When WellFirst Health — Provided by SSM Health Plan — determines a disaster or emergency has caused a disruption to our eligible Medicare members’ ability to access health care, we will ensure our members have access to their health plan benefits. Disasters and emergencies include a:
We will continue to provide access to health care benefits for 30-days after whichever of the following occurs first: 1) all sources that declared a disaster or emergency for the impacted service area have ended, 2) no end date was identified and all applicable emergencies or disasters declared for the area have ended, including through expiration of the declaration or any renewal of such declaration, or 3) there is no longer a disruption of access to health care.
During a qualified disaster or emergency, Medicare Advantage members have access to:
In the event that our health plan cannot resume normal operations by the end of the public health emergency or state of disaster, we will notify the Centers of Medicare & Medicaid Services (CMS).
We will decide how the refill-too-soon edits are lifted during a disaster or emergency, as long as access to the Part D drug is given at the point-of-sale. We may continue to lift these edits until the end of a public health emergency, or the end of a declared disaster or emergency. In the case of a public health emergency, it ends when the emergency no longer exists or at the end of the 90-calendar-day period starting from the initial declaration, whichever occurs first.
For major disasters or emergencies, we will: