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02. How safe is it to sign up on your site?

Triple-S Salud uses the most advanced security systems to provide you with the highest level of security. Our websites are protected by firewalls, as well as encryption and monitoring systems.


01. What should I do if I cannot log into my account or sign up on the site?

If you are having trouble signing up on our website or accessing your account, please refer to the registration handbook. You may also write to us by clicking on Contact Us. In order to expedite the process, please include the email you used to sign up and your contract number in your message. Our Customer Service representatives will be happy to assist you.


03. How can I ensure an optimum display of the Triple-S website?

To display the website correctly on Windows®, you should use browsers like Internet Explorer® (version 10 or higher), Google Chrome™, or Firefox®.


05. Which services can I access from my iPhone or Android?

  • Provider Directory
  • Payments and Account Statements
  • Coverages, Copayments, and Coinsurance
  • Your Card is Always with You – a digital image of your plan ID card, available to email it to your physician
  • Service Usage Report
  • Choose Your Health Plan
  • Contact Us

04. How do I access the site from my iPhone or Android?

You can download our mobile application at the iPhone App Store or Google Play for Android.


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)


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 servicioalcliente@ssspr.com, 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.


06. How do I find physicians, dentists, or service providers that accepts Triple-S Salud?

Our website’s modern search engine allows you to access your preferred physician’s information. Access our Provider Directory to find the information you need.

How to perform a search:  You may search by physician’s first or last name, full name, municipality, or specialization. The more information you provide, the more accurate the results will be.

What information will I find? Your search results will display the following information: physician’s name, specialization, street address, and phone number. You will also be able to see the physician’s ratings and add your own review.

You may also access additional provider directories, including the BlueCard Program Doctor and Hospital Finder.


07. How do I request to have my contract cancelled?

If you are the main policyholder of a Triple-S Directo Oro, Triple-S Directo Plata, or Triple-S Directo Bronce plan, you will need to sign and submit a written request. The request must include the desired date of cancellation and the contract number. All cancellations will be effective one month after you submit the request. Cancellations will not be made retroactively. You may send your written request by email to controldoc@ssspr.com, or by fax to 787-706-2833.

Please note that this only applies to the cancellation of individual contracts. If you belong to a group policy, you should ask the group administrator or refer to your benefits certificate, as you may have to submit your request through your group administrator. For more information, click on Contact Us.


08. What are the terms of coverage for medical and hospital services for students in the United States?

Medical and hospital services for registered full-time students in the US do not usually require precertification. However, the terms for deductibles and copayments may vary according to the selected group coverage.

To learn more about your payment terms, please contact our Call Center at 787-774-6060 or 1-800-981-3241 (toll free). We are 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.


09. How do I report my child as a full-time student in the United States?

To identify and register a dependent as a full-time college student in the US, you must submit an official copy of the certification of studies or evidence of the dependent’s enrollment at the university or academic institution for each semester. Otherwise, your claim payments for rendered services could be affected. Please remember to include the dependent’s contract number.
You may send the information by email to servicioalcliente@ssspr.com, by fax to 787-706-2833, or by mail to:

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


10. When can I add or cancel dependents?

The general enrollment rule states that you may only add or cancel dependents during the policy renewal period, and you should provide evidence of the relationship with your direct dependent in the contract. You will have thirty (30) days after qualifying events, such as marriage, birth, or others, to notify a change in your registered dependents. These changes shall be effective one month after we receive your request, except in the case of newborns, who will be covered from the date of birth.

If you have a Triple-S Directo Oro, Triple-S Directo Plata, Triple-S Directo Bronce, or ELA plan, you will need to fill out the procedure form or send a written request. You may send the information by email to servicioalcliente@ssspr.com, by fax to 787-706-2833, or by mail to:

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

For more information, or to learn more about the documents needed to process your request, click here.

If you belong to a group policy, please refer to your benefits certificate to verify the dependent’s eligibility, as you may be required to submit the request through your group administrator.

Please note you may also visit our Service Centers throughout the Island or Contact Us to obtain more information.


11. Where can I find information about benefits, inclusions, and cancellations as a Federal Government employee or retiree?

If you are a Federal Government employee or retiree, click here for more details about benefits and services. To access the page of the Office of Personnel Management (OPM), click here.


12. How do I request a service reimbursement?

You must include your payment receipts with your reimbursement request. Make sure to fill out the entire form to avoid any delays in the review process. You may:

  • Submit your reimbursement request online by clicking here. To obtain basic instructions or assistance to fill out the form, please click here.
  • You may print, fill out, and send the reimbursement request form, including your payment receipts, for medical or dental services via:
    • Email: servicioalcliente@ssspr.com
    • Fax: 787-706-2833, to the attention of the Reimbursement Department or Dental Reimbursement Department (as applicable)
    • By mail:

Triple-S Salud

Reimbursement Department or Dental Reimbursement Department (as applicable)

PO Box 363628

San Juan PR 00936-3628


13. How can I make my insurance payments?

Automatic Payments – We can automatically deduct your health insurance premium from your checking account, savings account, or credit card. To download an Automatic Payment Request form, click here.

Online Payments – If you are already a registered member in our website (Sign Up), you may issue your insurance payments via: the Triple-S Salud Mobile App, your checking or savings account, VISA, MasterCard, American Express, or Banco Popular debit card. If you need help making online payments, click here.

Bank Branches – You may also make your payments at any Banco Popular de Puerto Rico, Banco Santander, First Bank, or Oriental Group branch. Please remember to bring your payment slip.

Triple-S Service Centers – Plaza Carolina, Plaza Las Américas, Arecibo, Mayagüez, Ponce, Caguas, and Central Offices.


14. How do I request a student or coverage certification?

  • Our website – If you are a registered member, click here to obtain it. If you haven’t signed up yet, click here to start using our available online services.
  • You may also request these certifications by clicking on Contact Us.
  • You may also contact our Call Center, 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).

15. How do I request a card duplicate?

You may request a duplicate via:

  • Our website – click here to send a request and start using our available online services.
  • The Contact Us section in our website.
  • The Your Card is Always with You feature in our mobile app lets you store an image of your member ID card so you can instantly email it to your physician.
  • Our Telexpreso system; or you may contact our Call Center, 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).

16. Where can I find information about your individual products and how to acquire them?

The following products are currently available: Triple-S Directo Oro, Triple-S Directo Plata, and Triple-S Directo Bronce. We also have a Drug Discount Card, which offers savings of up to 38% on pharmaceuticals. You must be enrolled in one of our individual insurance plans in order to apply for this card.

Click here for more information about our individual insurance plans. To speak with one of our authorized agents, please call 787-792-2226, Monday thru Friday, from 8:00 AM a 5:00 PM. During weekends and holidays, please email us at servicioalcliente@ssspr.com, or you may leave a message, and we will get back to you the following business day.