Notice: Please be aware that our website will be undergoing scheduled maintenance and may be temporarily unavailable for a short period between 11pm Eastern on 10/8 and 5am Eastern on 10/9. We apologize for any inconvenience this may cause.
Home›Documents›Member Chronic Condition Coverage Request Form (CA)
Our members with certain health conditions or adverse health outcomes may be eligible for additional benefits under the Special Supplemental Benefits for the Chronically Ill (SSBCI). This form should be used by members to request that CCA determine eligibility for SSBCI benefits.
Member Chronic Condition Coverage Request Form (CA)