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Federal Employee Health Benefits (FEHB) Program

Federal Employee Health Benefits (FEHB) Program

Triple-S Salud has proudly worked for nearly 60 years, offering great service to federal employees, retirees, 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).

Find out your eligibility for health benefits

Contact us:

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 for this plan has limits. You must live and work in Puerto Rico or US Virgin Islands to enroll. Please verify our Triple-S Salud Service Benefit Plan Brochure to learn more. For more about your rates share, you must call your company or retirement agency. If you’d like to know more about the eligibility for 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 retiree only
  • Self plus One – federal employee or retiree and one (1) eligible dependent
  • Self and family – federal employee or retiree and two (2) or more eligible dependents

Eligible Dependents

  • Legally married spouse.
  • 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 the age of 26. It must be approved by the agency or OPM as it may apply.
  • Foster children are considered for coverage only if the employee or retiree shows documents as proof of the regular and main support of the child. It must be approved by the agency or OPM as it may apply.

Programs and Benefits

Federal Employee Health Benefits (FEHB) Program

Benefits that keep you healthy:

  • You pay $2 for generic drugs
  • You pay $1 per lab tests
  • You pay $0 in benefits, such as:
    • Hospital stays
    • MRI and MRA
    • X-Rays
    • CT Scan
    • Breast exams
    • Exams to prevent illnesses

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, for each type of therapy. Excess of therapies will be covered subject to a preauthorization according to medical necessity.

  • $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 use, 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 100% through reimbursement
  • You pay $0 for air ambulance, only in Puerto Rico and US Virgin Islands.

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.

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 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

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 PROGRAM ADVANTAGES OFFERS?

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

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 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.

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).