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To address the spread of COVID-19, the federal government and the Puerto Rico Department of Health have taken steps to improve its detection and prevent its transmission.

The federal government established a program through which each household can order free tests. Currently, the third round of orders is available, so each household has up to sixteen (16) free tests. You can get your free at-home COVID-19 tests by filling out a simple request form at https://covidtests.gov.

Meanwhile, the Puerto Rico Department of Health has continued performing tests all over Puerto Rico, free of charge and without requiring a medical order. To find out where the tests are being administered, visit the Department of Health's social networks at https://www.facebook.com/desaludpr/ .

In addition, the federal government issued an order and specific guidelines to promote access to at-home COVID-19 tests. As of January 15, 2022, all of our members in commercial plans are entitled to have their (group or individual) health plan cover up to eight (8) at-home COVID-19 tests per month without copays or deductibles and without needing a medical order.

At the same time, Medicare beneficiaries with Part B coverage, starting April 4th, 2022 will have access to eight (8) at-home COVID-19 tests per month without copayment or deductibles and without prescription. In order to have access to this benefit, the member will have to present their Original Medicare card at one of the chain pharmacies that are participating in the program.

We urge anyone who exhibits symptoms or who has been exposed to COVID-19 to read this document and learn more about the process to acquire their at-home COVID-19 tests.

  1. Does the federal government's order (enacted on January 15, 2022) regarding the at-home tests apply to all member, including Vital plan beneficiaries?

    No. The order that went into effect on January 15, 2022 (on which this document provides guidance) only applies to those insured by group or individual commercial plans and to federal employees and their dependents. The rules for acquiring the COVID-19 tests under the Vital plan are not included in this document.

  2. If I have a Medicare Advantage plan, how can I get the at-home tests?

    Triple-S Advantage members have 2 alternatives to acquire their at-home COVID-19 tests:

    • Members will have access to up to eight (8) at-home COVID-19 tests by calendar month presenting their Original Medicare card (the blue, red and white card) at the prescription counter of one this pharmacies: Costco Pharmacy, CVS, Walgreens and Walmart.
    • Using your over-the-counter (OTC) benefit, if they have it available. At present, reimbursement will not apply. Any changes made to this process will be notified.
  3. Which at-home tests are covered under this federal order?

    All FDA-approved at-home tests will be covered under this order. Therefore, before acquiring your at-home test, it is important to confirm if it has been authorized. To check if the test you are about to acquire is covered, you may visit www.fda.gov, go to the In Vitro Diagnostics EUAs section, and search for the product in the Search space provided.
    You can also use this link: https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas-antigen-diagnostic-tests-sars-cov-2.

  4. In order to qualify for reimbursement, do the tests need to be purchased at an in-network pharmacy or can they be purchased at any store or online?

    The reimbursement protocol is only available for those insured by a commercial plan, either Triple-S Directo or through your employer. The at-home tests that qualify for reimbursement may be purchased at pharmacies, stores, and online. The amount paid for FDA-approved at-home tests to be used by the member due to COVID-19 symptoms or exposure will be reimbursed. At-home tests used for employment purposes or for uninsured persons will not be covered. We also recommend that you verify the seller's legitimacy and that the tests have not been altered or expired.

  5. How many tests does the plan cover?

    Up to eight (8) tests are covered per month, per person insured by the plan. It is important to note that the coverage is per test, not per package. In other words, if the package contains two (2) tests, you have acquired two (2) from a maximum of eight (8) tests per month.

  6. Do I need a medical order to buy the at-home COVID-19 test?

    No. The eight (8) at-home COVID-19 tests covered per month under the federal order may be purchased without a medical order.

  7. How will Triple-S cover the cost of my at-home tests?

    Currently, the process is:

    • If you are insured by a commercial plan, either Triple-S Directo or through your employer, you will need to pay for the test and then submit the required documents established in the reimbursement document to Triple-S.
    • If you are a Triple-S Advantage member you can present your Original Medicare card at one of the participant pharmacies of the federal program to acquire up to eight (8) tests at no cost. In addition, if you your OTC benefit is available you may use your over-the-counter (OTC) benefit to acquire the at-home tests either at network pharmacies or through the Triple-S en casa service. At present, reimbursement will not apply.

    Any changes made to this process will be notified

  8. Which documents should I submit to get a reimbursement for the tests? How do I submit these documents?

    To request a reimbursement from Triple-S, you need to completely fill out the “Request for Reimbursement of Medical Expenses by Subscriber” form. You may access it through the following link: https://salud.grupotriples.com/en/insured-forms/. You must include the member's contract number and information and the bar code numbers on the package, as well as the reason for purchasing the test, and sign it. Remember that in order to be refundable, diagnostic tests must be intended to detect a COVID-19 infection due to the presence of any symptom associated with the virus or in cases of exposure (with or without symptoms),without the need to visit a clinical laboratory.

    The request must include proof of purchase indicating the date of purchase of the specific test, storename, quantity, and price. You may send your refund request to:

    • Triple-S Service Centers all around the island
    • By mail to:
      Triple-S Salud
      Departamento de Reembolsos
      PO Box 363628
      San Juan PR 00936-3628

  9. How long do I have in order to submit the refund request? How long does it take to be processed?

    Refund requests must be received within 12 months from the date of purchase. Once Triple-S receives the complete information and verifies if the product qualifies for reimbursement, the request will be processed within the following 15 days. By regulation, the payment should not take more than 30 days from the date when the request was received, as long as the required information was received in full.

  10. Is there a price limit for the at-home test to be reimbursed?

    Currently, the reimbursement will be the total cost paid for the test, including IVU. Any changes that arise will be notified.

  11. If I bought the tests before January 15, will I be reimbursed for the cost?

    No. Only FDA-approved at-home tests purchased on or after January 15, 2022 (when the federal order was enacted) are covered.

  12. If I have Medicare parts A and B and I bought tests beforte the April 4th, will I be reimbursed for the cost?

    No. Only test acquire at the participant pharmacies with the Original Medicare card starting April 4th, 2022 will be covered.

  13. Is there a time limit for this benefit?

    The federal order establishes that this benefit will be available for the duration of the declared emergency or until there is a change in the order. We will keep you updated and notify you of any changes, if necessary.

  14. Will my plan cover laboratory COVID-19 tests even if I have an at-home test?

    Yes. As long as you have a medical order and it is for a medical reason, the plan will cover laboratory COVID-19 tests without copayment or coinsurance.

  15. Can I transfer the tests I acquired under the plan to someone not covered under my health plan?

    No. Your health plan benefits are only for you. This would be a misuse of the plan and may be considered fraud.

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