Active Employees – PSHB Program

Coverage

• Services Provided by the Hospital

  Back

  Services Provided by the Hospital

  $0 copay

  for hospital stay.

  $10 copay

  for Urgent Care Centers.

  $10 copay

  for emergency room visits, when referred by TeleConsulta.

  $25 copay

  for emergency room.

  ×

  Next

• Outpatient Services

  Back

  Outpatient Services

  $0 copay

  per visit to a general practitioner at Salus clinics.

  $0 copay

  in preventive tests such as CBC, lipid panel, colorectal cancer test, bone density test, PSA test, routine women cancer tests. and routine breast exams..

  $0 copay

  X-rays, sonograms, MRI, MRA and CT Scans.

  $0 copay

  in immunizations.

  $1 copay

  per lab tests.

  $7.50 per office visit

  to a general doctor.

  $7.50 per office visit

  to a specialist and subspecialist doctor.

  20% coinsurance

  per diagnostic test, non-invasive heart exams.

  ×

  Next

• Physical, Occupational or Speech Therapies

  Back

  Physical, Occupational or Speech Therapies

  We cover up to 60 therapies per condition, for each type of therapy. Excess of therapies will be covered subject to a preauthorization according to medical necessity.

  $10 copay

  per therapy.

  ×

  Next

• Maternity Care

  Back

  Maternity Care

  Glucometer and blood pressure

  monitor for high-risk pregnancies.

  $0 copay

  per prenatal visits and postpartum visits^*

  Coordination

  for your breast pump^*

  In-home Support

  Help with tasks such as light cleaning and meal preparation

  • 16 hours postpartum (4 hours x 4 days)
  • 16 hours prenatal for high-risk pregnancies (4 hours x 4 days)

  ^* When you register in the Maternal Program

  ×

  Next

• Mental Health Services

  Back

  Mental Health Services

  $0 copay

  for inpatient or partial hospitalization.

  You pay $7.50

  per office visit to a psychiatrist, psychologist, and social workers.

  $0 copay

  in virtual visits with a psychologist through TeleConsulta MD.

  Contigo Professional Counseling

  The mental health program for Federal Employees aims to provide adequate care for mental health conditions and substance use, to help improve the overall health.

  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

  ×

  Next

• Preventive Services

  Back

  Preventive Services

  $0 copay

  for annual preventive checkup in our exclusive preventive care centers.

  • Get a ride to your best health: We offer 4 trips per year for your preventive care appointments at any of our 11 centers around the island, free of charge.

  NEW $0 copay

  • Thyroid test once a year, as part of your preventive services. Additional tests: $1 copay.
  • Prostate Specific Antigen (PSA) test once a year, as part of your preventive services. Additional tests: $1 copay.
  • Digital bilateral tomosynthesis screening.

  $0 copay

  in vaccines.

  ×

  Next

• Ambulance Services

  Back

  Ambulance Services

  Local ambulances

  are covered 100% through reimbursement.

  $0 copay

  for air ambulance, only in Puerto Rico and US Virgin Islands (USVI) up to $50,000 per ocurrence.

  ×

  Next

• Eyeglasses or Contact Lenses

  Back

  Eyeglasses or Contact Lenses

  Up to one (1) pair of eyeglasses or contact lenses a year for members up to age 21. Covered at 100% up to a maximum benefit of $109 by reimbursement.

  ×

  Next

• Prescription Drug Benefits

  Back

  Prescription Drug Benefits

  Copays with 30-day supply:

  Generic Drugs

  You pay $2 per unit or refill (30 days)

  • Except for Antihypertensives (medications known as ACE Inhibitors, ARBs and Direct Renin Inhibitors), Antidiabetics (excludes insulins), Ahtihyperlipidemics (includes only statins) which will have $0 copay.

  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 our specialty drug network.

  How to calculate how much you will pay for your medications?

  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.

  

  *Disclaimer

  These prices show the most current cost information. 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.

  How to access your patient portal

  Your prescription plan offers a range of features to help you with your medications. Sign in at your patient portal to access affordable pricing, and network pharmacy options. Review your coverage, deductible, and expenses, and set communication preferences to stay updated with your prescription plan.

  Access you patient portal

  LEARN MORE

  Flex 90 Program

  You can get a 90-day supply for certain maintenance drugs in our Program pharmacies. All you need is to ask your doctor for a prescription 90 days plus one (1) refill of your maintenance drugs.

  WHAT BENEFITS DOES THE 90 DAY SUPPLY OFFER?

  • You save time
  • You save on co-payments
  • You help improve how you manage your condition by having a greater supply of medications.
  • Generic Medications: $4 (90 days supply)
  • Preferred Brand Medications: $40 per repetition (90 days supply)
  • Non-Preferred Brand Drugs: 20% coinsurance or $60, whichever is greater, up to a maximum of $375 per refill (90-day supply)

  ×

  Next

• Basic Dental Coverage

  Back

  Basic Dental Coverage

  $0 copay

  for cleanings for children and adults (one (1) every six months)

  $0 copay

  for periapical and bitewings X-rays

  30% coinsurance

  for panoramic X-rays (one every 3 years)

  30% coinsurance

  for amalgam restorations, endodontics, extractions and mouth surgery

  ×

  Next

• Services in United States

  Back

  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 pre-authorized, 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.

  ×

  Next