Do you qualify for a C-SNP?
If you have one of the health conditions listed below — and you live in a county where we offer a C-SNP — you qualify.
Qualifying health conditions
- Diabetes
- Congestive or chronic heart failure
- Cardiac arrhythmias (irregular heartbeat such as atrial fibrillation or AFib)
- Coronary artery disease (narrow or blocked heart arteries)
- Peripheral vascular disease or chronic venous thromboembolic disorder (problems with blood flow or frequent blood clots)
- Valvular heart disease (problems with heart valves)
How to join a C-SNP
Return this completed form with your plan application and we’ll enroll you in our C-SNP. A couple notes:
- Complete only the first 3 pages of the form (skip the For Provider section on page 4)
- Be sure to fill out the form accurately — we’ll then contact your provider to verify your chronic condition and complete page 4
If you don't return the form with your application, we'll reach out to you to complete it — we can’t enroll you in the plan without it.
We must have a completed form — including the For Provider section with your provider’s signature — by the end of your second month on the plan. If we don’t have it by then, we’ll have to disenroll you and you’ll need to join a new plan.