Care Management Form Submission

Captive Health has partnered with your company to provide care management support for chronic health conditions. This support helps employees and spouses enrolled in the health plan to close gaps in healthcare needs. Eligibility for this program is based on having been diagnosed with specific health concerns or chronic conditions.

If you have an active diagnosis (with the last 24 months) of Hypertension (High Blood Pressure), Hyperlipidemia (High Cholesterol), or Diabetes you will be asked to submit proof of routine maintenance care for these conditions. Further definitions for each diagnosis can be found below:

  • Hypertension: Confirmed diagnosis of hypertension through medical or pharmacy claims in the past 24 months. Excludes hypertensive disease complicating pregnancy, childbirth, and puerperium. Excludes hypertension involving vessels of the brain and eye.
  • Hyperlipidemia: Confirmed diagnosis of hypertension through medical or pharmacy claims in the past 24 months.
  • Diabetes: Confirmed diagnosis of diabetes mellitus Type 1& 2 as defined by active claims. Excludes gestational diabetes mellitus.