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Triple-S Salud FEHB

Triple-S Salud has proudly worked for over 53 years, offering a great service to federal employees, annuitants, and their families. This Health Plan is offered and managed by Triple-S Salud. It offers local coverage to people residing in Puerto Rico (PR) and the US Virgin Islands (USVI). To learn more, please contact our Customer Service Call Center at 787-774-6081 or 1-800-716-6081, (toll free). TTY/TDD users should call 787-792-1370 or 1-866-215-1999. Our call center is available Monday thru Friday from 7:30 AM to 8:00 PM, Saturdays from 9:00 AM to 6:00 PM and Sundays from 11:00 AM to 5:00 PM – AST (Atlantic Standard Time).

Am I eligible for this plan?

Enrollment in this plan has limits. You must live or work in Puerto Rico or US Virgin Islands to enroll. Please check our Triple-S Salud Service Benefit Plan Brochure to learn more. For more about your premiums share, you must call your company or retirement agency. If you’d like to know more about these Health Benefits visit: https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/eligibility-for-health-benefits/

Types of Enrollment

  • Self Only – federal employee or annuitant only
  • Self plus One – federal employee or annuitant and one (1) eligible dependent
  • Self and family – federal employee or annuitant and two (2) or more eligible dependent

Eligible Dependents

  • Legally married couple (including same sex marriage).
  • Natural children, adopted and stepchildren are covered until their 26th birthday. It does not matter if they are married, studying, or working.
  • Children that cannot support themselves because of a mental or physical handicap that began before age 26.
  • Foster children are considered for coverage. This, only if the Employee or annuitant shows documents as proof of the regular and main support of the child. It must be approved by the employment or retiree agency.

Some benefits of this plan are:

  • You pay $0 for generic drugs
  • You pay $1 per lab tests
  • You pay $0 in benefits, such as:
    • Hospital stay
    • MRI and MRA
    • X-Rays
    • CT Scan
    • Breast exams
    • Exams to prevent illnesses
  • As a reward for carrying out the Health Risk Assessment (HRA), you will get an Exercise Kit. It has a backpack, a water bottle, a pedometer for counting your steps, wristband, and jump rope free!

Coverage

Services provided by the hospital

  • You pay $0 for hospital stay
  • You pay $25.00 for emergency room visits
  • You pay $10.00 for emergency room visits, when referred by Teleconsulta

Outpatient services

  • You pay $0 for preventive tests such as CBC, lipid panel, colorectal cancer test, tests for weak bones, PSA test, routine women cancer test, routine breast exams and shots for children and adults.
  • You pay $7.50 per office visit to a general doctor
  • You pay $10.00 per office visit to a specialist doctor
  • You pay $0 in X-rays, MRI, and MRA
  • You pay 20% for diagnostic test, non-invasive heart exams
  • You pay $0 for Gardasil and Cervarix shots

Physical, occupational or speech therapies

We cover up to 60 therapies per condition. We may offer coverage for therapies that go beyond the limit if we believe they are needed.

  • $10.00 per therapy

Pregnancy and Newborn Care

We cover maternity benefits, like visits during pregnancy and after giving birth.

  • You pay $10 per office visit
  • You pay $0 for delivery (natural birth or C-section)
  • You pay $0 for manual breast pump

Mental Health Services

  • You pay $0 for inpatient or partial hospitalization
  • You pay $7.50 per office visit to a psychiatrist, psychologist, and social workers

Mental Health, Total Health
The mental health program for Federal Employees aims to provide adequate care for mental health conditions and substance abuse, to help improve the overall health of the insured.

The program is available 24 hours a day and includes visits to a psychiatrist, social workers and psychologists, partial and regular hospitalization.

Call 1 (800) 660-4896 or coordinate services through the website: www.fhcsaludmental.com

Ambulance Services

  • Local ambulances are covered at a 100% through reimbursement
  • You pay $0 for air ambulance, only in Puerto Rico and US Virgin Islands.

Eyeglasses or contact lenses

One pair of eyeglasses or contact lenses a year for members up to age 21 from selected Network providers, you pay nothing up to the fee.

Prescription Drug Benefits

  • Generic Drugs: You pay $0 per unit or refill (30 days)
  • Preferred Brand Drugs: You pay $20 per unit or refill (30 days)
  • Non-Preferred Brand Name Drugs: You pay 20% or $20, whichever is higher, up to $125 per unit or refill (30 days)
  • Preferred Specialty Drugs: You pay 25% or $200, whichever is the lowest, per unit or refill. Only through certain specialty drug stores.
  • Non Preferred Specialty Drugs: You pay 30% or $300, whichever is the lowest, per unit or refill. Only through certain specialty drug stores.

Drug Cost Calculator

By using the Drug Cost Calculator you can see an estimate of how much you will pay for your covered medicine, and learn about the different treatments for you under your plan.

calculadora-eng

*Disclaimer
These prices show the most current cost information, but sometimes it will not necessarily be the same as the real cost. These estimated drug prices could change. There is an amount that the member must pay to get the medicine, and it depends on the pharmacy coverage.

This may mean a fixed amount or percentage of the price. It will be based on the rate of the plan for each prescription. To get the amount, the maximum number of day supply and what is normally dispensed is used. This is why it may not show the prescribed dose.

Flex 90 Program

Is a voluntary program that allows the member to get a 90-day supply of some medicines at retail drug stores that are part of the program. To get it, follow these steps:

1. Ask your doctor for a 90-day prescription plus one (1) refill of your medicines
2. Select a particular pharmacy from the Flex 90 Program
3. Ask your pharmacist for a 90-day amount

Basic Dental Coverage

This basic dental coverage offers you benefits such as:

  • You pay $0 for cleanings for children and adults (one (1) every six months)
  • You pay $0 for mouth and bitewings x-rays
  • You pay 30% for panoramic x rays (one (1) group every 3 years)
  • You pay 30% for amalgam restorations, endodontics, extractions and mouth surgery

Services in United States

We cover medical emergencies and pre-authorized services only. When you get covered services outside the area that are neither emergency nor preauthorized, we will pay back 90% of Triple-S Salud’s established fees, after any copay or coinsurance that applies. You are responsible up to the billed charges for these services.

Benefits 2017

Documents Size
Federal Policy (FEHB) 2017

Know the benefits and services that Triple-S Salud has for you.

235 KB 2017 FEHB Brochure.pdf
2,11 MB 2017 Drug List.pdf
Documents Available

We offer you details on Costs and Prevalence for Most Common Illnesses 2015, Procedure Range of Allowances 2015, Pre-authorization of medical services and information on appeals to the Office of Personnel Management

5,49 KB Costs and Prevalence for Most Common Illnesses 2015.pdf
4,08 KB Procedure Range of Allowances 2015.pdf
29,7 KB Preauthorize a medical service.pdf
SBC FEHB 2017

The Summary of Benefits and Coverage (SBC) is a document created by the National Association of Insurance Commissioners (NAIC) that will help consumers understand, compare and make better decisions about their health coverage.

298 KB SBC.pdf
139 KB Glossary of Common Terms.pdf
Health Capsules

We show you how to take care of your blood pressure and cholesterol, and how to detect health conditions on time, such as breast cancer.

524 KB Blood Pressure.ppsx
858 KB Cholesterol.pdf
162 KB Breast Cancer.pdf

Benefits 2016

Here you can read more about the various benefits provided by your Triple-S Salud coverage.

Documents Size
Federal Policy (FEHB) 2016

Know in detail the benefits and services that Triple-S Salud has for you.

809 KB 2016 FEHB BROCHURE.PDF
809 KB 2016 DRUG LIST.PDF
809 KB PHARMACY 2016.PDF
SBC FEHB 2016

The Summary of Benefits and Coverage (SBC) is a document created by the National Association of Insurance Commissioners (NAIC) that will help consumers understand, compare and make better decisions about their health coverage.

238 KB SBC.pdf
139 KB Glossary of Common Terms.pdf

Quarterly newsletters for federal retired employees

Triple-S Salud keeps you informed about important factors of your benefits, our services and preventive health so you may live a full and healthy life.

2016

Documents Size
What is the Health Risk Assessment?

Available questionnaire for federal insured with Triple-S Salud.

385 KB Download
Drug Coverage

Learn about your drug coverage in the FEHB 2016 Triple-S Salud policy.

87,3 KB Download
New benefits and changes for Federal Employess and Annuitants in Triple-S Salud FEHB (January)

In this newsletter you can read in detail the changes in new benefits on your FEHB Triple-S Salud.

219 KB Download

2015

Documents Size
Diabetes (December)

Know more in detail what diabetes is and how to treat it.

488 KB Download
Breast Cancer (October)

Know the risk factors, signs and symptoms, testing and treatment for breast cancer.

443 KB Download
Triple Blue Assistance: Our definition of Quality without Limits (July)

Innovative program designed to promote customer service at an unbeatable level.

329 KB Download
Facts About Hypertension (April)

Facts About Hypertension.

736 KB Download
New benefits and changes for Federal Employees and Annuitants in Triple-S Salud FEHB (January)

In this newsletter you can read in detail the changes in new benefits on your FEHB Triple-S Salud 2015 policy.

234 KB Download

2012

Documents Size
Coordination of Benefits (October)

Method used by health insurance plans in order to determined the payment of a claim when you have more than one plan in your family.

299 KB Download

Triple-S Salud Supplementary
Dental Plan (FEDVIP)

Triple-S Salud offers a supplementary plan under the Federal Employee Dental and Vision Insurance Program (FEDVIP) which is a different program from the Federal Employee Health Benefits (FEHB). This additional plan provides a broad coverage for your dental needs. The service area is Puerto Rico. If you need help or have questions about your coverage, please call 787-774-6081 or 1-800-716-6081, (toll free). TTY/TDD users should call 787-792-1370 or 1-866-215-1999. Our call center is available Monday thru Friday from 7:30 AM to 8:00 PM, Saturdays from 9:00 AM to 6:00 PM and Sundays from 11:00 AM to 5:00 PM – AST (Atlantic Standard Time).

To find out if you can apply, go to: www.BENEFEDS.com. You can also call 1-877-888-FEDS (1-877-888-3337) or TTY 1-877-TTY-5680 (1-877-889-5680) Monday thru Friday from 8:00 AM to 9:00 PM. If you do not have a phone on hand, talk to your employing office or retirement system for guidance on how to sign up.

This dental health plan is not part of the FEHB Program.

Can I Apply?

If you are a Federal employee or annuitant, you can. You do not need to register for the FEHB Program or a Health Insurance Marketplace (Exchange) plan.

Registration

  • Self Only – federal employee or annuitant
  • Self plus One – federal employee or annuitant and 1 eligible dependent
  • Self and Family – federal employee or annuitant and 2 or more eligible dependents

Eligible Dependents

  • Legally married spouse. This includes same sex marriage.
  • Single children, adopted and stepchildren under 22.
  • Children who cannot support themselves due to a mental or physical disability. It must have begun before they were 22.
  • Foster children, if the employee or annuitant can prove enough support of the child. The employer or annuitant’s agency must approve it.

Some benefits:

You pay $0 for Class A (Basic) Services. This includes:

Oral checks, cleanings, tests that show images of the mouth, coating used to protect teeth, and more.

You pay 30% of the total for Class B (Intermediate) Services. This includes:

Procedures to strengthen, crowns, deep cleanings, denture adjustments, tooth pulling, and more.

You pay 60% of the total for Class C (Major) Services. This includes:

Care for the interior of the tooth and other parts of the mouth, and services such as crowns, dentures, and bridges. For some major care, you will pay 30% of the total cost.

Class D Services (Braces) covered at 50% through refund

It covers up to $2,000 per member per lifetime. If you are a new member, you must wait 12 months to get services, but there is no age limit.

Benefits 2017

Documents Size
2017 FEDVIP Brochure

861 KB Download
Supplementary Dental Plan Summary

970 KB Download


Benefits 2016

Documents Size
2016 FEDVIP Brochure

647 KB Download


787-277-6653 787-474-6326