Triple-S Salud (FEHB)

Know some of the benefits of your plan^*

• Preventive Services

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  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 immunizations.

  $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.

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• Prescription Drug Benefits

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  Prescription Drug Benefits

  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.

  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*.

  

  *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 DOES THE PROGRAM OFFER?

  • Save time and visits to the drugstore
  • Savings in copayments or coinsurances
  • Improve your life-long health problems with a higher supply on hand

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• Basic Dental Coverage

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  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

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• Medical Services and Diagnostics

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  Medical Services and Diagnostics

  $0 copay

  per visit to a general practitioner at Salus clinics

  $0 copay

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

  $7.50

  per office visit to a specialist and subspecialist doctor

  20% coinsurance

  coinsurance per diagnostic test, non-invasive heart exams

  $1 copay

  per lab tests

  $7.50

  per office visit to a general doctor

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• Physical, Occupational or Speech Therapies

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  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.

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• Mental Health Services

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  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

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• Maternity Care

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  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

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• Services in United States

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  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.

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