We have family health insurance plans to help you protect your family at affordable prices.
Grandchildren, godchildren and nieces and nephews are for loving and spoiling continuously. That’s why you wait for them every time they come home from school with their favorite snack in hand and give them ground beef because they dont like meatballs. Its important to protect these special little people you love so much and a health plan like Triple-S can do this. With this plan, they will be protected even when their mischievous and explorer spirits take over, which happens all the time when you have small children. Having a Triple S health plan gives you the peace of mind of knowing that they are protected when theres unusual silence in the house and you think they’re hiding something or up to something naughty.
With an individual Triple-S health plan, you guarantee them access to a network of over 10,000 doctors, hospitals and laboratories and you can also count on the TeleConsulta over-the-phone service with professional nurses available 24/7 to help you clarify your questions. Its very useful when there are children in the house, and even more so when theyre really young and cant yet communicate well what bothers them. All our plans include pharmacy coverage since children get sick very easily and since elderly people have to take certain medications consistently, and medicine can be expensive. We also cover vaccinations required by federal law to keep children healthy always.
In addition, for those responsible for seniors, our medical plans offer preventive tests with no copayments to make sure they are healthy for as long as possible.
Triple-S has been protecting more than 1.7 million Puerto Ricans for over 50 years. Check the list of necessary documents [link to checklist] to apply for their health insurance. You can also apply online to save time.
The family guardian plan covers:
- Professional Nurses available 24/7 through an over-the-phone service to clarify your medical questions
- Emergency room services in case that odd silence turns into a problem
- Pharmacy coverage for when they get sick
- Glasses (until they turn 21) for when you see them squinting their eyes while watching TV
- Vaccines as required by federal law to get them ready for school
Coverage of this plan
Hospital Services
- Semi-private room, 365 days a year
- Hospitalizations for mental conditions and substance abuse
- Skilled Nursing Facility (SNF) unit
Hospital Medical & Surgical Services
- Visits from physicians to hospitalized patients; specialist consultations and diagnostic services
- Skin, bone, and cornea transplants
- Surgery and anesthesia
- Extracorporeal Shock Wave Lithotripsy (ESWL) procedure
- Invasive cardiovascular tests and gastrointestinal endoscopies
Medical-Outpatient Services
- Unlimited visits to primary care physicians (PCP), specialists, and subspecialists
- Visits to podiatrists, optometrists, audiologists, and chiropractors
- Visits to the psychiatrist and psychologist; including group therapy and collateral visits for mental conditions and substance abuse
- Visits to a nutritionist, up to six per policy year
- Clinical laboratories and X-rays
- Outpatient surgery at the doctor’s office
- Home Health Care
- Emergency Room Services
- Ground ambulance services, up to $80 per case
- Preventive services and vaccines, as required by federal law
Specialized Diagnostic Tests
- Cardiovascular and vascular non-invasive tests
- Neurological tests
- Nuclear medicine tests
- Computed tomography and MRI, one test per anatomical region, per year
- Sonograms and SPECT
- Echocardiograms and electroencephalograms
- PET CT and PET Scan, one per year
Maternity
- Pre and Post-Natal visits
- Hospitalization costs for natural childbirth or cesarean section
- Biophysical profile, one per pregnancy, 50% coinsurance
- Production and interpretation of fetal monitoring
- Visits for preventive newborn care
Services in the United States
The Blue Card Program offers coverage for emergency care and for services that have been pre-certified by Triple-S Salud. You are responsible for the coinsurance corresponding to the benefit in the United States, according to the coverage you select.
Pharmacy
Brand and generic drugs as the first option from a list of medications. Except when there is no generic drug available in the market for a brand-named drug. If the insured chooses, or the physician prescribes, a brand-name drug when the generic drug is available in the market, the insured will pay the brand-name drug copayment / coinsurance and the difference between the brand-name drug and the generic.
Dental Services
Youre 100% covered with any of our dental plans, which offer diagnostic and preventive services. $0 copay for the following services:
- Initial comprehensive exam by generalist or specialist
- Routine periodic exams
- Emergency exam
- Individual periapical x-rays
- Bitewings x-rays
- Dental Prophylaxis (cleanings)
- Fluoride (topical) varnish application to children under age 5
- Topical Fluoride applications to children under age 19
- Topical fluoride applications only for adults with special conditions
Additional Benefits
- Triple-S Natural: Enjoy the benefits of alternative therapies, such as acupuncture, aromatherapy and naturopathic medicine, among others, for up to six visits.
- Glasses: One pair per policy year for those insured, until age 21
- Durable Medical Equipment
