Frequently Asked Questions

You may see any Saint Francis Medical Partners at your Tier 1 benefits.

We offer 3 convenient options to schedule your care:

Saint Francis has many specialties that do not require referrals. Examples are orthopedics, cardiology and endocrinology.

Please contact your health plan’s customer service or your Benefits Team at your employer to confirm your out-of-pocket costs on your health plan. If you would like to receive an estimate for future care, please contact 573-331-5217 option #2 to speak with one of our financial counselors.

Please instruct the provider’s office staff to call the number on your ID card.

Generally, a Preferred Provider Organization (PPO) network is available if you live outside of the Saint Francis service area.

Tier 1 benefits will apply whenever emergency care is needed while traveling in the United States. Many health plans include a Preferred Provider Organization (PPO) for scheduled care outside of Saint Francis but at a higher benefit tier.

Most pharmacies are in-network; however, there may be preferred pharmacies that may be identified on your summary of benefits. Please call the pharmacy number on your ID card for more information.

Please call 573-331-5217 if you have a question on a Saint Francis invoice.

Saint Francis Health Plans is a direct contracting option backed by the nationally recognized quality and safety of Saint Francis Medical Center. Whether 5 or 5,000 employees, our offerings 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 affordable healthcare and award-winning quality.

Direct contracting is an arrangement where an employer partners directly with a health system to provide healthcare services for their employees and their dependents enrolled on their health plan. Saint Francis provides preferred pricing and coordinated care models designed to improve quality and reduce total cost of care.

  • Mid-size to large employers (typically 100+ lives, though varies)
  • Employers seeking cost control and predictability
  • Organizations with concentration of employees in Saint Francis Healthcare System’s geographic footprint
  • Employers committed to employee engagement and care navigation

Unlike traditional models that rely primarily on broad carrier networks:

  • Saint Francis plays a more active role in cost management
  • Pricing is pre-negotiated versus relying on a carrier
  • Employers gain more customization to steer towards preferred health system

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

Saint Francis Health Plans is Pharmacy Benefit Manager (PBM) agnostic; however, we do ask that our onsite pharmacy be included in-network.

Yes, we offer small group products down to 5 enrolled employees through Level Health. Learn more about Level Health.

To learn more about Saint Francis Health Plans, please contact our team member Beth Keller at 573-331-3580 or bkeller@sfmc.net.