Senegal has been committed to universal health coverage (UHC) for many years. One of the strategies utilized to achieve UHC is the organization of large-scale professionalized health insurance. Two departmental health insurance units (UDAM) have been set up with international partners since 2014. Although the international partners stopped support in 2017, the UDAMs have maintained their performance. The arrival of the COVID-19 pandemic in March 2020 in Senegal is a new test of the resilience of the UDAMs. In this reflective article, we present the main challenges that UDAMs have had to face since the pandemic: participating responsibly in the fight against the pandemic; maintaining the contribution collection; continuing to care for beneficiaries in health facilities; and ensuring payment of invoices in a context of government delays. Then, based on the experience of the two UDAM directors and their staff, we explain how they were able to meet these challenges in order to maintain their organizational routines and the services offered to their members.