Do you qualify for a C-SNP?

Check your state below. If you have one of the health conditions listed for your state — and you live in a county where we offer a C-SNP — you qualify. 

Tennessee, Texas

• Diabetes

Arizona

• Diabetes
• Congestive heart failure
• A qualifying cardiovascular condition:
  Swelling in your legs or fluid in your lungs due to a heart problem
  Cardiac arrhythmia
  Atrial fibrillation
  Coronary artery disease
  Peripheral vascular disease
  Frequent or recurrent blood clots
  Heart attack
  Valvular heart disease

How to join a C-SNP

Return this completed form with your plan application and we’ll enroll you in our C-SNP. Within 30 days of your plan’s start date, we’ll use the form to verify your chronic condition with your doctor.

If we don't get a completed form from you — including a completed last page with your doctor’s signature — we’ll have to disenroll you and you’ll need to join a new plan. Be sure to fill out this form completely and accurately so we have all the information we need.