WellFirst Health — Provided by SSM Health Plan — strongly encourages all individuals to stay up-to-date on COVID-19 vaccines for your age group.
With the end of the COVID-19 Federal Public Health Emergency on May 11, 2023, coverage of COVID-19 related care will change to standard benefits for members.
WellFirst Health — Provided by SSM Health Plan — covers FDA-approved COVID-19 vaccine(s) and boosters with no member cost-sharing when received at an in-network provider. Cost sharing will apply when you get the vaccine at an out-of-network provider. HMO plans have no out-of-network coverage. You can learn more about the vaccine by visiting the CDC's COVID-19 website.
Normal cost-sharing requirements will apply for medically appropriate provider-ordered tests at either in-network or out-of-network providers. Please note there is no out-of-network coverage for HMO plans.
Tests purchased to fulfill employer-directed testing requirements are not eligible for reimbursement.
Members will pay the retail cost of over-the-counter COVID-19 test kits. The cost of an at-home test kit is an eligible medical expense that can be paid or reimbursed from a flexible spending account, health savings account, or health reimbursement account.
The U.S. Centers for Disease Control and Prevention offers guidance on symptoms and when to contact your medical provider.
Expanded coverage of telehealth services for many common health conditions will continue. This allows additional methods of health care access for members such as Skype, FaceTime or Zoom.
Some mental health telehealth care, such as psychological testing and applied behavioral analysis (ABA), will revert to pre-pandemic standard benefit coverage and only specific services will be covered virtually.
These services are available to our Commercial HMO/POS (Individual Coverage), Marketplace (healthcare.gov), and Medicare members.