To qualify for the Special Needs Plans (SNPs) the member lets the Plan know that they have one of the chronic diseases that were discussed on the “Introductory” page or that they qualify for Medicare and Medicaid benefits.
Chronic Combined or Pulmonary SNP
A member may qualify and enroll in one of these Plans at any time during the year. If the member did not have one of these chronic diseases at the time of their initial enrollment, but now have one of these diseases, they may qualify to change to one of these Plans.
Once the member has requested enrollment in one of these Plans, Optimum Healthcare will have to receive confirmation from a physician that they do indeed have one of these diseases before their enrollment is completed. You or the member will receive an “Enrollment Qualification/Verification Form” and return envelope that needs to be completed by a physician and returned to the Plan before enrollment can be completed.
Dual Eligible SNP
Dual eligible beneficiaries are classified as either full or partial dual eligible depending on their current income level and other qualifying criteria. Optimum Healthcare will confirm their level of eligibility at the time of their request for enrollment, and will later receive confirmation of their actual level from Centers for Medicaid and Medicare Services (CMS) soon after enrollment. The information from CMS will be the deciding factor or their eligibility for this program.
If you would like more information regarding these Plans or would like to recommend a member for enrollment please contact Member Services at the number located on the back of your Identification Card.