SSBCI: Providers

SSBCI Special Supplemental Benefits for Chronically Ill

The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.

If your patient is a member of our plan, has one or more qualifying chronic conditions, and meets all SSBCI eligibility criteria, they may be eligible for the supplemental benefits described below. They must meet all three criteria to be eligible:

1. Has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee. (Please see the list of qualifying chronic conditions below)
2. Has a high risk of hospitalization or other adverse health outcomes.
3. Requires intensive care coordination.

Your patient gets an allowance they can use for groceries (healthy food and produce), and general supports of living (utility payment like their electric bill and rent or mortgage assistance). This allowance is shared with the member’s OTC benefit. They get the OTC benefit automatically, but if they qualify for SSBCI, they can then use that allowance on both OTC and their SSBCI benefits.

Qualifying chronic conditions:

Chronic alcohol and other drug dependence, Autoimmune disorders, Cancer, Cardiovascular disease, Chronic heart failure, dementia, diabetes, end-stage liver disease, end-stage renal disease (ESRD), severe hematologic disorders, HIV/AIDs, chronic lung disorders, chronic and disabling mental health conditions, neurologic disorders, stroke, Overweight, obesity, and metabolic syndrome, Chronic gastrointestinal disease, Post-organ transplantation, Immunodeficiency and Immunosuppressive disorders, conditions associated with cognitive impairment, conditions with functional challenges, chronic conditions that impair vision, hearing (deafness), taste, touch, and smell, and conditions that require continued therapy services in order for individuals to maintain or retain functioning.

How to qualify:

Our plan uses medical claims and encounter data to identify members with qualifying chronic conditions. Eligible members are automatically enrolled and provided access to applicable SSBCI benefits and allowances. No action is required if eligibility can be verified through Plan records. If eligibility cannot be verified through available claims or encounter data, you, as our member’s provider may submit an SSBCI Attestation Form through our website, by mail, or by fax for review and eligibility determination. This can be found on our website http://www.healthy-ar.com located under the provider section, under “SSBCI.”

We encourage patients and providers to have, at the very least, yearly visits to help manage their chronic condition. Claim verification is the easiest way to be eligible. Please be sure to submit these qualifying claims as soon as you’re able.

Your patient will be sent a NationsBenefits debit card. This debit card can be used on groceries at participating retailers, or through NationsBenefits online. For general supports and living (utilities) members can use the card as a debit card payment for utility bills, rent, or mortgage.

Your patient can call us at our Member services number, or they can call NationsBenefits at 877-740-2369 (TTY: 711) or visit HealthyAR.NationsBenefits.com for more information about these benefits