ELA Frequently Asked Questions

ELA

• 01. Who can I call if I have an emergency regarding my transplant case outside regular business hours?

  Global Medical Management (GMMI) provides telephone access 24 hours a day, 7 days a week. Their contact information is:

  Global Medical Management, Inc. (GMMI)

  • Toll-free number: 1-954-370-6404
  • Local area number: 1-800-682-6065
  • Fax: 1-954-370-8130
  • 800 SW 145th Avenue, Suite 400, Pembroke Pines, FL 33027
  • Email: moc.a1735263990summg1735263990@eciv1735263990resre1735263990motsu1735263990c1735263990
• 02. What is Global Medical Management (GMMI)?

  Global Medical Management (GMMI) is the company hired by Triple-S to provide management for its Organ Transplant insurance in Puerto Rico and the United States.

• 03. Who should I call with questions about my Organ Transplant coverage?

  You may call our Customer Service Department at 787-774-6070. Our service representatives will answer any question regarding your coverage.

• 04. Do I qualify for Organ and Tissue Transplant Insurance if I live outside Puerto Rico?

  Only permanent residents in Puerto Rico may qualify for Organ and Tissue Transplant insurance benefits.

• 05. What if Medicare is primary to my Organ and Tissue Transplant insurance policy?

  After your initial orientation, you should coordinate with Medicare and the specific facilities certified by Medicare to receive transplant services. You must also keep in touch with the case managers at Global Medical Management (GMMI) and let them know you will undergo a transplant procedure.

  This will help our case manager coordinate with the facility regarding service payments not covered by Medicare that would be covered under this insurance policy.

• 06. How are services covered under this insurance policy?

  After Global Medical Management (GMMI) precertifies the case, they will make arrangements with one or more of the participating facilities in the Transplant Network in and outside Puerto Rico. These services will be covered according to the fees negotiated with the facilities, subject to the coinsurance established in your selected coverage.

• 07. Is it necessary to precertify organ transplant services?

  Yes, all organ transplant services need to be precertified by Global Medical Management (GMMI) at every stage:

  • Pretransplant evaluation
  • Pretransplant
  • Transplant
  • Post-transplant
  • Retransplantation
• 08. Which documents should I submit in order to request any of the following changes to my contract?

  To add a spouse: Marriage Certificate
  To add a newborn: Birth Certificate
  To switch to Care Plus coverage: Medicare A and B card
  To cancel due to death: Death Certificate

• 09. What options do dependents have if they are no longer eligible for the plan?

  They may continue receiving services as long as they request to have their policy converted to an individual insurance plan.

• 10. What should I do if the main policyholder passes away?

  You should notify Triple-S Salud within 30 days after the date of death. Please remember to submit a Death Certificate or an equally valid document to the service representative handling the case.

  You may send the information by email to moc.r1735263990psss@1735263990etnei1735263990lclao1735263990icivr1735263990es1735263990, by fax to 787-706-2833, or by mail to:

  Service Management Division
  PO Box 363628
  San Juan PR 00936-3628.

• 11. How does Triple-S Salud determine if a service is considered experimental, investigative, or not medically necessary?

  Triple-S Salud abides by the definitions established the Federal Drug Administration (FDA), the Department of Human and Health Services (DHHS), and the Puerto Rico Department of Health, as well as the health care policies established by the Blue Cross and Blue Shield Association Technology Evaluation Center.

• 12. Can I combine the main policyholder’s contributions with those made by other dependents to make the insurance more affordable?

  Only the contributions made by the main policyholder and his or her spouse may be credited, if they are both eligible governmental employees as per Act No. 95. This act states that the employing agency shall be responsible for coordinating with Triple-S Salud. You may also fill out form SC1335. Please refer to your employer for more information.

• 13. What do I pay my premium?

  Your contributions to your health plan are deducted from your paycheck. If you are retired and have not yet begun receiving your pension, you shall pay the full amount directly to Triple-S Salud until you start receiving your pension. Then you should notify Triple-S Salud so we may begin invoicing the corresponding premium to the Retirement System.

• 14. Am I still covered if I retire or take leave without pay?

  If you resign, you could be eligible for coverage under a governmental retirement plan. Your coverage will remain uninterrupted under the contract, as long as you submit a new request through your retirement system within 30 days after retirement.

  If you take an unpaid leave, Act No. 95 states that the employing agency shall determine the start and end date of such leave of absence. Employees are entitled up to 12 months’ worth of their employer’s contribution, unless the leave of absence is granted under the Family and Medical Leave Act of 1993, which establishes a maximum contribution of 12 weeks.

• 15. Which dependents qualify for the Triple-S Salud Care Plus coverage? When can I request the change?

  Pensioners or retirees and their direct or optional dependents covered under Medicare Parts A and B, as stated by the federal Social Security Act, are eligible for this coverage.

  Pensioners or retirees may request a Triple-S Salud Care Plus (Model-C) coverage on their date of retirement, or at any time afterwards whenever he or she is eligible for coverage during the term of this contract. The coverage will become effective on the first day of the month after Triple-S Salud receives the request.

• 16. Does Triple-S Salud have a privacy policy?

  Triple-S Salud has established a privacy policy in order to comply with federal and state laws, which require us to maintain the privacy of your personal, financial, and health information.

• 17. How do I sign up to the Triple-S Salud website?

  For instructions on how to sign up to the Triple-S Salud website, please click the following link: How to Register .

  To sign up, you must complete the following steps:

  • Select from the available username options.
  • Fill out the entire form and click on CREATE MY ACCOUNT.
  • You will be redirected to the main page, where you will be able to log in.
• 18. What services are available on your website?
  • Access to your benefits
  • Information regarding health and wellness education programs
  • Provider Directory
  • Requests for card duplicates or to modify your mailing address
  • Online reimbursement requests
  • Explanation of Benefits (EOB)
  • Student Certification/Certificate of Valid Health Insurance
  • Health risk evaluations
  • Sending us questions or comments
• 19. Does Triple-S Salud provide services on holidays?

  Yes. You may visit us online to check our schedule notifications, which we post prior to every holiday in order to inform you which Service Centers and/or phone services will be available.

• 20. What are Triple-S Salud’s business hours?

  At Triple-S Salud, we are at your service, and we want you to be able to contact us as quickly as possible. To learn about our business hours, click on Service Centers.

• 21. Wich drugs are dispensed through the Triple-S Salud Pharmacy Mail Order Program?

  Certain maintenance drugs may be dispensed through this program.

• 22. What is the Mail Order Pharmacy Program?

  The Triple-S Salud Pharmacy Mail Order Program offers our beneficiaries a convenient and accessible option to receive prescriptions in the comfort of their own homes

• 23. What should I do to begin using the Triple-S Salud Pharmacy Mail Order Program services?

  You can get certain maintenance drugs through the mail, in the comfort of your home; up to a 90-day supply.

  HOW TO BEGIN USING THE SERVICES OF PHARMACY MAIL ORDER PROGRAM?
  Request your prescription drugs by mail in the following way:

  INTERNET
  • Signup in Walgreens.com/MailService.
  • From the page of confirmation of registration, follow the instructions to submit your recipe.

  E-MAIL
  • Complete the registration form included with your registration packet.
  • Send the form including the original prescription.

  TELEPHONE
  Call Customer Service Center at 1-866-560-5881 and have your information list.

  SEND THE PRESCRIPTION TO THE PHARMACY BY:
  • Facsimile
  • E-prescribe

  IF YOU NEED THE DRUG IMMEDIATELY
  Ask your doctor for two prescription, one for the first 30 days that you can fill it in your local pharmacy and other for 90 days with one refill for our mail order pharmacy to dispense.

  CONTACT INFORMATION
  Walgreens.com/MailService
  Telephones: 1 (800) 345-1985 (English), 1 (800) 778-5427
  TTY 1 (877) 220-6173 (Spanish)
  Fax: 1 (800) 332-9581
  Mail: PO Box 29061 Phoenix, AZ 85038-9061
  Opening Hours: 24 hours / 7 days a week

• 24. What is the 90 Days Extended Supply Program?

  This is a feature of the Pharmacy Program that allows you to receive a maintenance drug supply of up to 90 days from more than 1,050 participating pharmacies. Participating pharmacies include pharmacies in chains and independent community pharmacies.

• 25. What is the best way to help lower or maintain my pharmacy coverage costs?

  You should not lend your insurance card to anybody, and you should never ask your physician to issue prescriptions for somebody else. This not only increases costs, but it is also fraud. Follow your physician’s instructions when taking your medications, and do not stop using them just because your condition improves or you feel better. This will prevent further complications and relapses.

• 26. My coverage requires that the pharmacy dispense generic drugs as a first option. What if I decide to use a brand-name drug despite the existence of a generic equivalent in the market?

  If you decide to use a brand name drug for which there is a bio-equivalent, you will have to pay the pharmacy for the difference in cost between the two, plus the brand name drug’s copayment/coinsurance.

• 27. What are generic drugs?

  The word generic refers to the drug’s chemical name (its active ingredient). Once the exclusivity time period expires, other companies may manufacture the drug formula, but they cannot use the same name.

  Generic drugs have the following characteristics:

  • They have the same healing effect and work in the same way within the body
  • They have identical strength
  • They are identical in presentation (ex: pill form), although their color and shape may vary
  • They are administered the same way (ex: orally)
• 28. What are acute drugs?

  Acute drugs, such as antibiotics, are prescribed to treat non-recurring illnesses.

• 29. What are maintenance drugs?

  Maintenance drugs are used to treat life-long conditions, such as thyroid disease, hypertension, and diabetes, among others.

• 30. How can I know which are the organization’s relationship with other entities and how those relationship impact me as a member?

  You may contact our Customer Service Call Center to address your request. Customer Service Call Center is available Monday thru Friday from 7:30 AM to 8:00 PM, Saturday from 9:00 AM to 6:00 PM, and Sunday from 11:00 AM to 5:00 PM. You just need to call 787-774-6060 or 1-800-981-3241 (toll free)

• 31. What happens if my reached a cap?

  You may contact our Customer Service Call Center to address your options. Customer Service Call Center is available Monday thru Friday from 7:30 AM to 8:00 PM, Saturday from 9:00 AM to 6:00 PM, and Sunday from 11:00 AM to 5:00 PM. You just need to call 787-774-6060 or 1-800-981-3241 (toll free)