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Triple-S ELA Universal Health Insurance

Triple-S ELA Universal Health Insurance

Who is eligible for this plan?

ELA Universal is a plan for government employees, retirees, and their direct and optional dependents, who during the established enrollment period join and/or renew their coverage.

Some benefits of this plan

  • $8 copay for General Practitioner office visits.
  • $10 copay for Specialist office visits.
  • Teleconsulta Program 24/7.
  • $0 copay for preventive services required by Federal Law, including services for children, women and adults.
  • One pair of eyeglasses from the Preferred collection or contact lenses up to a maximum of $150 per policy year, through Ivision International participating providers.
  • $0 Oral chemotherapy.
  • $7 copay for respiratory therapies.
  • Up to $1,000,000 per year, per member for Organ and Tissue transplant services through Major Medical coverage, subject to 20% coinsurance.
  • Dental coverage for exams, cleanings, extractions, endodontics and more.

Coverage of this plan

Hospital services

Triple-S Salud will provide hospitalization services, such as:

    Triple-S Salud will provide hospitalization services, such as:

    • Hospital admissions up to a maximum of 365 days.
    • Mental and Substance abuse hospitalizations.
    • Post-hospitalization services through a Skilled Nursing Facility.

Medical-surgical services during hospitalization

  • Services and consults by specialists, sub-specialists and surgeons.
  • Lithotripsy procedure (ESWL).
  • Invasive cardiovascular diagnostic procedures.
  • Surgical assistance.

Medical-ambulatory services

  • General Practitioner, Specialist and Subspecialist office visits.
  • Emergency room and Urgent Care room.
  • Preventive services and vaccines as required by the Federal Law.
  • Manipulations and physical therapy services, up to 20 therapies in combination, per policy year.
  • Respiratory, occupational and speech therapy services.
  • Laboratories and X-rays.
  • Ambulatory Surgery.

Specialized Diagnostic Tests

  • Non-Invasive Cardiovascular and vascular diagnostic procedures.
  • Magnetic resonance services, up to one per contract year.
  • Nuclear Medicine studies and SPECT.
  • Neurological studies.
  • PET/CT Scan, up to one per contract year.
  • Computerized tomography and sonograms.

Maternity

  • Pre and post-natal visits
  • Hospitalizations for natural or cesarean delivery
  • Production and interpretation of fetal monitoring
  • Biophysical Profile, one per pregnancy
  • Preventive care visits for newborns
  • Maternity services for the first born of dependent children

Services in the United States

Services for emergency cases in the United States through the Blue Card Program, as well as international destinations through the Blue Cross Blue Shield Global ® Core Program, covered under the Major Medical coverage.

Pharmacy

  • Coverage for Brand and Generic medications prescribed by a physician.
  • The maximum benefit of the drug coverage for the Universal plan will be $2,000 per contract year. After reaching the maximum top, a 40% coinsurance will apply when purchasing the medications.
  • FDA approved contraceptives required by the Federal Law and oral chemotherapy are covered 100%.

Dental services

  • Under the dental coverage all services will have a maximum benefit of $1,000 per contract year, except for diagnostic, preventive, restorative, extractions and endodontic services rendered to insureds under 19 years of age, as required by the Federal Law.
  • Dental coverage includes partial and complete dentures.

Additional benefits

  • Triple-S Natural Program for alternative therapies, including:
    • $15 copay per visit
    • Medical Acupuncture
    • Therapeutic Massage
    • Aromatherapy
    • Music therapy
  • Total Wellness Program focused in the prevention, early detection of illnesses and effective management of existing chronic conditions.
  • Nutritionist services.
  • Ground ambulance services, up to a maximum of $80.00 per trip.
  • Air ambulance services covered 100% in the service area, up to one service per year.
  • Durable Medical Equipment.

ELA Frequently Asked Questions

Documents Size 2019
Brochure

Promotional brochure that provides information about some of the covered benefits, such as, physicians visits, hospitalizations and the copays and/or coinsurances applicable to the services, pharmacy benefits and more.

3,37 MB Download
Drug List or Formulary

Your pharmacy coverage uses a Drug List or a Formulary that offers a wide selection of treatment options.

2,18 MB Download
Provider Directory

List of the Network's participating providers.

1,61 MB Download
Enrollment Form

Form for new enrollment or renewal of the health plan. Instructions to complete the form are included.

147 KB Download
Summary of Benefits

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

449 KB Download
Premiums Brochure

This document presents the established premiums for the active and retired government employee, approved by ASES.

1,58 MB Download
Ivision Brochure

Promotional brochure that provides information about the vision benefits and how the insured can receive the benefits.

320 KB Download
Ivision Provider Directory

Ivision International's participating providers list.

91,8 KB Download
*Documents Not available in English