How to enroll

Qualifying for a D-SNP

Before applying for coverage, you’ll first need to know if you qualify. 

Highmark Health Options Duals

To qualify, you’ll need to:

• Live in the state of West Virginia
• Be eligible for Medicare Part A and Medicare Part B
• Be eligible for full Medicaid benefits

SSBCI eligibility requirements 

To qualify for the Special Supplemental Benefits for the Chronically Ill (SSBCI), you must first meet specific eligibility criteria. Eligibility is determined by meeting all three of the following:

• You must be diagnosed with one or more of the qualifying chronic conditions below.
• You must have a high risk for hospitalization and/or adverse health outcomes.
• You must actively participate in the plan’s Care Management Program.

Please note: A diagnosis of one of the qualifying chronic conditions alone does not guarantee eligibility. All three criteria listed above must be met. How to Qualify for SSBCI Benefits After Meeting Eligibility Criteria: Once you meet the eligibility criteria, qualification for SSBCI benefits can be determined in one of two ways: 

1. Review of Historical Information: The Plan will review your historical claims and medical records to determine if you meet the requirements for SSBCI benefits based on your documented history.
2. Provider Attestation: If additional information is needed to confirm your eligibility and qualification, your doctor will be required to complete a Provider Attestation Form on your behalf, indicating that you meet these requirements.  

Accessing the Provider Attestation Form: 
The Provider Attestation Form is available in your welcome kit, enrollment kit, and can also be found here.  

Effective Date 
Your eligibility becomes effective on the date the Health Plan determines that you meet all three eligibility criteria described above.  
Qualifying Chronic Conditions

• Autoimmune disorders 
• Cancer 
• Cardiovascular disorders 
• Chronic alcohol use disorder and other substance use disorders (SUDs) 
• Chronic and disabling mental health conditions 
• Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell 
• Chronic gastrointestinal disease 
• Chronic heart failure 
• Chronic kidney disease (CKD) 
• Chronic lung disorders Conditions associated with cognitive impairment 
• Conditions with functional challenges 
• Dementia 
• Diabetes mellitus 
• HIV/AIDS Immunodeficiency and Immunosuppressive disorders 
• Neurologic disorders 
• Overweight, obesity, and metabolic syndrome 
• Post-organ transplantation 
• Severe hematologic disorders 
• Stroke 
• Therapy services required for individuals to maintain or retain functioning