Strive for Wellness® Health Center Provi

sions, Charges, and Services PURPOSE: This rule establishes the policy of the board of trustees in regard to provisions, charges, and services available to mem bers of the Missouri Consolidated Health Care Plan (MCHCP) through the Strive for Wellness® Health Center. (1) Eligibility. Subscribers and their dependents aged eighteen (18) years and older enrolled in MCHCP medical coverage shall be eligible for and able to access the services available at the health center as described in this rule. (2) Available Services. The health center provides access to contracted services for treatment for uncomplicated minor illnesses and preventive health care services. (3) Limitations and Exclusions. (A) The following MCHCP eligibles are not able to utilize the health center: 1. Active employees and members who are not enrolled in MCHCP medical coverage; and 2. Members enrolled in the Medicare Advantage plan. (B) Services that are beyond the scope of the health center including but not limited to the following: 1. Emergency services; 2. Urgent care services; 3. Radiology services; 4. Specialist services; 5. Pharmacy services; 6. Occupational, speech, and physical therapy services; and 7. Chiropractic services. (4) Charges for the following services apply: (A) Office visit— 1. For members enrolled in the MCHCP PPO 750 or PPO 1250 Plan, fifteen dollars ($15) payable at the time of service; 2. For members enrolled in the Health Savings Account (HSA) Plan, forty-five dollars ($45) payable at the time of service; and 3. The office visit includes the evaluation and management of the patient and any associated laboratory services performed by the health center; (B) Preventive services— 1. For members enrolled in the MCHCP PPO 750 Plan, PPO 1250 Plan, or HSA Plan, preventive services are covered at one hundred percent (100%); and 2. Preventive services shall have the same meaning as in 22 CSR 10-2.055; and (C) Health center services are outside the MCHCP PPO 750 Plan, PPO 1250 Plan, and HSA Plan benefits and payments for health center services do not apply toward any associated de ductible or out-of-pocket maximum. AUTHORITY: section 103.059, RSMo 2016.* Emergency rule filed Oct. 30, 2013, effective Jan. 1, 2014, expired June 29, 2014. Original rule filed Oct. 30, 2013, effective June 30, 2014. Amended: Filed Oct. 29, 2014, effective May 30, 2015. Amended: Filed Oct. 28, 2015, effective May 30, 2016. Emergency amendment filed Oct. 31, 2018, effective Jan. 1, 2019, expired June 29, 2019. Amended: Filed Oct. 31, 2018, effective May 30, 2019. Emergency amendment filed Oct. 29, 2021, effective Jan. 1, 2022, expired June 29, 2022. Amended: Filed Oct. 29, 2021, effective May 30, 2022. Emergency amendment filed Oct. 27, 2023, effective Jan. 1, 2024, expired June 28, 2024. Amended: Filed Oct. 27, 2023, effective May 30, 2024. Emergency amendment filed Oct. 25, 2024, effective Jan. 1, 2025, expired June 29, 2025. Amended: Filed Oct. 25, 2024, effective May 30, 2025. *Original authority: 103.059, RSMo 1992.