Understanding SSBCI Qualification 2026

We want to ensure you and your clients have a clear understanding of how members can qualify (and remain eligible) for Clear Spring Health Special Supplemental Benefits for the Chronically Ill (SSBCI).

This is important for your clients with certain chronic conditions. Your guidance helps them maintain uninterrupted access and improves their quality of life. 💙

✅ Step-by-Step: How Clients Qualify

1️⃣ Complete a Health Risk Assessment (HRA)

• Each client (HMO & C-SNP) must complete an HRA and indicate they have at least one qualifying chronic condition.
  • You can assist your client with this during enrollment through Sunfire.

    Once you submit an app, you will see a “Start HRA” button on the final enrollment screen. 

  • Your clients can also complete their HRA online through this link: https://hra.clearspringhealthcare.net 
  • If you are using Connecture/DRX, on the Enrollment Confirmation Screen, you will see a “Complete Health Risk Assessment” link.   
• HMO members must have either diabetes, COPD, chronic heart failure, and/or chronic kidney disease.
• CSNP members must have diabetes, chronic heart failure, and/or cardiovascular disorders.
  • This will enable your client to receive the benefit, but validation is required.

2️⃣ Required Verification

• HMO member (Not enrolled in a C-SNP plan)
  • The client's health care provider must verify the chronic condition by submitting the SSBCI Provider Attestation Form OR confirmation of the chronic condition through claims data within 4 months of enrollment.
    • CLICK HERE FOR THE 2026 SSBCI PROVIDER ATTESTATION FORM
  • If we don’t receive the provider attestation and there is no claims data to verify, the member will no longer qualify and will stop receiving the benefit in month 5.
  • C-SNP members will be validated through the normal C-SNP enrollment verification process, which is managed by internal teams. 

💬 How Agents Can Help Clients Get Verified

Agents play an important role in helping HMO members stay on track with their SSBCI benefits.  Your support can empower clients and make them feel cared for as they navigate the process.

• Encouraging them to contact their provider’s office soon after enrollment to complete the SSBCI Provider Attestation form helps clients feel supported and confident in their progress.  
• Checking in after 30 days to make sure the provider’s office has received the request and submitted the confirmation form.
• Email or print and give your client a copy of the provider attestation. Then suggest that your client give that to their provider.

Friendly reminders from you can make a big difference — helping clients keep their benefits and ensuring smooth verification before the deadline.