Scott & White Health Plan

Best Available Evidence for Low Income Subsidy Beneficiaries

In accordance with the statutory requirement to provide a cost-sharing subsidy to Part D eligible individuals who are full-benefit dual eligible individuals or recipients of supplemental security income (SSI), Scott and White Health Plan (SWHP) must provide access to Part D drugs at the correct LIS cost-sharing level when presented with evidence of LIS eligibility, even if the sponsor’s systems and CMS’ systems do not yet reflect that eligibility. SWHP also must update our own systems to reflect the LIS status indicated by the best available evidence and, if necessary, must submit a request to CMS so that, for the deemed population, the agency’s systems can be updated as well. These requirements apply to all beneficiaries who are “deemed” subsidy eligible (including full benefit Medicare/ Medicaid eligibles, partial dual eligibles, and people receiving SSI) as well as those who must apply and are awarded LIS by the Social Security Administration (SSA).

For more information and to see what forms of documentation is needed for evidence of low-income status, please visit "Best Available Evidence" on the CMS website or contact Scott & White Prescription Services Customer Call Center at 1-800-728-7947, Monday – Sunday, 8:00am – 8:00pm CST or TTY/TDD users call 1-800-735-2989.

The above information is current as of October 2010.

"Medicare-Approved HMO"  

H4564_SC_WEB_BAE_2011_REV_122010  CMS Approved 02/08/2011