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

The CDC recommends everyone age 12 and older get a COVID-19 vaccination to help protect against COVID-19.

Booster update: The booster dose of the COVID-19 vaccine is available for eligible people who have received the COVID-19 vaccination. For updates or more information see the CDC.

What is member cost-share for the COVID-19 vaccine?

We will cover FDA-approved COVID-19 vaccine(s) (SARS CoV-2) with no member cost-sharing, consistent with the requirements set forth by the CARES Act.

Who is eligible for a COVID-19 vaccination?

See the FDA and CDC websites for updates. Both agencies make recommendations on COVID-19 vaccine distribution. There is also information available from Wisconsin's Department of Health Services.

COVID-19 testing and treatment

WellFirst Health — Provided by SSM Health Plan — is currently taking the following steps to protect the health of our members:

  • Testing for current infection: There will be no copayment, coinsurance, or deductible for medically necessary COVID-19 tests ordered by a provider during the Public Health Emergency.
    • Medically necessary testing includes tests for members with known or suspected symptoms or known or suspected exposure. Also includes tests for members entering a medical facility for services.
    • Diagnostic testing requested by a member or third party such as those for employment, school admission, entertainment or travel are not covered by us.
  • Testing for past infection: When a provider orders COVID-19 antibody testing, member cost-sharing is waived, meaning no copayment, coinsurance or deductible.

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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