SSBCI
TRUE OR FALSE
A members DSNP plan will be terminated if SSBCI verification is not received.
What is False
The DSNP plan will not terminate - they will not have the healthy food or utilities benefit anymore (and transportation in certain markets) they will still receive OTC for approved products or wellness support products like fitness items or assistance through The Helper Bees for in-home services, weight management counseling, and caregiver relief
Required for all specialist office visits as well as physical, occupational, speech therapy visits for members on all HMO plans.
What is a referral?
TRUE OR FALSE
Agents will now be able to upload and attach documents for pending applications such as Medicare/Medicaid verifications or CSNP verification in the Jarvis portal.
What is True
Attach documents in Jarvis Enroll Agents can submit enrollment documents that can be processed with the application
This verification program will not include benefits related to Prescription drugs or Part D
What is SSBCI?
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Where can we as SSRs see if SSBCI has been verified for a member
GPS
All SSBCI verifications will be handled and stored systematically in GPS
Eligibility status, where a verification is in the outreach process, what provider(s) was contacted, grace period expiration and a host of other details pertaining to a member’s SSBCI status will be in GPS and available via API for other platforms. GPS will also feed SSBCI eligibility to Optum for UCard benefit administration.
TRUE OR FALSE?
Tier 3 & 4 prescription drugs on UHC MAPD and tier 3 on UHC Preferred PDP plans will now have co-insurance payments instead of copays?
What is true!
Once the SSBCI verification has been received it will fall off the Book of Business dashboard but will still be visible on the Member Profile Page within the Jarvis Book of Business.
Yes!
SSBCI Status will remain visible in the Member Profile Page as long as the member is in the plan, however, it will fall off the BOB dashboard.
What is voluntary extra OT?
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If a member self indicates SSBCI they will be able to use their credits on healthy foods/utilities in addition to approved OTC products for a limited timeframe. How many days is that limited timeframe?
What is 60 days
If a member self-indicates, they will be able to use their credits on Healthy Food / Utilities in addition to approved OTC products for a limited 60-day time frame to allow for the verification process. If we do not receive verification within 60 days, they will lose their access to use their credits towards healthy food and utilities but will continue to be able to spend their credits on approved OTC or wellness support options.
$2100
What is the Out of Pocket Maximum for 2026?
Will referrals still be required when members are traveling and using the National Network?
Yes!
Referrals are required for all applicable services nationwide. Referral requirements are not waived when members are travelling and using National Network.
Urgent and emergency care is always covered without a referral.
If members are using the Passport Benefit - Passport does not require a PCP referral (same as 2025). Members must activate Passport by calling UHC.
Does UHC deny referrals?
What is True!
UHC does not deny referrals. If a referral is submitted, the member may see the specialist.
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What does SSBI stand for?
Special Supplemental Benefits for the Chronically Ill
On this type of plans members can choose any provider, never have to get referrals and have the freedom to travel all knowing their plan wont change and will be around for years to come.
What are Medicare Supplement Plans?
When is the referral grace period timeframe to allow members time to receive all the necessary referrals from their PCP ?
1/1 -1/31 2026
Agents can still write Dental, Vision, and Hearing (DVH) plans in 2026?
What is no
DVH Plans will no longer be marketed and sold as of Oct. 1, 2025. Renewal commissions for these plans will continue for any existing policy.
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TRUE OR FALSE
If the SSBCI verification for a member on a DSNP plan is not verified they will lose the healthy food/utility and OTC benefits
What is false
If not qualified or verified, D-SNP members will still be able to use the OTC credit on approved products and NEW for 2026 - Wellness support products like fitness items or assistance through The Helper Bees for in-home services, weight management counseling, and caregiver relief. It’s important to note that members who don’t qualify for SSBCI will not be disenrolled from their plan.
Members affected by Service Area Reduction(SAR) will have a special enrollment period. What is the timeframe for this special enrollment period?
12/8/2025-2/28/2026
Members impacted by a Service Area Reduction or Closure will receive a Non-Renewal Notice
Impacted members need to make a new MA plan selection by December 31st. Otherwise, they’ll move to Original Medicare on 1/1.
Note: Duals who do not enroll into an MA plan by 12/31 will be auto-enrolled into a PDP plan + Original Medicare
Members have a Special Enrollment Period (SEP) from 12/8 – 2/28.
Double trouble or one-and-done? If you're already a delegate for one account, do you need to create another OHID to delegate again?
What is no!
Delegated users will only need one delegated access OHID even if they are a delegated user for many Jarvis accounts.
What is the percentage of co-insurance for comprehensive dental benefits in 2026?
What is 50%?
50% coinsurance on all covered comprehensive services and this applies to Non-SNP, C-SNP, partial D-SNPs with comprehensive dental packages.
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