Centers for Disease Control and Prevention offers guidance on symptoms and when to contact your medical provider.

If you're experiencing symptoms, you can initiate an e-visit, A provider will determine the right care for you. If testing is recommended, you will be directed to the nearest testing site.

If you are not experiencing symptoms but are concerned about a potential exposure, you should seek free testing through the nearest community testing site.

Expanded telehealth services

We are currently expanding its coverage of telehealth services. This allows additional methods of health care access for members such as Skype, FaceTime or Zoom.

Security tips for accessing health care online

These services applies to our Individual & Family Marketplace, Direct, and SSM Health Employee ASO members.

We encourage using an SSM Health e-visit and our Nurse advice line to limit the potential spread of the virus to those in waiting rooms as well as medical staff.

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