Special Needs Plan: Introduction - Providers

Introduction

Optimum Healthcare offers Special Needs Plans for Dual-eligible members, those who receive both Medicare and Medicaid benefits.
Effective January 2012 Optimum Healthcare additionally offers Special Needs Plans (SNPs) for members who have certain chronic diseases. The following SNPs are available:

  • Chronic Combined SNP- for members with Diabetes, Cardiovascular Disease or Chronic/Congestive Heart Failure
  • Chronic Pulmonary SNP- for members with Chronic Lung Disorders
  • Dual Eligible SNP- for members who receive both Medicare and Medicaid benefits

Chronic Combined SNP
The chronic diseases that are included under the Combined SNP are

  • Diabetes
  • Cardiovascular Disease for the following only:
    • Cardiac arrhythmias
    • Coronary Artery Disease
    • Peripheral Vascular Disease
    • Chronic Venous Thromboembolic Disorder
    • Chronic/Congestive Heart Failure

Chronic Pulmonary SNP
The chronic diseases that are included under the Chronic Pulmonary SNP are:

  • Chronic Lung Disorders
    • Chronic Obstructive Pulmonary Disease which includes Chronic Bronchitis, Asthma and Pulmonary Fibrosis                     

Dual Eligible SNP
The Dual Eligible SNP includes all members who qualify for Medicare and Medicaid benefits and is not based on any chronic disease

Last Updated: 10/01/2018