Neurological Support Sensory Kit

Carolina Complete Health members who are actively enrolled in Long Term Services and Supports (LTSS) and diagnosed with a developmental, intellectual or neurodegenerative disorder.

Eligibility

Carolina Complete Health members must be 18 years or older and have been diagnosed with a neurological disorder and enrolled in Long Term Services and Supports (LTSS). One kit per member per plan year (April 1 - March 31).

NEUROLOGICAL SUPPORT SENSORY KIT FORM

Are you currently enrolled in Carolina Complete Health's Long Term Services and Supports? Yes No

You must be enrolled in Carolina Complete Health's Long Term Services and Supports to request this Value-added Service.

If you need assistance, please contact Member Services at 1-833-552-3876 (TTY: 711).

Member Name * As it appears on your Carolina Complete Health Member ID card

Member ID Number * As it appears on your Carolina Complete Health Member ID card

Member Date of Birth *

Member Address * Must match address on file with Carolina Complete Health

City *

Zip Code * Must be 5 digits

Member Phone Number *

Member Email Address *