SSBCI & Spendables

SSBCI Info 1

100

What does ME means? 

Manually Enrolled 

200

What does AE means? 

Automatically Enrolled

300

What are the DSNP plans that are not included in the SSBCI program?

Georgia

543-004-000 Wellcare Dual Access Open (PPO D-SNP)

California

H3561-007 Wellcare CalViva Health Dual Align (HMO D-SNP)

400

What are the eligibility criteria for SSBCI program for Auto-qualified members?

Auto-qualified Members:

• Current members will not have the ability to qualify using the Manual process for PY2026.
• All returning members in an eligible 2026 SSBCI plan will receive detailed benefit letters notifying them of their eligibility.
  • These members will receive their letter by 9/30.
• New members that auto qualify after 1/1/2026 will receive benefits within 4 business days.

500

What benefit is this - This benefit is available to members with qualifying chronic conditions like Diabetes, Hypertension, Chronic Lung Disorders, Asthma, Chronic Heart Failure Cancer, and Coronary Artery Disease (CAD). This is not an all-inclusive list. Members must meet all three criteria requirements to qualify for the benefits 

SSBCI

SSBCI Info 2

100

What does SSBCI stands for?

Supplemental Benefits for the Chronically Ill 

200

Who is the vendor managing the SSBCI benefit for 2026?  

Lynx - wellcare spendables card

300

What part in CC (FIELD) you will check if the member has AE or ME designation?  

RC6 - Check under RC6 field in the Member Eligibility Record to determine if there is an AE (Automatically Enrolled) or an ME (Manually Enrolled) designation 

400

What are the eligibility criteria for SSBCI Program for Manually qualified member?

• Only new members will be able to qualify through the Manual Process for SSBCI benefits in PY2026.
  • These members will need to qualify within the first four months of their 2026 enrollment.
  • Members approved through manual attestation process will receive benefits within four business days after eligibility determination.

500

What are the criteria/requirements to qualify for the program?

• The members must require intensive care  management. 
• The member must be at high risk for unplanned hospitalization. 
• The member must have a documented and active diagnosis for a qualifying chronic condition. 
  • The chronic condition must be life threatening or significantly limit the overall health or function of the member.
    Note: This does not require active participation in a Care Management program. Be sure to provide all qualifying SSBCI benefits per Evidence of Coverage (EOC).

SSBCI Info 3

100

True or False - Is reimbursement provided for the SSBCI benefit?

False - 

• Members cannot pay out-of-pocket and then request reimbursement. Reimbursements are not provided for SSBCI benefits.

200

True or False - ONLY NEW members will be able to manually qualify for SSBCI in 2026.

True - Note: Only new members will be able to manually qualify for SSBCI benefits in PY2026. 

300

All DSNPs will be participating in the SSBCI program except for what States and plans?

Georgia

543-004-000

Wellcare Dual Access Open (PPO D-SNP)

California

H3561-007

Wellcare CalViva Health Dual Align (HMO D-SNP)

400

What is the website that a provider should be using in submitting attestation?

https://ssbci.rrd.com

500

Once a member qualifies for the SSBCI approved benefits, what are the added items for their WellCare spendables card?

• New Pest Control Items and services
• Home Assistance and Safety Items with installation (NEW)
• Healthy Food Items
• Rent and Utilities Assistance
• Gas-pay-at-pump

SSBCI Info 4

100

How many spendables card should a member receive for 2026?

One 

200

True or False - Only PCP can provide the attestation for the members 

False - 

• Advise the member that the provider attestation can be completed by any of the member's providers not just the member's Primary Care Provider (PCP).

300

Will members be able to utilize the SSBCI benefit funds for the months missed (receive retro benefits) since the beginning of the year?

• Members who are deemed eligible for SSBCI will have benefits available to them within four days, after the member is deemed eligible. Since the member does not receive any additional funds after being deemed eligible for SSBCI, there is no need for a funding correction.

400

How do you escalate an SSBCI issue?

Things to Remember:

• Help caller/provider understand that attestations submitted to us do not result in immediate benefit activation with our ancillary vendors.
• It takes a few days for us to receive attestation, update our internal systems and get information to the ancillary vendors to activate benefits.
  Note: Benefits will begin within four business days after a member is determined eligible for SSBCI. 
• SSBCI program will not credit members account for missed/delayed benefits due to the timing of an office visit or submission of an attestation.
• If it has been more than one month, escalate the issue to your supervisor.

500

If there is no SSBCI indicator present, what can you suggest as a CSA?

• Members must schedule an appointment with their provider of choice for an office visit to have the attestation completed.
  • Offer to schedule an appointment with provider of choice.
• Provider will complete attestation on the attestation site: https://ssbci.rrd.com
• Offer to send the member a manual attestation letter detailing the process.
• SSBCI eligibility will be updated in OMNI and CAREConnects if attestation confirms SSBCI criteria met.

Spendable

100

What are the included benefits for DSNP Plans (SSBCI approved benefits) for 2026? 

OTC
Dental, Vision, Hearing (DVH)
SSBCI-approved members:

•  Gas pay-at-pump
• Healthy food
• Utilities assistance
• Rent assistance
• Home assistance & safety items (with installation) (new)
• Pest control services (new)

200

What are the approved benefits for a non-DSNP plans for 2026?

OTC

• Dental, Vision, Hearing (DVH)

300

Until when can members use their remaining funds  for the 2025 Spendables?

Dec 31st 2025

400

What is replacing the Healthy Benefits plus app for 2026?

Wellcare Spendables and Rewards

500

What are the eligible food categories included for the healthy food benefit and what are excluded?  

Included food categories: 

• Fresh fruit and vegetables
• Frozen produce and meals
• Beans and legumes
• Dairy items
• Pantry staples (flour, spices, etc.)
• Soups
• Meat and seafood
• Nutritional shakes and bars

Excluded:

• Ice Cream, Frozen Yogurt, Sherbet
• Other Desserts/Sweets
• Appetizers, French Fries, Onion Rings etc.
• Salty Snacks
• Cookies
• Crackers
• Lard
• Bakery (Pies, Cakes, Muffins)
• Alcohol
• Cake/Cookie Mixes, Frosting, Chocolate Chips, Marshmallows, Decorations
• Soda
• Bottled Energy Drinks
• Candy/Candy Bars