In our continuous effort to provide exceptional customer service to our members, we would like to inform you that we are actively handling all inquiries related to SSBCI (Special Supplemental Benefits for the Chronically Ill) benefits and are taking additional steps to expedite the process.

As you may be aware, the seven (7) new and expanded SSBCI benefits generated much interest in the market. The number of members who outreached to the plan to understand their eligibility and how to access SSBCI benefits far exceeded estimated volumes, which resulted in a backlog of about 8,000 customer inquiries. The Member Services and the Medicare Concierge teams continue to diligently work to answer each inquiry received. In addition, increased training of existing staff and staff additions are in progress to reduce the current backlog and minimize the backlog moving forward. Manual enrollment is currently taking up to 15 days as the backlog is worked by the team. 

Member Eligibility and Enrollment Process

SSBCI Eligibility

As a reminder, SSBCI benefits are offered on select plans to high-risk members (as defined by the health plan), and only to those who meet all 3 of the following criteria (as defined by CMS): 

1. Have at least one chronic condition from the Chronic Condition list
2. Be identified as high risk for hospitalization
3. Need intensive care management. This does not require active participation in a care management program

It is important to understand that these benefits are not available to all members with a qualifying chronic condition. The chronic condition is just one piece of the CMS-required criteria. These benefits are available only for those members with the highest medical risk, which amounts to around 5-10%of members on plans that offer the benefit.

SSBCI Enrollment

Eligible members can qualify for auto-enrollment or may complete the manual process. Please refer to the previous email communication for details on the enrollment process.

We encourage you to review the Special Supplemental Benefits for Chronically Ill FAQ and other resources previously shared regarding SSBCI benefits for additional detailed information.

As always, thank you for your continued partnership!