loco

Special supplemental benefits for the chronically ill (SSBCI)

Expanded benefits for the chronically ill. You may be eligible. Ask your provider.

Find the SSBCI form
A woman grocery shopping
If you’re a member of the Geisinger Gold Secure Rx (HMO D-SNP) plan, you may be eligible for expanded options to spend your benefits on food or utilities. See if you qualify.
Members who have met all eligibility criteria, either by Geisinger Gold reviewing your healthcare provider records or via a healthcare provider attestation form, will become eligible to receive SSBCI. 

SSBCI requirements for your condition

To qualify, you must have a chronic health condition and meet all these requirements. Your condition must:
Be life-threatening
It must be life-threatening or significantly limits your overall health or function. 
Be high-risk
Not getting care carries a high risk of hospitalization or other serious outcomes.
Require coordination
It must require intensive coordination between providers to manage.

What can I receive with the SSBCI benefit?

You can expand your benefits purchase options to include:

Healthy foods

  • Fresh fruit and vegetables
  • Healthy grains
  • Canned or frozen fruit and vegetables
  • Dairy
  • Meat and seafood

Utilities

  • Water/sewer
  • Electricity
  • Gas/heating oil
  • Sanitary/trash
  • Phone bills
  • Internet

Eligible chronic conditions include:

  • Autoimmune disorders
  • Cancer
  • Cardiovascular disorders
  • Chronic alcohol & substance use disorders
  • Chronic and disabling mental health conditions
  • Chronic gastrointestinal disease
  • Chronic heart failure
  • Chronic hyperlipidemia
  • Chronic hypertension
  • Chronic kidney disease (CKD)
  • Chronic lung disorders
  • Cognitive impairment conditions
  • Functional challenge conditions
  • Dementia
  • Diabetes mellitus
  • HIV/AIDS
  • Immunodeficiency & immunosuppressive disorders
  • Myasthenia gravis & related disorders
  • Neurologic disorders
  • Overweight, obesity, metabolic syndrome
  • Post-organ transplantation care
  • Severe hematologic disorders
  • Stroke
 

Signs you meet these requirements

 

Meeting these conditions must be demonstrated by one or more of the following:

  • 1 or more inpatient admissions (including behavioral health) related to the chronic condition within the last 36 months
  • 2 or more outpatient visits (primary care or specialty care) related to the chronic condition in the last 36 months
  • 1 or more urgent care or emergency room visits related to the chronic condition in the last 36 months
  • Home health visits are required for you to manage the chronic condition
  • You must be unable to do daily tasks without help, like bathing, dressing, toileting, transferring or eating; or have cognitive impairments
  • You need to use durable medical equipment in the outpatient setting, including a:
    • Group 3 power/manual wheelchair
    • Non-invasive ventilation (NIV), BiPAP, wound vacuums
    • Mechanical in-exsufflation devices
    • Group 2 or Group 3 mattresses

Submit the SSBCI form

If you’re eligible for the SSBCI benefit, you may be automatically enrolled. If not, to receive the SSBCI Medicare benefit, fill out your portion of this provider attestation form and then give it to your provider to complete. 
Man taking medical advice from a female doctor

Common questions about SSBCI

When can I start to use my expanded benefit?

The eligibility review process can take up to 30 days while Geisinger Gold reviews information from your healthcare provider and other available records. If Geisinger Gold determines you to be eligible, your SSBCI benefits will become effective on the first day of the month following the eligibility determination. SSBCI eligibility and benefits are not applied retroactively, and benefits are not available for periods prior to the effective date of eligibility.

What items are not covered under SSBCI?

Items that are not covered under the SSBCI benefit include but are not limited to:

  • Procedures that are solely cosmetic in nature (e.g., cosmetic surgery, such as facelifts; cosmetic treatments for facial lines, atrophy of collagen and fat and bone loss due to aging)
  • Alcohol
  • Tobacco
  • Cannabis products
  • Non-healthy food

Can I roll over the balance from month to month?

No. Unused amounts cannot be rolled over from one calendar month to another.

Does SSBCI cover taxes?

Geisinger Gold is not responsible for fees or sales tax associated with your SSBCI. 

What if there aren’t enough funds on my SSBCI prepaid benefits card to make an eligible purchase?

It will be your responsibility to cover the remaining balance at the time of purchase.

The benefits mentioned are a part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program. Not all members qualify. Qualifying conditions include but are not limited to diabetes, dementia, behavioral health conditions, cancer, and neurologic disorders. For more information, please review your Evidence of Coverage (EOC). Eligibility for these benefits cannot be guaranteed based solely on your condition. All applicable eligibility requirements must be met before the benefit is provided.

Benefits, premiums and/or copayments/co-insurance may change on Jan. 1 each year.

Geisinger Gold Medicare Advantage HMO, PPO, and HMO D-SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company/Geisinger Quality Options, Inc., health plans with a Medicare contract. Continued enrollment in Geisinger Gold depends on contract renewal. Geisinger Health Plan, Geisinger Indemnity Insurance Company, and Geisinger Quality Options, Inc. are part of Geisinger, an integrated health care delivery and coverage organization. Risant Health, Inc. is the parent organization of Geisinger.

 

  • Y0032_26265_1_M