HOW DO I SIGN UP FOR VITAL?
Anyone who wants to see if they can sign up for Vital can visit their local Medicaid Office. They will look at the person’s information and tell them if they are eligible for Vital.
To find out where your Medicaid Office is, call the Medicaid Program call center at 787-641-4224. The call is free. Or visit www.medicaid.pr.gov.
WHAT IF I HAVE A NEWBORN?
If you have a newborn, visit your Medicaid Office and give them a copy of the newborn’s birth certificate to enroll the newborn in Vital. If you do not do this, the newborn cannot get services under Vital. When you have a newborn, you also might be able to get other benefits, so it is important to visit the Medicaid Office so they can check.
HOW DO I KEEP MY VITAL BENEFITS?
To keep your Vital benefits, you have to go to all your Medicaid appointments. Your Insurer will send you a letter 90 days, 60 days and 30 days before the day when your Vital benefits stop. These letters will remind you that you have to go to your local Medicaid Office to maintain your eligibility in Vital.
If you miss your appointment, call the Medicaid Program Call Center at 787-641-4224 or visit your local Medicaid Office to ask for a new appointment.
HOW DO I CHOOSE AN INSURER?
Once you sign up for Vital, you can choose your Insurer. Your Insurer will work with you and your doctors to keep you healthy.
There is an enrollment counselor available in Medicaid offices and on the phone who can help you choose an Insurer. The enrollment counselor does not work for any Insurer or any providers. They are neutral. They can give you information about Vital and your benefits. They can tell you about the choices available to you and help answer your questions. They can’t choose for you. They can help you:
- Choose a new Insurer or change Insurers
- If you change your Insurer, they can also help you change your Primary Care Physician (PCP) or Primary Medical Group.
You can contact the Enrollment Counselor for support:
There are Enrollment Counselor staff in each of the Medicaid Offices. The offices are open Monday through Friday from 7:30am to 4:00pm. Your Insurer can tell you the Medicaid Office that is closest to you.
If you do not choose an Insurer, one will be chosen for you.
CAN I CHANGE MY INSURER?
Yes, you can ask to change your Insurer. Once you have chosen an Insurer or one has been chosen for you, you have 90 days to change Insurers. You can also change your Insurer once a year during the “open enrollment period”, which is from November 1 to January 31.
If you want to change your Insurer, call the Enrollment Counselor at 1-833-253-7721 or visit your local Medicaid Office.
You can also ask to change your Insurer at any time if you have certain reasons, like:
- You are not able to access services or providers
- You cannot get all related services you need at one time from the doctors, healthcare professionals and service facilities that work with your Insurer.
- You get poor-quality care
- You ask for a service that your Insurer does not cover because of moral or religious reasons.
- Your Insurer does not have doctors that are experienced in dealing with your health care needs.
If you want to change your insurer for one of these reasons, you can ask for this change from the Insurer, the enrollment counselor or ASES. ASES will decide if you can change or if you have to wait until Open Enrollment. If you do not like the decision ASES makes, you can ask them to reconsider. If the decision is still not to your liking, you can ask for a hearing.
CAN MY MEMBERSHIP WITH MY INSURER STOP?
Yes, your membership with your Insurer will stop if you:
- Lose eligibility for Vital.
- Move outside of Puerto Rico.
- Go to prison.
- Give your ID card to someone else to use.
- Move to a long-term care nursing facility or intermediate care facility for the developmentally disabled.
You will not lose your membership with your Insurer if:
- You have changes in your health.
- You are using more health care services.
You also might want to stop your membership with your Insurer if you no longer need your Vital benefits. If this happens, let your Medicaid Office and your Insurer know.
HOW DO I REPORT CHANGES?
Vital and your Insurer are committed to helping you. To support your needs, we need your help.
Please remember to let your Medicaid Office and Insurer know of any changes that may affect your membership or benefits. Some examples include:
- You are pregnant
- You have a newborn
- You have changes in your family group (for example, you get married, someone in your family dies, and someone in your family reaches age 21).
- You move or your phone number changes
- You or one of your children has other health insurance
- You have a special medical condition
- You move outside of Puerto Rico
- Your income changes (for example, you lose your job or get a new job)
To report a change, call the Medicaid Program call center at 787-641-4224 or visit your local Medicaid Office.
It is important to make sure your contact information is up to date with your local Medicaid Office. This is important because Medicaid and your Insurer send you important information about your Vital coverage and benefits in the mail. If they don’t have your current address, you could lose your Vital benefits. To report a change, call your Insurer or visit your local Medicaid Office.
YOUR ID CARD
Everyone in Vital has an ID card. This is an example of what it looks like:
Each insured person in your family will have his/her own ID card, even if he/she is a newborn. Your ID card has important information like:
- Your ID number (MPI).
- How to access emergency services.
- Any money you will pay for health services.
- Your Insurer’s free of charges phone number (on the back of your card).
- The phone number for the free Vital Service Line and the free of charges 24/7 Vital Medical Advice Line (on the back of your card).
If you need to use your health benefits before you get your ID card, use your MA-10 form given to you by your Medicaid Office.
- Always carry your ID card with you.
- Keep your card in a safe place so you don’t lose it.
- Take your ID card when you go to the doctor or to the emergency room.
- Be sure they give you your ID card back.
Your ID card is only for you. Don’t let anyone else use your card. If your card is lost or stolen, you can ask your Insurer for a new card. You can visit your Insurer’s Service Centers or call them at 1-800-981-1352. The phone call is free.