How do I sign up for the Government Health Plan Vital?

HOW DO I SIGN UP FOR PLAN VITAL?

Anyone who wants to know if they qualify to sign up for Plan Vital can visit their local Medicaid Office. They will evaluate the information and tell you if you are eligible for Plan 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 the www.medicaid.pr.gov website

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 the Plan Vital. If you do not do this, the newborn cannot get services under Plan 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 offer you additional information.

HOW DO I KEEP MY PLAN VITAL BENEFITS?

To keep your Plan Vital benefits, you have to assist to all your Medicaid appointments. Triple-S Salud will send you a letter ninety (90) days, sixty (60) days and thirty (30) days before the day when your Plan Vital benefits expire. These letters will remind you that you must go to your local Medicaid Office to maintain your eligibility active in the Plan Vital.

HOW DO I CHOOSE AN INSURER?

Once you sign up for the Plan Vital, you can choose your Insurer. Your Insurer will work with you and your doctors to keep you healthy.

The Enrollment Counselor does not work for any Managed Care Organization (MCO) or any providers. They are neutral. They can give you information about Plan Vital and its 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 Managed Care Organization or MCO (insurance company) or change to a different MCO.
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:

By phone at 1-833-253-7721; Monday through Friday, 8:00 a.m. to 6:00 p.m. TTY/TDD users should call 1-888-984-0128.
Visiting the Medicaid offices.
You can also download the ASES Vital App (Download for iOS – Download for Android)

If you do not choose an Insurer, one will be chosen for you.

CAN I CHANGE MY MCO (Insurance Company)?

Yes, you can request to change your current MCO. Once you have chosen an MCO (insurance company) or one has been chosen for you, you will have ninety (90) days to request a change to get enrolled under another MCO. You can also change your MCO once a year, during the “Open Enrollment Period”, that occurs from November 1st. to December 15.

If you want to change your current MCO call the Enrollment Counselor at 1-833-253-7721 or visit your local Medicaid Office. TTY/TDD users should call 1-888-984-0128. You can also download the ASES Vital App (Download for iOS – Download for Android)

You can also ask to change from your MCO at any time, if you have certain reasons as:

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 MCO.
You are receiving poor-quality care.
You ask for a service that your MCO does not cover because of moral or religious reasons.
Your MCO does not have doctors that are experienced in dealing with your health care needs.

If you want to change your MCO for one of these reasons, you may request a change of MCO to the Enrollment Counselor. ASES will decide if you can change or if you must wait until the Open Enrollment Period. 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 an administrative hearing.

CAN MY MEMBERSHIP WITH TRIPLE-S SALUD STOP?

Yes, your membership with Triple-S Salud will stop if you:

Lose eligibility for Plan Vital.
Move outside of Puerto Rico.
Are sent to prision.
Let someone else use your Plan Vital member card.
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 might also want to stop your membership with Triple-S Salud if you no longer need your Plan Vital (Medicaid) benefits. If this happens, let your Medicaid Office and Triple-S Salud know about it.

HOW DO I REPORT CHANGES?

Plan Vital and Triple-S Salud are committed to helping you. To support your needs, we need your help.

Please remember to let your Medicaid Office and your MCO 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 MCO send you important information about your Plan Vital coverage and benefits by email. If they don’t have your current address, you could lose your Plan Vital benefits. To report a change, call Triple-S Salud at 1-800-981-1352 or visit your local Medicaid Office; TTY/TTD users should call at 1-855-295-4040.

YOUR PLAN VITAL MEMBERSHIP CARD

Everyone in Plan Vital has a member card. This is an example of how it will look:

Each member in your family will have his/her own ID card, even if he/she is a newborn. Your member card has important information like:

Your ID number (MPI).
How to access emergency services.
Any copay you will pay for health services.
Your plan’s free phone number (on the back of your card).
The phone number for the free Plan Vital Service Line and the free 24/7 Plan Vital Medical Advice Line (on the back of your card).

If you need to use your health benefits before you get your member card, use your Notice of Decision formulary given to you by your Medicaid Office.

Remember to:

Always carry your member card with you.
Keep your card in a safe place so you don’t lose it.
Take your member card when you go to the doctor or to the emergency room.
Be sure they give you your member card back.

Your member card is only for you. Don’t let anyone else use your card. If your card is lost or stolen, you can ask Triple-S Salud for a new card. You can visit your plan’s Service Offices or call at 1-800-981-1352. TTY / TDD users should call 1-855-295-4040. The phone call is free.

Eligibility