Good Use of your Health Plan
Triple-S Salud
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
Imagen de la tarjeta
1
Contract Number: This number identifies you as a member of Triple-S.
2
Group Number: Number that identifies the group you belong to.
3
Effective Date: Date plan coverage begins. This information is important to your provider.
4
Coverage: The coverage you have is identified with letters.
Examples:
  • Basic = B
  • Dental = D
  • Complementary = Supp
  • Pharmacy = Ph
5
Copays and Coinsurance information: The part that you must pay for services covered.
6
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.
 
Mi Triple-S
 
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.
Triple-S en casa
Order and receive prescriptions and OTC at your home or anywhere you need, at no delivery charge.
TeleconsultaMD*
Virtual consultations with primary doctors and psychologists.
Mi Triple-S app
  • Access your digital medical id card
  • Make payments
  • Review history of services received
TeleConsulta 1.800.255.4375*
24/7 telephone health orientation by registered nurses.
*Consult your policy to verify if your plan offers the benefit.
CONTACT US
Customer Service 787-774-6060
Service Centers Carolina, San Juan, Ponce, Mayaguez, Arecibo and Caguas
Internet Portal ssspr.com
© Triple-S Salud 2023
Triple-S Salud, Inc. cumple con las leyes federales aplicables de derechos civiles y no discrimina en base a raza, color, origen de nacionalidad, edad, discapacidad, o sexo. Triple-S Salud, Inc. complies with applicable federal civil rights laws and does not discriminate because of race, color, national origin, age, disability, or sex. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 787-774-6060, (TTY/TDD), 787-792-1370 or 1-866-215-1999. Free of charge 1-800-981-3241. If you are a federal employee or retiree call 787-774-6081, Toll Free 1-800-716-6081; (TTY / TDD) 787-792-1370; Toll-Free 1-866-215-1999 ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística llame al 787-774-6060, Libre de costo 1-800-981-3241. (TTY/TDD) al 787-792-1370 o 1-866-215-1999. Si es empleado o retirado federal llame al 787-774-6081, libre de costo 1-800-716-6081; (TTY / TDD) 787-792-1370; libre de costo 1-866-215-1999. Concesionario independiente de BlueCross BlueShield Association. Triple-S Salud contracts with other organizations (or vendors, or entities) to perform certain health services such as, Pharmacy Benefit Manager (i.e., manage prescription drug benefits, developing and maintaining the formulary, contracting with pharmacies and processing and paying prescriptions drug claims), Mental Health Benefit Administrator for utilization management, care management, intensive case management, Vision Benefit Administrator and a Nurse Advice Line Call Center available 24/7, the 365 days of the year to enable nurses to assess a member’s level of health risk and case management among others. For more information regarding these organizations and how they impact you, you may contact customer service via any of the available service channels. You should consult your policy to verify your plan coverage and if there are any benefit caps. You may request information regarding your benefits and your options in case you have reached the CAP by contacting customer service via any of the available service channels. TSS-MKT-4985-2023-B