SCAN's New SSBCI Rules: What to Tell Clients

Starting with 2027 plans, SCAN decides SSBCI eligibility, and clients' doctors may need to help

Self-attestation is out. Starting with 2027 plans, SCAN members can no longer self-attest to qualify for Special Supplemental Benefits for the Chronically Ill (SSBCI), and having a chronic condition doesn't qualify a member on its own. SCAN now makes the call using its own data, with help from the member's provider when needed.

Members Must Meet All Three Requirements

How SCAN Decides

• SCAN reviews existing data. For both new and existing members, SCAN uses claims data to determine eligibility. Members who qualify receive an approval letter by the end of October.

• Provider attestation fills the gaps. If a member isn't approved automatically, their provider can complete the SSBCI questionnaire for further review. SCAN recommends that new members with January 1, 2027 or later effective dates ask their provider to complete it, which helps SCAN speed up the review.

• Enrollment platforms no longer include SSBCI forms. The form now goes from the provider directly to SCAN.

• Current SSBCI recipients will hear from SCAN about their 2027 eligibility.

What to Tell Clients

Keep talking about SSBCI benefits during enrollment, but make clear that SCAN has to confirm eligibility. Give new clients the provider attestation form and encourage them to have their doctor submit it.

For full details, see SCAN's 2027 SSBCI Job Aid in the Producer Portal: Producer Dashboard, then Docs & Resources, then Shared Resources, and search "SSBCI."