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Do you qualify for a C-SNP plan?

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.