Benefit Update and Accessing Special Supplemental Benefits for the Chronically Ill

Attention Valued Partner,

This communication serves to provide updates on key benefits like the Flex Card and SHIPT Grocery Delivery, as well as provide additional detailed information to help qualified members access their SSBCI benefits.

Update: Flex Cards

Issues impacted the timely delivery of Flex Cards to members who qualify for the benefit. New Flex Cards will begin being shipped next week, clearing backlogged members first. Until then, members who have a Flex Card may use their existing Flex Card or new members may utilize the reimbursement form for covered Out of Pocket expenses within 90 days.

Update: Grocery Delivery Benefit

To access SSBCI Grocery Delivery Benefits provided through SHIPT, qualified members should log into their member web portal to obtain their coupon code and instructions for activating their SHIPT membership. One code is issued per eligible member and the benefit is fully activated for the plan year after the member registers and redeems their code on the SHIPT website.

Due to volume, additional coupon codes have been generated and should be accessed through the member web portal for qualified members.

Please Note: Delivery is not currently available in all zip codes where the benefit has been filed but members may have groceries delivered to a friend or family member residing in a covered zip code. Wellcare is working with the vendor to improve coverage in areas with current limitations.

SSBCI Eligibility

Special Supplemental Benefits for the Chronically Ill (SSBCI) help qualified members with chronic illnesses improve health outcomes. To qualify for SSBCI benefits (coverage varies by plan), a member must meet certain eligibility criteria. 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.

SSBCI Benefit Eligibility Criteria* (All 3 Criteria Must Be Met)

1. Have at least one chronic condition from the Chronic Condition l CMS 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

*Member Data is used to determine Wellcare’s overall risk categorization for members.

** This list is not exhaustive/all inclusive. For some of the conditions listed, eligibility is further limited to very specific diagnoses.

SSBCI Enrollment

For members who qualify for auto-enrollment:

• Qualified members, based on their claims history, may already have a flag on their member profile. This flag is visible to Customer Service. These members can begin accessing their benefits.  Members new to Wellcare as of 1/1/2022 or who do not yet have an auto-enrollment flag will be reviewed for eligibility on a weekly basis and flagged once eligibility criteria have been met.

For members with an urgent need to access the benefits before the automated process has completed:

• If a member believes they meet the base criteria for high risk with a qualifying chronic condition, they may call Customer Service at the number listed on their ID card to request an evaluation. Members should not be directed to call any other phone number. 

Once enrolled:

• Members will have preliminary access to their SSBCI benefits. To continue benefits a provider must attest to the member's eligibility within 30 days.
• If a member is determined to be ineligible or the provider does not return the attestation form within 30 days members will no longer be able to access their SSBCI benefits.

Please Note: A manual process is in place for new or otherwise qualified members to access their SSBCI benefits. Manual enrollment can take up to 5 business days. Until their provider attests to the member's eligibility, they will have preliminary access to their benefits.

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

As always, thank you for your continued partnership!

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Our company provides programs and services to government healthcare programs. We are the country's largest Medicaid managed care organization. See our current standing: https://fortune.com/company/centene/fortune500/

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