C-SNP Eligibility and Verification

There are often many questions about C-SNP plans. Understanding how these plans work will make it easier for you to connect the right members with the right type of support. Here’s a quick overview to get you started.

To enroll in a Chronic Condition Special Needs Plan (C-SNP), your client must have at least one qualifying chronic condition, such as diabetes, chronic heart failure, or certain cardiovascular disorders. This condition must be documented and verified by their healthcare provider after the application is submitted. The plan enrollment is considered “pending” until that verification is received.

Here’s a clear overview of the process from application to verification and beyond to help you guide clients effectively:

• 60-Day Verification Window – After the C-SNP enrollment request is submitted, the member’s healthcare provider has 60 days to complete and return the required verification form confirming the qualifying chronic condition. This step is essential to maintaining C-SNP coverage.

• 30-Day Notification – If verification has not been received by day 30, the member will receive a reminder notice. This reminder is meant to prompt the member to reach out to their provider and ensure the form is completed and returned on time.

• 60-Day Deadline – If the verification form is still not received by day 60, the member will be disenrolled from the C-SNP plan. At that point, they will no longer have access to the tailored C-SNP benefits designed for their condition.

• Re-Enrollment – If the member is disenrolled due to missing verification, they will have a Special Enrollment Period (SEP) for Loss of SNP to enroll in another plan. They do not need to wait for a separate SEP to re-enroll; however, timely action is important to avoid gaps in coverage or disruption in care.

As an agent, you can play a vital role in helping your clients complete this process, which directly affects their coverage continuity and your client retention.

You can:

• Remind your clients to contact their provider soon after enrollment, which helps you feel proactive and confident in supporting their coverage needs.

• Explain why the 60-day timeline matters and what could happen if the form is not returned.

• Follow up with your clients during the 30 to 60-day window to show your commitment and help ensure their provider completes and sends back the verification on time.

•  Encourage clients to keep copies of any documentation and to let you know if they receive notices related to their C-SNP verification.

By staying engaged and proactive, you can help ensure eligible clients maintain access to the coordinated, condition-focused benefits available through a C-SNP.