Lisa's C-SNP Video

CSNP

DO YOU NEED A YEAR-ROUND ENROLLMENT SEP?

C-SNP is your answer…Let’s learn about it!

C-SNP eligible consumers are entitled to a Special Election Period (SEP) that is available anytime during the year.  United Healthcare has a C-SNP plan available in Alabama. 

UnitedHealthcare Chronic Condition Special Needs plans (C-SNP) are designed for consumers with one of three specific qualifying chronic conditions: ·       Diabetes ·       Cardiovascular Disorders ·       Chronic Heart Failure

Benefits and services tailored to support the qualifying conditions: ·       Lower copays and prescription drug costs ·       Ancillary benefits, such as OTC & Healthy Food credits ·       Care Management

Note:  Pre-diabetes is not a qualifying condition

·       $0 premiums with cost sharing designed to help members pay less out-of-pocket compared to non-SNP’s

·       Richer ancillary benefits compared to non-SNP, including Healthy Food + OTC benefit

·       Access to broad local of providers, with some plans offering a national network

Most C-SNP’s will offer over-the-counter (OTC) & Healthy Foods credit to help pay for thousands of covered healthy foods like fruits and vegetables, meat, seafood, dairy products, bread, cereals and OTC products.

Drug & Insulin Coverage.  Includes Medicare Part D Prescription drug coverage and a unique C-SNP drug formulary that has lower tiering for commonly used drugs to treat the qualifying conditions.  Members have access to $25 or less covered insulin and $0 diabetic supplies when using Optum Home Delivery Pharmacy.

Care Management. Plans include access to clinical management programs for qualifying members, which includes a telephonic nurse, health education and care reminders.

How Can I Identify an Eligible Member?

Often when an agent looks up a consumer’s providers or medications, they see signs the consumer may have a qualifying chronic condition, or they may hear statements like those listed below.  Agents may ask probing questions to learn more about a consumer’s condition to help determine eligibility.

Statements Agents Might Hear

“I take insulin for my high blood pressure” “I need test strips” “I have a cardiologist” “I had a heart attack” “I have blood pressure problems”

How is Eligibility Determined?

A member’s chronic condition of diabetes, cardiovascular disorder and/or chronic heart failure must be verified by a provider after enrollment.  United Healthcare’s Verification Team will reach out to the provider to verify the consumer’s chronic condition.  The Team will attempt telephonic outreach efforts to the provider listed on the Release of Information.  UnitedHealthcare will make multiple attempts to verify the chronic condition within the allotted timeframe.  UnitedHealthcare has 60 days, from the plan effective date, to verify if the member has a chronic condition.

Agents receive chronic condition verification status emails as a courtesy for awareness of the notification sent to the member. 

Providers can:

·       Call the 1-800 number on the provider verification form to validate.  A doctor or nurse can leave a message.  REMEMBER:  this line is ONLY for providers. 

·       Email form to mandrenrollment@uhc.com

·       Fax form in using the chronic verification form