We are excited to announce a significant update to the Community Health Plan of Washington (CHPW) Dual Special Needs Plan (D-SNP). In our ongoing commitment to provide exceptional care to our members, effective January 1, 2024, we are creating two separate Dual Eligible Special Needs Plans, Dual Complete and Dual Select, to better cater to the unique needs of our beneficiaries.
Dual Complete is designed for full dual-eligible individuals, including those covered under QMB+, SLMB+, CNP, and LCP-MNP. It offers an extensive range of benefits and services, designed to deliver comprehensive and personalized care.
Dual Select is for partial dual-eligible individuals, including those under QMB, SLMB, QI, and QDWI. It offers similar benefits and services, with some exceptions such as (Non-Emergency Medical Transportation, Grocery Allowances, and Over-The-Counter Allowances).
However, regardless of the plan our members are enrolled in, both Dual Complete and Dual Select plans provide the same level of care coordination, ensuring they receive the support and attention they need to maintain their health and well-being.
Your Role in Implementing these Changes.
As key members of the member care team, your understanding and communication of these changes are vital to ensuring a smooth transition for our members. Please continue to apply the knowledge and skills you acquired in your DSNP Model of Care training, emphasizing the benefits and care coordination that remain consistent in both plans.
Should you have any questions or require further clarification about these changes, please reach out to your point of contact within CHPW. We have also updated the Annual D-SNP Model of Care training for 2023 to reflect these changes.
|CHPW MA Plan/Benefit||Dual Complete* (HMO D-SNP)||Dual Select* (HMO D-SNP)|
|Monthly Premium||$0**||$0 – $40.60 (exact amount depends on level of Extra Help)|
|Part A | Inpatient Hospital||$0||$0 or 20%|
|Outpatient Hospital Observation||$0||$0 or 20%|
|Part B | Deductible||$0||Without full Medicaid cost-share assistance, deductible of $226 applies. This amount changes every year|
|Primary Care/Telehealth (per visit)||$0||$0 or 20%|
|Mental Health (per visit)||$0||$0 or 20%|
|Specialist Care/Telehealth (per visit)||$0||$0 or 20%|
|Urgent Care (per visit)||$0||$0 or 20%; $55 limit|
|Emergency Care (per visit)||$0||$0 or 20%; $100 limit|
|Ambulance (per service)||$0||$0 or 20%|
|Diabetic Supplies||$0||$0 or 20%|
|Vision Exams and Hardware †||$0 copay – 1 routine eye exam per year, $500 plan coverage limit every year for eyewear||$0 copay – 1 routine eye exam per year, $500 plan coverage limit every year for eyewear|
|Dental Services ‡||$5,000 for preventive and comprehensive services||$500 for preventive and comprehensive services|
|Health & Wellbeing||Combined total of 25 visits a year for acupuncture, naturopathy, chiropractic, and massage||Combined total of 25 visits a year for acupuncture, naturopathy, chiropractic, and massage|
|Fitness Program||Fitness kit, gym membership||Fitness kit, gym membership|
|Meals When You Need It Most||28 meals upon hospital discharge or positive COVID-19 diagnosis||28 meals upon hospital discharge or positive COVID-19 diagnosis|
|Over-the-Counter (OTC) & Grocery||$100 every month to spend on covered grocery and OTC items||Not covered|
|Hearing Aids, Exams and Fittings||$2,250 every year; $0 copay for exam & fitting||$2,250 every year; $0 copay for exam & fitting|
|Transportation||40 one-way trips (50-mile limit) per year||Not covered|
|Family on Demand||60 hours a year of personalized support and assistance||60 hours a year of personalized support and assistance|
|Part D | Deductible||$0||$0 – $545 (exact amount depends on level of Extra Help)|
|Part D Prescription||Generic Drugs: $0 | Brand Drugs: $0||Generic Drugs: $0 | Brand Drugs: $0|
† Benefits shown are in-network and administered by VSP. You have a number of options for frames and basic lenses within this benefit amount.
‡ Dental benefits are administered by Delta Dental of Washington. You must see a Delta Dental network dentist to receive coverage. To find the most current listing of Delta Dental PPO Plus Premier network dentists, visit deltadentalwa.com.
* Dual Complete and Dual Select plans offer added support for individuals who qualify for both Medicare Parts A and B and Apple Health (Medicaid) benefits. All cost sharing on these plans, including premiums, medical, and prescription drug costs, is based upon your level of Medicaid eligibility. If you are enrolled with the State or another plan for Medicaid benefits, Community Health Plan of Washington (CHPW) will help you resolve any billing issues. Under the Dual Complete plan, if you have full Dual status your doctor cannot bill you for cost sharing covered under your Medicaid benefits. Your doctor must accept our plan payment as payment-in-full or bill the correct Medicaid source.
** Your monthly plan premium of $40.60 is paid for as long as you qualify for 100% Low Income Subsidy (“Extra Help”).