Member Forms Library

When You Should Submit an SSBCI Eligibility Request:

• Longevity HMO members who qualify for SSBCI benefits – Please submit your request
• Value HMO members who qualify for SSBCI benefits – Please submit your request

No Action Required:

• Total+ HMO C-SNP members – You don’t need to submit an SSBCI eligibility request
• Breathe+ HMO C-SNP members – You don’t need to submit an SSBCI eligibility request

Need Help Determining Your Eligibility?
Not sure if you qualify for SSBCI benefits or which plan you’re enrolled in? We’re here to support you! Check your member ID card for your plan details, learn more about SSBCI eligibility, or reach out to our caring member services team. We understand that healthcare can sometimes feel complicated, and we’re committed to walking alongside you every step of the way.

Your health and peace of mind matter to us. If you have any questions about these requirements or need assistance with your request, please don’t hesitate to contact us. We’re proud to serve our diverse community of members and are always ready to provide the guidance you need.