Good Use of your Health Plan

This guide will help you make good use of your health plan and maximize the benefits you have as a Triple-S Salud member. Our commitment is to offer you and your family programs and innovative services for your health care and well-being.

Know your id card

Contract Number: This number identifies you as a member of Triple-S.
Group Number: Number that identifies the group you belong to.
Effective Date: Date plan coverage begins. This information is important to your provider.
Coverage: The coverage you have is identified with letters.
Examples:
- Basic = B
  Dental = D
  Complementary = Supp
  Pharmacy = Ph
Copays and Coinsurance information: The part that you must pay for services covered.
Maximum Out-of-Pocket expenses (MOOP): Maximum amount you need to pay for covered services in a policy year. After paying that amount in deductibles, copayments and coinsurances, the health plan will pay 100% of costs for covered services.

Get to know your coverage, benefits, copays and coinsurance

Your plan pays 100% of the preventive services that will help you stay healthy. Plus it will share part of the costs of the health care services you receive as a member. Learn the terms to better understand your coverage, and everything that has to do with paying for the medical services received.

Coinsurance: The amount you pay for covered services. Example: If your plan says you need to pay 25% for clinical laboratory tests, you pay $12.50 (25%) for a lab test that costs $50.

Deductible: The initial fixed amount you need to pay for covered services before your health plan starts paying.

Copay: A fixed amount (for example $15) you pay for the medical services covered, generally at the time you receive them. The amount may change by type of service.

Additional charges: If your plan does not cover certain services, or these are not reimbursable based on your type of policy, you will need to pay for them.

Get your preventive routine tests done, according to your age and genre.

They promote the health and well-being of all plan members. (21 years and older).
Only one visit a year and no copays in most tests.
Detect health conditions in time.
Facilities available at the centers to get your laboratories and diagnostic tests done.

Have a primary doctor you trust

A primary physician is the first step to an integrated medical care. This includes family medicine, general medicine, internal medicine, or general pediatrics. Primary physicians can offer you preventive, chronic, or acute care.

Make good use of your medications and comply with your maintenance therapy.

Avoid returning to your doctor for a prescription and pay again the corresponding copayment or visit an emergency room for misusing a medication.

When you are prescribed medications ask:

How to take your medicines
Possible side effects
Storage
Treatment term
Follow as recommended. Do not discontinue treatment if you feel better.
Check your medicine cabinet, you may have taken the prescribed medication before. Verify the expiration date.
Never lend your plan id card, or request prescriptions for others.
Use OTC medications when possible. It is a great option with the benefit of a lower cost in your therapy. $0 copay (according to OTC list)

Identify when to visit an urgent care facility vs. an emergency room

Visit an urgent care facility when you need medical attention, but your life is not at risk.

$Urgent Care: Cough, Dehydration, Sprain or minor fracture, Headache or dizziness, Bronchitis, Ear infection, Nausea, or Indigestion$

Emergency room: High fever, Broken bones, Chest pain, Hemorrhage, Asthma, Vision loss, Convulsions, or loss of consciousness

Many emergencies can be prevented by maintaining healthy lifestyles.

Preventive Care Centers, Urgent Care Centers and Salus Clinics

Visit an emergency room when you need medical attention but your life is not in danger.

Salus, Urgent Care Centers, Preventive Care Centers

Take advantage of technology to have access to your health care anywhere.

Go to mitriples.com to access your information and that of your minor dependents. You will be able to see clinical information, list of medications, provider directory, receive preventive care alerts, health articles, and share medical information with family members. You can also complete the Health Risk Assessment (HRA) and education modules.