Special Supplemental Benefits for the Chronically Ill (SSBCI) – eternalHealth

Special Supplemental Benefits for the Chronically Ill (SSBCI)

Additional benefits available to qualifying eternalHealth members with certain chronic conditions.

eternalHealth members with certain health conditions may be eligible for additional benefits as part of the Special Supplemental Benefits for the Chronically Ill (SSBCI) program. Read on to learn whether you qualify and how to get approved so you can take full advantage of the benefits available to you.

What is SSBCI?

Special Supplemental Benefits for the Chronically Ill (SSBCI) are benefits available to members who have been diagnosed with certain chronic conditions and meet specific criteria established by the Centers for Medicare & Medicaid Services (CMS). These benefits are designed to help improve or maintain your overall health and your ability to function day to day.

Which eternalHealth Benefits Are Considered SSBCI?

If you qualify for SSBCI, you may be able to use your quarterly Healthy Grocery* benefit allowance for eligible grocery purchases and utility payments** through NationsBenefits.

Qualifying Chronic Conditions

To be eligible for SSBCI benefits, you must have been diagnosed with at least one of the following chronic conditions:

Cardiovascular Disorders

  • Cardiac Arrhythmias (abnormal heart rhythm)
  • Chronic venous thromboembolic disorder (blood clots in the legs)
  • Coronary artery disease (history of chest pains, heart attacks, or hardening of the arteries of the heart)
  • Peripheral vascular disease (hardening of the arteries in the legs)
  • Chronic heart failure
  • Congestive Heart Failure
  • Hypertension

Chronic & Disabling Mental Health Conditions

  • Bipolar disorders
  • Major depressive disorder
  • Paranoid disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Eating disorder

Diabetes Mellitus

Type I or Type II

Cancer

Active cancer diagnosis as determined by your treating provider.

Chronic Kidney Disease (CKD)

Any stage documented by your treating provider.

In addition to having at least one qualifying condition, eternalHealth must receive information confirming that the condition meets all three of the following criteria:

1
Is life-threatening or significantly limits your overall health or function; and
2
Puts you at a high risk of hospitalization or other adverse health outcomes; and
3
Requires intensive care coordination.
How Do I Get Approved for SSBCI Benefits?

For eternalHealth to approve your SSBCI benefits, we must have one of the following on file:

Option 1 — Provider Attestation

A valid attestation completed by your treating provider demonstrating that you meet all criteria to qualify for SSBCI benefits.

Option 2 — Claims & Assessment

Active qualifying chronic condition claims combined with documentation from a current MDS assessment confirming all SSBCI qualifying criteria are met.

Once all SSBCI criteria have been confirmed, your Healthy Grocery card will be updated to reflect your approved SSBCI benefits.

Please note: SSBCI eligibility approval applies to the current benefit year only and is not applied retroactively.

Have Questions? We're Here to Help.

Member Services: 1-800-680-4568 (TTY 711)
October 1 – March 31: 8am – 8pm local time, 7 days a week
April 1 – September 30: 8am – 8pm local time, Monday – Friday

*The benefits mentioned are part of a special supplemental program for the chronically ill. Qualifying conditions include cardiovascular disorders, diabetes, chronic and disabling mental health conditions, cancer, and CKD. Having a listed condition does not guarantee coverage, as benefits are specifically for members who meet the criteria for "chronically ill enrollee" status.

**Utility payments are only available to Valor Give Back HMO-POS members.
Page Last Updated On: May 21, 2026
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Tida Garcia

Tida Garcia

Vice President of Contracting and Network Operations

Tida Garcia is Vice President of Network Operations for eternalHealth, where she oversees provider network operations including management of provider relationships and network performance. Tida brings extensive experience in provider claims, network adequacy strategy, and Medicare Advantage operations, along with deep expertise in delegated oversight.  She has led delegated oversight for large carriers including monitoring and performance management of delegated providers and entities, ensuring regulatory compliance operational integrity, and strong network performance.  Tida partners cross-functionally to support a scalable, high-quality care delivery model.   

Tom Lawless

Tom Lawless

Chief Financial Officer

Tom Lawless has spent the past 20+ years building, sustaining, and growing new healthcare-related programs that balance fiscal responsibility & prudence with creativity & innovation, focusing on models of care that are novel, person-centered, and improve the social welfare of those who are served. He is very excited to continue doing so in his role as the Chief Financial Officer of eternalHealth.

Tom comes to eternalHealth from a not-for-profit, member-centric, health insurance cooperative. He helped the company continuously strive toward its dual goals of thriving financially, while keeping members at the very epicenter of its mission and service model. While there, Tom also spearheaded the creation of a brand new private, charitable foundation, which will be meaningfully giving back to those in need in the surrounding communities for years to come. Previously, Tom worked in the finance department of a successful hospice that provided high-quality care to persons experiencing their unique and poignant end-of-life journeys, assuring that the appropriate financing was always available. Tom’s career began as a civil servant in the Wisconsin Medicaid program, where he helped to create a program that expanded the institutional entitlement to care into home and community-based settings. Starting with only a blueprint in hand, the program now serves more than 57,000 frail elders and disabled adults and is considered a national model. Growing into a senior leadership role, Tom was a key architect of an innovative financing model, through which the public and private sectors successfully collaborated to better the lives of persons in great need.

Tom holds undergraduate and graduate degrees from the University of Chicago, with additional graduate work in economics completed at the University Wisconsin-Madison.

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