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.
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