Triple-S Salud HMO medical plan

If you’re a Mountaineer based in Puerto Rico, you’re eligible for the Triple-S Salud HMO Medical Plan. Take care of your physical, mental, and emotional health with the available resources and tools. Read below to know how your plan works and all the available services.

Your costs for the Triple-S plan can be found below and within the enrollment experience.

To enable healthy lives, Triple-S takes care of your physical, mental, and emotional health. As a member, you are well cared for, from prevention to care for a health condition or possible hospitalization.

Triple-S plan summary

Below is a summary of the Triple-S medical plan. For complete information and details, click here.

Manage your care online with the Triple-S portal

Manage your health and that of your loved ones through the Triple-S Portal. Here, you can view your history of medical visits, emergency room visits, hospitalizations, medications, and existing conditions. If you wish, you can share your medical information with family members or caregivers.

In addition, you can request coverage certificate, ID card duplicates, process reimbursements, and manage dependents, among other things. You have access to your personal information and that of your underage dependents.

You can also check if a prescription is covered and your copayment before going to the pharmacy.

Eligibility: All Triple-S plan members

Get started: Register at ssspr.com

• Triple-S Salud HMO plan details

  Contact

  For assistance, contact the Service Call Center.

  787-774-6060

  Toll Free: 800-981-3241

  (TTY / TDD) 787-792-1370

  Toll Free TTY / TDD: 866-215-1999

  MEDICAL
  Maximum out of pocket for medical, pharmacy, and hospital services given by participating providers* *Non-essential benefits, services not covered or given by providers outside our network aren't eligible for the accumulation of maximum out of pocket.	$6,350 Individual $12,700 Family
  Preventive Preventive services (including those for females) Preventive immunizations (vaccines) Immunizations (vaccines) for Respiratory Syncytial Virus Sterilization and vasectomy	No charge No charge 20% No charge
  Medical visits General practitioner Specialist (including psychologist and psychiatrist) Subspecialist Nutritionist Chiropractor TeleconsultaMD (virtual consults)	$10 $15 $15 $0, up to 6 visits per policy year $7 $10
  Tests Labs X-rays Specialized tests Allergy tests Lithotripsy	30% 30% 30% $0, up to 50 tests per policy year Ambulatory surgery copayment applies
  Ambulatory Ambulatory surgery	$75
  Therapy Physical therapy Chiropractor manipulations Respiratory therapy	$7, up to 20 therapies per policy year $7, up to 20 manipulations per policy year $7, up to 20 therapies per policy year
  Mental health Group therapy Collateral visits	$15 $15
  Emergency room Accident Illness Recommended by Teleconsulta Urgent care facility	No charge $50 No charge $25 Sick / $0 Accident
  Hospitalization Regular (including mental health) Partial (due to mental illness) Skilled nursing facility Surgical assistance	$75 Preferred Hospital / $150 Non-Preferred Hospital $35 Preferred Hospital / $75 Non-Preferred Hospital No charge 20%
  Other Home health care Durable medical equipment	25% 25%

  Key Terminology

  Coinsurance: Coinsurance is the amount you pay for care after you meet your deductible, and is generally a percentage of the total cost of care for specific services.

  Out-of-pocket maximum: The most you’ll pay in a given year for all covered health care expenses. After you or any other eligible family member pays this amount, your plan pays 100% for the rest of the calendar year. Or, after the family out-of-pocket maximum has been met, the Plan pays 100% for each eligible family member’s expenses.

• Pharmacy coverage

  Pharmacy Coverage
  Rule of Generic Mandatory Medication	If the insured chooses a brand-name drug for which a generic drug exists, the insured will pay the brand drug copay plus the difference between the cost of the brand.
  Generic medication	$10
  Preferred brand medication	$25
  Non-preferred brand medication	20%
  Preferred specialized medication	20%
  Non-preferred specialized medication	20%
  Oral chemotherapy drug	No charge
  90-day supply for maintenance medications (by mail or pharmacy)
  Generic medication	$20
  Preferred brand medication	$50
  Non-preferred brand medication	15%
  OTC medications (Triple-S specified list)	No charge

• Vision Coverage

  Vision
  Glasses or contact lenses Refraction exam	$100 per policy year 30%

• Dental coverage

  Dental
  Diagnostic and preventive services Restorative services Endodontics Oral surgery Periodontics Prostheses and crowns Orthodontics	No charge No charge 30% 30% 30%, maximum of $1,000 per policy year 50%, maximum of $1,000 per policy year 0%; maximum of $2,000 per lifetime

  Click here for details and definitions on deductibles and out-of-pocket limits.

• Your cost

  Please click here to view a chart of your biweekly paycheck cost.

  You can also review these FAQs on salary bands.