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SSBCI Eligibility Criteria
Elevate Medicare Choice (HMO D-SNP) members who meet the following criteria are eligible for additional SSBCI benefits offered through Elevate Medicare Advantage. Qualifying members:
- Have at least one condition that is life-threatening or significantly limits overall health or function (see list below)
- Have a high risk of hospitalization or other adverse health outcomes
- Require extensive care coordination
Eligible members have access to additional spending categories on the Elevate FlexCard and can receive a Thrive Mobile Smartphone*.
Eligible Conditions | |
|---|---|
Autoimmune disorders | Conditions that require continued therapy services in order for individuals to maintain or retain functioning |
Cancer | Conditions with functional challenges |
Cardiovascular disorders | Dementia |
Chronic alcohol use disorder and other substance use disorders (SUDs) | Diabetes mellitus |
Chronic and disabling mental health conditions | HIV/AIDS |
Chronic conditions that impair vision/hearing (deafness)/taste/touch/smell | Immunodeficiency and immunosuppressive disorders |
Chronic gastrointestinal disease | Neurologic disorders |
Chronic heart failure | Overweight/obesity/metabolic syndrome |
Chronic kidney disease (CKD) | Post-organ transplantation |
Chronic lung disorders | Severe hematologic conditions |
Conditions associated with cognitive impairment | Stroke |
Providers:
If you have members who qualify but are new to the plan, please submit using ONE of the following methods:
- Submit the SSBCI Provider Attestation webform (preferred method)
- Print and sign the PDF form and fax to 303-602-2138
- Call 303-602-2111 and select Option 5 for the provider option to attest over the phone
Only a licensed medical provider may fill out this form. Attestations are valid for one year from receipt. Member must have a valid paid claim with diagnosis to continue being eligible for the benefit.
This benefit is part of special supplemental program for the chronically ill. Not all members qualify. Other eligibility and coverage criteria apply. Eligible conditions include: Cancer, Chronic heart failure, Diabetes, Chronic lung disorders, and Chronic and disabling mental health conditions. Other conditions also apply that are not listed.