Triple-S Salud
(FEHB)

• $0 for hospital stay
• $10 copay for Urgent Care Centers
• $10 copay for emergency room visits, when referred by TeleConsulta
• $25 copay for emergency room

• $0 copay for visits to a general practitioner at Salus clinics
• $0 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.
• $0 copay X-rays, MRI, and MRA
• $0 copay in immunizations
• $7.50 per office visit to a general doctor
• $7.50 per office visit to a specialist and subspecialist doctor
• 20% coinsurance for diagnostic test, non-invasive heart exams

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

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

• $0 for bilateral electric breast pump
• $0 for delivery (natural birth or C-section)
• When you register for our Contigo Mamá program during the first trimester:
  • $0 copay for prenatal visits and now post-natal visits

New for 2023

• Services for high-risk pregnancies
• Prenatal in-home support up to 16 hours, maximum four hours per day
• Blood Pressure Monitor
• Glucometer

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

• 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 policy year.

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.

• 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*.

*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

This basic dental coverage offers you benefits such as:

• $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 (1) group every 3 years)
• 30% coinsurance for amalgam restorations, endodontics, extractions and mouth surgery

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.