Special Supplemental Benefits for the Chronically Ill (SSBCI)
Solis Health Plans offers certain Special Supplemental Benefits for the Chronically Ill (SSBCI) to eligible members living with qualifying chronic health conditions.
SSBCI are supplemental benefits designed to help improve or maintain the health and overall function of eligible members with chronic conditions.
These benefits may include services or items that are not primarily health related when they are expected to help improve or maintain an eligible member's health or overall function.
Not all members qualify for SSBCI.
Who May Qualify?
To qualify for Special Supplemental Benefits for the Chronically Ill, a member must meet Solis Health Plans' eligibility requirements.
A chronically ill member must meet all three of the following requirements:
1. Have one or more medically complex chronic conditions that are life-threatening or significantly limit the member's overall health or function;
2. Have a high risk of hospitalization or other adverse health outcomes; and
3. Require intensive care coordination.
Having a qualifying chronic condition alone does not automatically make a member eligible for SSBCI.
Solis Health Plans reviews available health information to determine whether you qualify for SSBCI.
This may include your claims history, Health Risk Assessment (HRA) responses, medical records, and information from your doctor or other health care providers.
Your health care provider may be asked to confirm that their records include a diagnosis of one or more qualifying conditions and that you are at high risk of hospitalization or other adverse health outcomes and requires intensive care management.
Qualifying conditions
For the 2027 plan year, Solis Health Plans considers the following chronic conditions when determining eligibility for SSBCI:
Autoimmune Disorders
Cancer, excluding pre-cancer conditions or in-situ (localized) status
Cardiovascular disorders
Chronic heart failure
Diabetes mellitus
Overweight, obesity, and metabolic syndrome
Chronic gastrointestinal diseases
Chronic kidney diseases (CKD)
Severe hematologic disorders
Chronic lung disorders
Neurologic disorders
Stroke
Post-organ transplantation care
Immunodeficiency and Immunosuppressive disorders
Conditions associated with cognitive impairment
Conditions with functional challenges and require similar services
Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell
Conditions that require continued therapy services in order for individuals to maintain or retain functioning
Chronic hypertension
Chronic and disabling mental health conditions limited to:
Demans
HIV/AIDS
Supporting Your Everyday Health and Well-Being
Solis Health Plans offers a Healthy Living Allowance as a Special Supplemental Benefit for the Chronically Ill (SSBCI) to eligible members who meet certain health-related requirements.
The Healthy Living Allowance provides a monthly allowance that eligible members can use toward approved items and services that support their everyday needs.
Not all members qualify for this benefit. Eligibility is determined based on specific health conditions and other health-related criteria.
The Healthy Living Allowance pays for:
Healthy Foods
Fresh Produce • Healthy Groceries
Pet Care
Pet Supplies
Pet Services
Pet Services
Utility Bills
Utility bills where card payments are accepted
Transpò
Non-medical transportation
(e.g., taxi or ride-share)
(e.g., taxi or ride-share)
Gas
Automobile gas
(In-store purchases only)
(In-store purchases only)
Using your Healthy Living Allowance
How to Access Your Benefit
If you qualify for the Healthy Living Allowance, Solis Health Plans may need information from your primary care provider (PCP) to confirm that you meet the eligibility criteria for this benefit.
01
Talk to Your Doctor
Your Primary Care Provider (PCP) can help provide the health information needed for Solis Health Plans to review your eligibility.
02
Confirm Your Eligibility
Solis Health Plans will review the available information to determine whether you meet the eligibility requirements for the Healthy Living Allowance.
03
Receive Your Allowance
If you qualify, your Healthy Living Allowance will be made available on your Benefits Mastercard® for approved items and services.
04
Use Your Benefit
Use your allowance toward eligible everyday needs, such as healthy foods, pet care, utility bills, non-medical transportation, and automobile gas.
Once you qualify, this benefit is available at the beginning of each month in which you continue to meet the eligibility criteria. Funds do not roll over from month to month. Eligibility will be determined by Solis Health Plans using available clinical and administrative information, which may include claims history, Health Risk Assessment (HRA) responses, care management assessments, medical records, physician confirmation, provider documentation, and other relevant information, as applicable.
HOW TO PRE-QUALIFY
Complete the SSBCI Pre-Qualification Assessment Form. Your health care provider will need to review and sign the provider portion of the form to confirm applicable eligibility information.
Once completed, follow the submission instructions provided on the form.
questions about ssbci?
Have questions about SSBCI, eligibility or your Healthy Living Allowance?
Contact our Member Services Department at: 833-516-0475 (TTY: 711).
From October 1 - March 31, we are open 7 days a week; 8 a.m. to 8 p.m.
From April 1 - September 30, we are open Monday - Friday from 8 a.m. to 8 p.m.
