573-331-3580

211 Saint Francis Drive

Cape Girardeau, MO 63703

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Frequently Asked Questions

Why should I consider Saint Francis Health Plans?

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.

What network of providers are available with Saint Francis Health Plans?

Employers have two plan options to choose from with Saint Francis Health Plans. A PPO-Based plan or a Referenced-Based Pricing plan. When choosing Referenced-Based Pricing, there is not a traditional PPO network. Whichever option you choose, your best benefits are when you seek care locally. You can learn more here.

What is Reference-Based Pricing?

Reference-Based Pricing is a healthcare cost containment model that limits what a group health plan will pay for hospital and outpatient facility charges. Saint Francis offers the best contract rate available with its Health Plans for employers. Our Concierge Team is always available to assist members and providers with claim issues if/when they arise.

What pharmacies are in-network?

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.

Do you work with brokers?

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

How can I request a quote, and what information is required?

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

  • Census with age, sex, ZIP Code, 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)

Will Saint Francis Health Plans consider additional third-party administrators (TPA)?

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.

What should members do if a medical provider’s office staff says they do not accept Saint Francis Health Plans insurance coverage?

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.

If a member is currently undergoing treatment, pregnant or sees a provider out of the coverage area, will they be required to change to a Saint Francis Health Plans provider when they join?

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.

What network would members use if they live outside the coverage area?

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

What happens when a member needs care while traveling outside the coverage area?

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.

Are members required to complete a biometric screening?

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!

For employers with 5 – 99 employees:

When is the claims refund processed?

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

Is there aggregate protection on the stop loss contract?

Yes

Is there terminal liability or is there a run out?

Run out for six months.

What is the stoploss contract term?

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

How does leaving the plan work? Can employers just leave like any fully insured plan?

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