Special Supplemental Benefits for the Chronically Ill (SSBCI) are benefits offered to provide extra support for Medicare Advantage plan members with certain serious and complex health conditions who meet all eligibility requirements. These benefits can help with everyday needs that affect your health and make it easier to manage ongoing care. They work alongside your Medicare benefits and medical care to help support your overall health.

Qualifying for SSBCI benefits

To qualify for SSBCI, you must: 

• Be enrolled in a qualifying Medicare Advantage plan (HMO C-SNP, HMO D-SNP or PPO D-SNP)
• Have one or more qualifying chronic conditions (see the complete list below)

AND meet all of the following criteria:

• Live with an ongoing condition that is life-threatening or significantly limits your overall health or ability to function – A chronic illness is a long-term health condition that usually lasts one year or longer and requires ongoing medical care. The condition must be active and affect your health, daily functioning or need for ongoing care. Having a past diagnosis or a stable condition that requires little care does not meet this requirement.
• Be at higher risk for health complications – This may include a hospital stay or other serious health issues directly related to your qualifying chronic condition. Examples include one or more of the following:
  • One or more unplanned inpatient or observation hospital stays in the last 12 months
  • One or more emergency room visits in the last 12 months
  • Two or more outpatient visits (including primary care or specialty care) in the last 12 months
  • Need for home health visits
  • Difficulty with daily living activities (such as bathing, dressing, toileting, transferring and eating) or cognitive impairments
  • Need for durable medical equipment (DME)
  • Receiving dialysis
• Require ongoing, intensive care coordination – You must be actively working with one of our SNP case managers to help coordinate your care and manage your qualifying chronic condition
• Be likely to benefit from the service – The SSBCI benefit should have a reasonable expectation of helping to improve or maintain your health or ability to function.

Not all members will qualify for these special supplemental benefits. Eligibility is based on meeting all SSBCI requirements, must be supported by provider attestation AND medical, claims and/or care management records and is subject to Health Alliance Plan approval. To learn if you qualify, please talk to your Health Alliance Plan case manager or navigator.

Qualifying chronic conditions

• Alcohol use disorder and other substance use disorders (SUDs)
• Autoimmune disorders – dermatomyositis, polyarteritis nodosa, polymyositis, polymyalgia rheumatica, psoriatic arthritis, rheumatoid arthritis, scleroderma and systemic lupus erythematosus (SLE)
• Cancer (excluding pre-cancer or in situ status)
• Cardiovascular disorders – cardiac arrhythmias, chronic venous thromboembolic disorder, coronary artery disease (CAD) and peripheral vascular disease (PVD)
• Chronic kidney disease (CKD) – requiring dialysis or end-stage renal disease (ESRD)
• Dementia
• Diabetes (excluding pre-diabetes)
• Gastrointestinal disease – chronic liver disease, hepatitis B, hepatitis C and pancreatitis
• Heart failure
• HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome)
• Lung disorders – asthma, chronic bronchitis, chronic obstructive pulmonary disease
  (COPD), cystic fibrosis, emphysema, pulmonary fibrosis and pulmonary hypertension
• Mental health conditions – anxiety disorders, bipolar disorder, eating disorders, major
  depressive disorder, paranoid disorder, schizoaffective disorder and schizophrenia
• Neurologic disorders – amyotrophic lateral sclerosis (ALS), epilepsy, extensive paralysis
  (i.e., hemiplegia, monoplegia, paraplegia, or quadriplegia), Huntington’s disease,
  multiple sclerosis, Parkinson’s disease, polyneuropathy, spinal cord injuries, spinal
  stenosis and stroke-related neurologic deficit
• Severe hematologic disorders – aplastic anemia, hemophilia, immune thrombocytopenic
  purpura, myelodysplastic syndrome and sickle-cell disease (excluding sickle-cell trait)
• Stroke

Verifying SSBCI eligibility

To receive SSBCI benefits, your provider must complete and submit an attestation form to verify that you meet all the eligibility requirements.

To submit an attestation:

1. Print the SSBCI Clinical Eligibility Attestation Form.
2. Take the form to your doctor and ask them to review the eligibility requirements to determine whether you qualify for SSBCI benefits.
3. Have your doctor complete and sign the form.
4. Submit the completed, signed form using one of the following methods:
   1. Fax: (313) 664-5916
   2. Email: RMT@hap.org

Additional Information

If you have questions on submitting the attestation form, please email RMT@hap.org. For all other SSBCI questions, please email MSWeb1@hap.org.

SSBCI frequently asked questions