Compare and select the most convenient plan for you
TS Platinum 1 2019 |
TS Platinum 2 2019 |
TS Platinum 3 2019 |
TS 17 Metales Platinum 4 2019 |
TS Gold 1 2019 |
TS Gold 2 2019 |
TS Gold 3 2019 |
TS Acceso Óptimo 2019 |
TS Silver 2019 |
TS Bronze 2019 | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SALUS | PPN | PPO | ||||||||||
Basic Coverage |
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| Generalist | $0 SALUS/$5 | $0 SALUS/$5 | $0 SALUS/$10 | $0 SALUS/$5 | $0 SALUS/$10 | $0 SALUS/$10 | $0 SALUS/$10 | $0 | N/A | $18 | $0 SALUS/$10 | $0 SALUS/$10 |
| Specialist | $0 SALUS/$15 | $0 SALUS/$18 | $0 SALUS/$20 | $0 SALUS/$15 | $0 SALUS/$18 | $0 SALUS/$20 | $0 SALUS/$20 | $0 | $10 | $20 | $0 SALUS/$20 | $0 SALUS/$15 |
| SubSpecialist | $0 SALUS/$15 | $0 SALUS/$20 | $0 SALUS/$20 | $0 SALUS/$15 | $0 SALUS/$25 | $0 SALUS/$25 | $0 SALUS/$20 | $0 | $10 | $25 | $0 SALUS/$20 | $0 SALUS/$15 |
| Laboratory | 20% Selective/ 30% | 20% Selective/ 30% | 25% Selective | 25% Selective/ 35% | 40% Selective | 30% Selective/ 40% | 40% Selective | 30% | 35% Selective | N/A | 40% Selective | 50% Selective |
| X-Rays | $0 SALUS/ 20% Selective/ 30% | $0 SALUS/ 20% Selective/ 30% | $0 SALUS/ 25% Selective | $0 SALUS/ 25% Selective/ 35% | $0 SALUS/ 40% Selective | $0 SALUS/ 30% Selective/ 40% | $0 SALUS/ 40% Selective | $0 | 40% Selective | N/A | $0 SALUS/ 40% Selective | $0 SALUS/ 50% Selective |
| CT, MRI, Sonograms, PET CT and PET Scan | 20% Selective/ 30% | 20% Selective/ 30% | 30% Selective | 25% Selective/ 35% | 40% Selective | 45% Selective/ 55% | 40% Selective | 30% | 40% Selective | N/A | 50% Selective | 50% Selective |
| Urgent Care Services | $25 | $25 | $25 | $25 | $25 | $25 | $25 | $25 | $25 | $25 | $25 | $25 |
| Emergency Services | $25 Teleconsulta/$75 | $25 Teleconsulta/$50 | $50 Teleconsulta/$75 | $35 Teleconsulta/$50 | $50 Teleconsulta/$100 | 35% Teleconsulta/50% | $75 Teleconsulta/$100 | N/A | $50 Teleconsulta/$75 | $50 Teleconsulta/$75 | $50 Teleconsulta/$100 | 50% |
| Inpatient Services | Preferred: $75 Non Preferred: $200 | Preferred: $75 Non Preferred: $250 | Preferred: $75 Non Preferred: $300 | Preferred: $50 Non Preferred: $175 | Preferred: $100 Non Preferred: $350 | Preferred: $175 Non Preferred: $400 | Preferred: $200 Non Preferred: $350 | N/A | $100 | $400 | Preferred: $150 Non Preferred: $400 | Preferred: $200 Non Preferred: $600 |
| Services in the USA (emergency or precertified by Triple-S Salud) | 25% | 25% | 25% | 20% | 40% | 40% | 40% | N/A | N/A | 50% | 40% | 50% |
| Eyeglasses for members up to 21 years old | $0 | $0 | $0 | $0 | $0 | $0 | $0 | N/A | $0 | $0 | $0 | $0 |
| Eyeglasess or contact lenses for members over 21 years old (annual maximum benefit) | $100 | $100 | $100 | $100 | $75 | $75 | $75 | N/A | $75 | $75 | $50 | $50 |
Dental Coverage |
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| Diagnostic and Preventive | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | N/A | $0 | $0 | $0 |
Pharmacy Coverage |
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| Annual Deductible | N/A | N/A | N/A | N/A | N/A | N/A | N/A | $50 per person | $125 per person | N/A | ||
| First level of coverage | N/A | N/A | N/A | N/A | $1,750 per person | N/A | N/A | $800 per person | $800 per person | N/A | ||
| Preferred generic drugs | $5 | $5 | $5 | $5 | $5 | $5 | $5 | $5 | $5 | $5 | ||
| Non-preferred generic drugs | $15 | 20% | 30% | $15 | $20 | 35% | 50% | $25 | 40% | 95% | ||
| Preferred brand-name drugs | $30 | $20 | $15 | $30 | $30 | $50 | 50% | 40% | 25% | 95% | ||
| Non-preferred brand-name drugs | 30% | 20% | 30% | 30% | 30% | 40% | 50% | 50% | 40% | 95% | ||
| Preferred specialty products | 40% | 30% | 40% | 30% max. $500 | 40% | 50% | 50% | 50% | 70% | 95% | ||
| Non-preferred specialty products | 40% | 40% | 40% | 40% | 50% | 50% | 50% | 50% | 70% | 95% | ||
| Over-the-Counter Drugs (Triple-S Salud OTC Program) | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | ||
| Coinsurance after first level of coverage | N/A | N/A | N/A | N/A | 70% | N/A | N/A | 70% | 90% | N/A | ||
