Frequently Asked Questions

Saint Francis Health Plans is a direct contracting option backed by the nationally recognized quality and safety of Saint Francis Medical Center and our Clinically Integrated Network. Whether you have five employees or 5,000, our new offering will save you money on healthcare costs and improve the overall health of your staff. Saint Francis Health Plans is designed to lower member and employer costs, improve member benefits and establish long-term partnerships with care providers. We understand the importance of collaborative care and will provide you affordable healthcare, award-winning quality, provider selection and care management as part of our Health Plans.

Most pharmacies are in-network; however, there are preferred pharmacies that may be identified on your summary of benefits. Our Concierge Team is always available to assist you with questions regarding which pharmacy to use.

Yes, Saint Francis Health Plans is willing to partner with all brokers and employers.

Please click here to Request a Quote. The third-party administrator (TPA) will collect the following information:

• Census with age, sex, full home address(es), plan election and coverage election (employee, employee + child, employee + spouse, family)
• Current plan design(s)
• Current rates
• Renewal rates
• Carrier history (past five years)
• Preferred TPA
• If partially self-funded:
  • Medical/Rx claims by an employee by month (past two years)
  • Stop-loss policy
  • 50 percent stop-loss report (past two years)

Yes, Saint Francis Health Plans are TPA, broker, stop-loss and reinsurance company agnostic. All partners are expected to adhere to our administrative rules and regulations.

Please have members instruct the provider’s office staff to call the number on the back of the insurance card. Saint Francis Health Plans provides comprehensive coverage and can be verified by our team of experts.

No, Saint Francis Health Plans include a transition of care policy that allows the member to continue seeing their current provider throughout their treatment plan or birth of a child. Certain conditions such as chronic illness or long-term treatment plans will need to be reviewed by a Care Coordinator to assist with a reasonable transition of care.

A preferred provider organization (PPO) is available to members who live outside a 100-mile radius of Cape Girardeau, Mo.

Tier 1 benefits will apply whenever emergency care is needed while traveling anywhere in the United States. For members who live outside a 100-mile radius of Cape Girardeau, Mo, the national PPO is available.

Annual biometric screening is highly recommended and is covered at 100 percent. The plan is designed to assist members both physically and financially. Screening is the first step for patients to reach their goals for better health!

At the end of the contract period, after the 18th month.

Yes

Run out for six months.

The contract is a 12/18 contract. This means that the coverage is for claims incurred in 12 months and paid in 18 months. Other terms are available.

Employers may leave after 12 months, does not affect the run off period.