What is SSBCI (Special Supplemental Benefits for the Chronically Ill)?

Special Supplemental Benefits for Chronically Ill Enrollees (SSBCI) Eligibility Criteria

• Determination of eligibility for the SSBCI

  • Documentation must include that the member has completed a Health Risk Assessment and

  • Has one or more complex chronic conditions including:

    • Autoimmune Disorders

    • Cancer (excluding pre-cancer conditions)

    • Cardiovascular disorders limited to:

      • Cardiac arrhythmias

      • coronary artery disease

      • Peripheral vascular disease

      • Chronic venous thromboembolic disorder

    • Chronic Alcohol or Drug dependency

    • Chronic heart failure

    • Chronic and disabling mental health conditions limited to:

      • Bipolar disorders

      • Major depressive disorders

      • Paranoid disorder

      • Schizophrenia

      • Schizoaffective disorder

    • Chronic lung disorders limited to:

      • Asthma

      • Chronic bronchitis

      • Emphysema

      • Pulmonary fibrosis

      • Pulmonary hypertension

    • Dementia

    • Diabetes

    • End-stage liver disease

    • End-stage renal disease (ESRD)

    • HIV/AIDS

    • Neurologic disorders limited to:

      • Amyotrophic lateral sclerosis (ALS)

      • Epilepsy

      • Extensive paralysis such as:

        • Hemiplegia

        • Quadriplegia

        • Paraplegia

        • Monoplegia

      • Huntington’s disease

      • Multiple sclerosis

      • Parkinson’s disease

      • Polyneuropathy

      • Spinal stenosis

      • Stroke-related neurologic deficit

    • Severe hematologic disorders

      • Anemia

      • Sickle cell disease

      • Complications from chemotherapy or transfusions

      • Rare genetic disorders.

    • Stroke