Eligibility Requirements for Diabetes SNP – CareDirect (HMO SNP)

* Entitled to Medicare Part A 

* Enrolled in Medicare Part B through age or disability

* Resident within the Plan’s service area

* Diagnosed with diabetes mellitus (ICD-9-CM codes 250.xx)

* Not undergoing treatment  for end-stage renal  disease (ESRD) unless members of CarePlus  since  dialysis began.

* In  addition,  members  enrolled  in  the  Diabetes  SNP  (CareDirect  HMO  SNP)  must  have  their  physician or physician’s office confirm the qualifying condition either verbally or in writing by the  last  day  of the  first  month of enrollment;  written confirmation  can be provided by obtaining the physician’s  signature  on  the  Chronic  Condition  Verification  Form.  This  form  is  intended  to substantiate that the applicant has an appropriate diagnosis for participation in the plan. If CarePlus  does not receive confirmation of the member’s chronic condition by the last day of the first month of enrollment, the patient’s coverage under the Diabetes SNP will be involuntarily terminated.

Eligibility  Requirements  for  Cardiovascular  Disorders/Chronic  Heart  Failure  SNP  –  CareHeart (HMO SNP)
* Entitled to Medicare Part A 

* Enrolled in Medicare Part B through age or disability

* Resident within the Plan’s service area

* Diagnosed with cardiovascular disorder, specifically Cardiac arrhythmias, Coronary artery disease, Peripheral vascular disease, and/or Chronic venous thromboembolic disorder*.

* Diagnosed with chronic heart failure*.

* Not undergoing treatment  for end-stage renal  disease (ESRD) unless members of CarePlus  since  dialysis began.

* In  addition,  members  enrolled  in  the  Cardiovascular  Disorders/Chronic  Heart  Failure  SNP  (CareHeart  HMO  SNP)  must  have  their  physician  or  physician’s  office  confirm  the  qualifying  condition  either  verbally  or  in  writing  by  the  last  day  of  the  first  month  of  enrollment;  written confirmation  can  be  provided  by  obtaining  the  physician’s  signature  on  the  Chronic  Condition  Verification Form. If CarePlus does not receive confirmation of the member’s chronic condition by the  last  day  of  the  first  month  of  enrollment,  the  patient’s  coverage  under  the  Cardiovascular Disorders/Chronic Heart Failure SNP will be involuntarily terminated.