HEALTH PLAN W W Grainger, Inc - ENJOY THE BENE FITS OF BEING PART OF A - Grainger Total ...
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ENJOY THE BENEFITS
OF BEING PART OF A
HEALTH PLAN
SUMMARY 2021
W W Grainger, Inc.WELCOME TO TRIPLE-S SALUD Our focus is prevention. This is why we offer a variety of innovative programs and services for the care of your health and well-being. This guide will help you know how your plan works and all services you have available with Triple-S Salud. Read it with care and take advantage of everything we offer you!
SUMMARY OF BENEFITS
HOSPITAL SERVICES o Mammography screening
• Regular Admissions including mental health o FDA approved generic contraceptives. Requires a
prescription.
• Partial Admissions due to mental conditions
o Others
• Vaccines for children, adolescents, and adults recommended
SURGICAL SERVICES
by the United States Preventive Service Task Force will be
• Medical visits including consults with specialists and covered according to the immunization schedules of he Puerto
sub-specialists Rico Department of Health and the Center for Disease Control.
• Surgery and anesthesia administration • Dialysis and hemodialysis services during the first 90 days
from the date the insured is first eligible for this policy or the
• Lithotripsy (requires preauthorization)
date the first dialysis or hemodialysis is done.
• Post-hospital services: Home Health Care and Skilled
AMBULATORY SERVICES Nursing Care Unit.
• Unlimited visits to the offices of general practitioners, • Medical equipment
specialists and sub-specialists
• Nutritionist
MAJOR MEDICAL
• Ambulatory surgery
• To receive services not available in Puerto Rico in the
• Respiratory therapy United States you need a preauthorization, except in case
• Physical therapy, chiropractic manipulations of an emergency. Preauthorized services are covered
through our Blue Cross Blue Shield (BCBS) network and
• Chemotherapy, Radiotherapy and Cobalt will be paid directly to the participating provider, subject to
• Allergy tests the initial deductible and coinsurance of this coverage.
Non-participating providers in the United States are
• Emergency room services
covered only in emergencies.
• Covers services such as: cardiac rehabilitation, prosthetic
DIAGNOSTIC TESTS devices and implants, orthotic devices, surgical assistance,
• Clinical Lab Services and X-Rays sports medicine, allergy vaccines, among others.
• Specialized tests like: Sonograms, CT Scan, MRI,
Gastrointestinal Endoscopies, Electroencephalograms, PHARMACY
Electromyography, Nuclear Medicine and Invasive and
• The supply of medicines will be of up to 15 days for acute
Noninvasive Cardiovascular Tests
medicines and 30 days for maintenance medications.
• Pet Scan and Pet CT Includes 5 repetitions for maintenance medications.
• Maintenance medications can be obtained by one of three
MATERNITY methods:
• Pre and Post Natal Services o 90-day supply thru Prescription Thru Mail Program*
• Preventive care visits for the baby o 90-day supply thru select pharmacies*
• Specialized tests o 30-day supply at your preferred hired pharmacy
OTHER SERVICES
*The conditions that qualify for 90-day supply are: Hypertension, Diabetes (insulin
• Preventive services such as: and oral tablets), Thyroid, Cholesterol, Epilepsy (Anticonvulsants), Estrogen,
Alzheimer's (not applying the patches), Parkinson's, Osteoporosis and Prostate,
o Cervical cancer screening among others. Other maintenance medications can be requested monthly at your
preferred pharmacy.
o Gestational diabetesWW Grainger Inc (Effective Date 01/01/2021)
Services Deductibles, copays and coinsurance
Basic Covarage
Maximum Out of Pocket for medical, pharmacy and hospital services $6,350 Individual / $12,300 Familiar
given by participating providers
*Non-essential benefits, servives not covered or given by providers outside
our network aren't elegible for the accumulation of maximum out of pocket.
Preventive
Preventive Services $0
Preventive Immunization (Vaccines) $0
Immunizations (Vaccines) for Respiratory Syncytial Virus 20%
Medical Visits
General Practitioner $8
Specialist (including psychologist and psychiatrist) $12
Subspecialist $15
Test
Labs 0%
X-Rays 0%
Specialized Tests 0%
Lithotripsy 0%
Ambulatory
Ambulatory Surgery $0
Therapy
Physical Therapy (30) sessions per policy year $5
Respiratory Therapy (40) sessions per policy year $5
Mental Health
Group Therapy $5
Collateral Visits $12
Emergency Room
Accident $25
Illness $50
Recommended by Teleconsulta $0
Hospitalization
Regular (including Mental Health) $100
Partial (due to mental illness) $50WW Grainger Inc (Effective Date 01/01/2021)
Services Deductibles, copays and coinsurance
Pharmacy Coverage
Rule of Generic Mandatory Medication Generic as first choice is required.
Generic Preferred Medication $10
Generic Non-Preferred Medication $10
Preferred Brand Medication $20
Non-Preferred Brand Medication $20
Preferred Specialized Medication 10% MAX $250
Non-Preferred Specialized Medication 10% MAX $250
Oral Chemotherapy Drug $0
90 Day Supply for Maintenance Medications (by Mail or
Pharmacy)
Generic Preferred Medication $20
Generic Non-Preferred Medication $20
Preferred Brand Medication $40
Non-Preferred Brand Medication $40
Major Medical
Initial Deductible $100 by insured / $300 by family
Coinsurance 20%
Organ Transplant
Covered
Major Medical
Employee Assistance Program (EAP) for Mental Health Services Inspira
Chemotherapy $0
Radiotherapy $0
Triple-S Natural (alternative medicine) $15
This is a brief informational summary and does not replace or modify the policy. We urge you to review the Certificate of Benefits (Policy) so that you know in
detail the benefits, limitations and exclusions of the cover.PUERTO RICO
SAN JUAN
QUEBRADILLA BARCELONETA
AGUADILLA HATILLO DORADO
CATAÑO
VEGA TOA
ISABELA CAMUY MANATÍ BAJA LOIZA
VEGA BAJA
ALTA
MOCA
ARECIBO FLORIDA TOA LUQUILLO
RINCÓN AGUADA ALTA RIO
SAN BAYAMÓN CAROLINA GRANDE
SEBASTÍAN MOROVIS TRUJILLO FAJARDO
ALTO CULEBRA
CIALES NARANJITO GUAYNABO
COROZAL CANOVANAS
AÑASCO UTUADO
LARES
AGUAS GURABO
CIEBA
BUENAS
LAS MARÍAS COMERIO JUNCOS NAGUABO
MAYAGÜEZ JAYUYA
OROCOVIS
BARRANQUITAS LAS
ADJUNTAS CIDRA PIEDRAS
MARICAO
CAGUAS HUMACAO
HORMIGUEROS AIBONITO SAN
VILLALBA VIEQUES
SAN LORENZO
GERMÁN CAYEY
COAMO
YAUCO
SABANA PEÑUELAS YABUCOA
GRANDE PATILLAS
CABO ROJO JUANA DÍAZ
LAJAS PONCE SANTA
SALINAS
MAUNABO
GUÁNICA ISABEL GUAYAMA
GUAYANILLA
ARROYO
Service centers
MAIN OFFICE ARECIBO
1441 F.D. Roosevelt Ave. Caribbean Cinemas Building, Suite 101
San Juan, PR 00920 Road 2 km 81.0 Arecibo, PR 00612
Monday to Friday 8:00 a.m. - 5:00 p.m. Monday to Friday 8:00 a.m. - 5:00 p.m.
PLAZA LAS AMÉRICAS CAGUAS
2nd Level Angora Building, Luis Muñoz Marín Ave.
(Entrance through north parking) Corner/Street Troche, Caguas, PR 00725
Monday to Friday 8:00 a.m. - 7:00 p.m. Monday to Friday 8:00 a.m. - 5:00 p.m.
Saturday 9:00 a.m. - 6:00 p.m.
Sunday 11:00 a.m. - 5:00 p.m. MAYAGÜEZ
Road 114 km 1.1 Castillo Community,
PLAZA CAROLINA Mayagüez, PR 00680
2nd Level Monday to Friday 8:00 a.m. - 5:00 p.m.
Monday to Friday 9:00 a.m. - 7:00 p.m.
Saturday 9:00 a.m. - 6:00 p.m. PONCE
Sunday 11:00 a.m. - 5:00 p.m. 2760 Maruca Ave.
Ponce, PR 00728-4108
Monday to Friday 8:00 a.m. - 5:00 p.m.
Service call center
787-774-6060 SERVICE HOURS (AST):
Toll free: 1-800-981-3241 Monday to Friday 7:30 a.m. - 8:00 p.m.
TTY users: 787-792-1370 Saturday 9:00 a.m. - 6:00 p.m.
TTY users: 1-866-215-1999 Sunday 11:00 a.m. - 5:00 p.m.Self-Service
Use your online tools to handle your plan at any time and without waiting.
TELEXPRESO In Telexpreso, you can:
787-774-6060 • Check your eligibility and your dependents
1-800-981-3241 • Check the status of a reimbursement
(free of charge)
• Get information on asking for a reimbursement,
copies of your ID cards, certifications, among others.
INTERNET Connect to ssspr.com
ssspr.com In our portal, you can:
• Check your and your dependent’s eligibility
• Get a Coverage and Student Certificate
• View information of
• Your coverage
• Your drugs and pharmacy plan though SSS pharmacy
• Your record of care received
• Ask for copies of your ID card
• Request and check the status of a reimbursement
• Address and phone changes*
MOBILE APP You can enjoy these useful benefits:
Triple-S Salud • Your Card Always with You: Email your plan ID card
For iOS or Android or your dependent’s card to doctors.
• Review your and your dependent's coverage easily.
• Find the provider nearest you.
• Have our main phone numbers and addresses.
• Service questions
• View the records of the care you received.
*If you have a group plan, some of these options must be coordinated with your employer.Your Triple-S Salud plan gives you easy access to health care services all around the island
URGENT CARE CENTERS (See Provider Directory)
787.789.1996 Generalists, specialists,
sub-specialists and X-rays
saluspr.com A single electronic medical record
GUAYNABO PONCE
• Primary Care Physicians • More than 40 Specialists • Primary Care Physicians • Walk-ins welcome
• Dentists • Imaging Centers • Women's Health Calle Navarra 1825, Torre Sofía, 3rd floor
and Breast Care • Mammograms, Sonograms, and Mon - Fri 8:00 a.m. - 5:00 p.m.
Biopsies • Chronic Condition Management
• Preventive Programs • Laboratory • Pharmacy
Ave. Casa Linda #1, Carr. 177, Los Filtros, Km. 2.0, Bayamón
AGUADILLA
(by the entrance to the American Military Academy) • Primary Care Physicians • Walk-ins welcome
Mon - Fri 7:00 a.m. - 6:00 p.m / Sat 8:00 a.m. - 3:00 p.m. Aguadilla Medical Services
Mon - Fri 8:00 a.m. - 5:00 p.m.
CAROLINA
• Primary Care Physicians • Specialists CAGUAS
• Imaging Center • Audiology Center
• Laboratory • Walk-ins welcome • Primary Care Physicians • Walk-ins welcome
Plaza del Carmen Mall, Suite 29
Carr. 190, Km. 1.8, Sabana Abajo (entry by Universidad Ana G. Méndez)
MOn - Fri 8:00 a.m. - 5:00 p.m.
Mon - Fri 8:00 a.m. - 5:00 p.m.
CONDADO MAYAGÜEZ
• Primary Care Physicians • Pediatric Care • Nutrition • Primary Care Physicians • Walk-ins welcome
• Immunizations • Walk-ins welcome Urb. La Sultana, UBS Financial building
2 Calle Washington, San Juan Mon - Fri 8:00 a.m. - 5:00 p.m.
Administration Building, Ashford Presbyterian Community Hospital
(first floor, behind the emergency room)
Mon - Fri 8:00 a.m. - 7:00 p.m. / Sat 8:00 a.m. - 12:00 m.d. * Services vary by clinic and/or urgent care center.Hemorrhage Bronchitis
Loss of Nausea or
vision indigestion
Broken
U Dehydration
ES
bones
RG
RGENCI
Seizures
or loss of Headache o
dizziness
ENCIES
consciousness
Chest Ear
E
pain infection
M
High
E Sprains
or minor
fever fractures
Asthma Cough
URGENT CARE CENTERS WIDE NETWORK INCLUDING
44 MUNICIPALITIES
Save time and money. Visit an urgent care center when you have a health situation that needs
quick medical attention but your life is not in danger.
HUMACAO CAYEY
• General Practitioners • Laboratory • X Rays • General Practitioners • X Rays • Laboratory
• Hydration • Minor Surgery • Respiratory Therapy • Minor Surgery • Hydration
Boulevard del Río • Respiratory therapy • Health Certificates
Mon 8:00 a.m. - 8:00 p.m. / Tues - Sun 8:00 a.m. - 6:00 p.m. Cayey Shopping Center
www.premiermedicalcenterpr.com Mon - Sun 7:30 a.m. - 9:00 p.m.
787.656.2727 www.haspr.com 787.286.6060
MAYAGÜEZ CAGUAS
• General Practitioners • Laboratory • X Rays • General Practitioners • X Rays • Laboratory
• Hydration • Minor Surgery • Respiratory Therapy • Minor Surgery • Hydration
Plaza Sultana • Respiratory therapy • Health Certificates
Mon - Sun 7:00 a.m. - 10:00 p.m. Plaza del Carmen Mall Calle Troche
www.premiermedicalcenterpr.com Mon - Sun 7:30 a.m. - 9:00 p.m. Mon - Sun 7:30 a.m. - 9:00 p.m.
787.652.0231 www.haspr.com www.haspr.com
* Refer to the Provider Directory for the full list of Emergency Centers 787.286.6060 787.286.6060IN THE HOSPITAL
SPECIALIZED CARE DURING
YOUR HOSPITALIZATION
Because you deserve care as special as you, you will receive personalized assistance
during your hospital stay and guidance for a successful transition of care with your
primary doctor.
We want to help you complete your treatment as prescribed and avoid the need to
return to the hospital.
AMONG THE SERVICES GIVEN ARE:
• Coordination of services or equipment needed to continue
treatment at home
ASHFORD PRESBYTERIAN CENTRO CARDIOVASCULAR
• Coordination of follow up visit with your doctor in the first
seven days after discharge
• Medication reconciliation
• Educational information about your medical conditions MANATÍ MEDICAL CENTER MAYAGÜEZ MEDICAL CENTER
• Member rights and duties guidance
• During admission our case manager will contact you and
become part of your discharge planning
SAN LUCAS PONCE DOCTORS’ CENTER HOSPITAL
San Juan • Bayamón • CarolinaWE GO THE
EXTRA MILE
TO TAKE CARE
OF YOU
CLINICAL CARE PROGRAMS
At Triple-S, we go the extra mile CLINICAL CARE PROGRAMS:
to take care of your health. We • Evaluate your health, social, and nutritional needs.
• Develop a health care plan based on your specific
have a group of experts available needs.
to you, including nurses, health • Schedule your services (appointments and others).
• Coordinate group and individual educational
educators, social workers, and activities for physical and mental health.
nutritionists focused on your • Manage chronic health conditions that are out of
control.
wellbeing.
HEALTH MODIFICATION AND CARE PROGRAMS:
Do you need help controlling a chronic condition?
Our team is available to offer the tools you need to
manage and care for conditions, such as:
• Diabetes • Chronic Obstructive Pulmonary
• Asthma Disease (COPD)
• Heart Failure • Obesity
• Hypertension
For more information about our Clinical We also have programs to help you manage:
Care Programs, please call us at • Prenatal care
787-706-2552. • High-risk pregnancies
• Terminal stage cancer
CONTACT US • Ulcers and homebound care needs
M-F 8:00 a.m. – 4:30 p.m. • Children with special needs requiring service
787-706-2552 or 1-800-981-4860 coordination
• High usage of emergency room services
Fax: 787-774-4824 or 1-855-887-8275 • Cerebrovascular accidents
Email: manejocasos@ssspr.com • Mental healthPREVENTIVE CENTERS
Triple-S has 10 Preventive Care Centers that promote the health and well-being of your
staff. These centers simplify access to preventive checkups for better quality of health.
Through these centers, members 21 years and over can get their yearly checkup in one
visit without copayments in most tests.
NO COPAYS OR LONG WAITS!
EVALUATION PREVENTIVE CARE CENTERS
SALUS, Guaynabo
• Medical history
(787) 789-1919 ext. 1044 & 1054
• Physical examination (787) 999-3096
• Screening of depression SALUS, Carolina (787) 999-0580
• Risk behavior noemi.cruz@saluspr.com
• Guidance: alcohol, smoking, diet, SALUS, Ashford Condado (787) 999-0569
nutrition and others michelle.rodriguez@saluspr.com
Tiger Med, Caguas (787) 646-2800
(787) 286-2800 ext. 636 & 248
ssspreventive@tigermedpr.com
Centro de Medicina y Cirugía Ambulatoria
San Sebastián (787) 501-5324, (787) 926-0000
coordinadora.spc2@cmcapr.com
Preventive Care Service, Ponce
(787) 651-1435, (787) 651-6479
(787) 651-3607, (787) 651-3914
citas@preventivecareservicespr.com
Villa Los Santos, Arecibo
(787) 879-1585 ext. 233
relacionespublicas@cdtvillalossantos.com
Bella Vista Family Medicine Center, Mayagüez
(787) 834-6160 ext.203; (787) 834-6172
imunizbfmc@gmail.com
Wellness Alliance, Guaynabo
(787) 708-6777, (787) 708-6778
Centro Preventivo de Quebradillas, Quebradillas
(787) 919-7277, (939) 225-7867Travel healthy with all the benefits The Blue Card Program has to offer Thanks to our affiliation with BlueCross BlueShield, you can access health care services with your Triple-S Salud card when you travel to the United States. You may use the BlueCross BlueShield network of participating providers, available throughout the United States, for: • Medical emergencies • Treatments not available in PR* • Full-time college students** 1.To find program providers, you may call 1-800-810-BLUE (2583) or visit http://provider.bcbs.com/. 2.Visit a participating healthcare provider in the BCBS network and show your insurance card. 3. The provider will verify your eligibility and your policy deductibles, coinsurance, and conditions. The provider will then bill their local BlueCross BlueShield. 4. You will pay the deductible and coinsurance corresponding to your benefit in the United States. 5. The BCBS plan in the area the service was provided will pay the provider and send Triple-S Salud the insurance claim electronically. 6. Triple-S Salud will reimburse the BCBS plan. They will also mail you a report with the explanation of provided services. * Preventive services included are those identified by the United States Preventive Services Task Force (USPSTF) ** Requires a certificate from the university
Triple-S Natural Program
Get medical services using an integrated model of medicine, in which complementary
techniques and treatments validated by the National Institute of Health in the United
States and agencies recognized at the international level are used.
THE TRIPLE-S NATURAL PROGRAM INTEGRATES:
• Primary Conventional Medicine • Traditional Chinese Medicine
• Holistic health and Complementary • Reflexology
• Medical Acupuncture • Clinical Nutrition
• Therapeutic Massage • Botanical Medicine
• Naturopathic Medicine • Aromatherapy
• Bioenergetic medicine (Pranic Healing) • Music Therapy
• Hypnotherapy • Chiropractic
MULTIDISCIPLINARY FACILITIES THAT INTEGRATE SEVERAL SERVICES:
Armonia Natural - Manatí Acupati PSC Condado Wellness
Urb Atenas, J49 calle JP Reyes 32 calle Del Río, Mayagüez San Juan Health Centre
Tel. 787-884-7024 Tel. 787-831-7173 150 Ave de Diego, Piso 2
San Juan
Armonia Natural - Dorado Body Align- Aguadilla Tel. 787-230-7557
Dorado del Mar Shopping Center Edif Professional Plaza
500 Carr 693 suite 20, Dorado Carr 2 Km 118.9, Aguadilla
Tel. 787-796-3380 Tel. 787-238-7909
As well as a variety
Centro Universitario de Medicina Body Align- Vega Baja
of chiropractors and
Integral y Complementaria Urb. Brasilia, D10
acupuncturists within
Hospital Dr Ramón Ruiz Arnau calle Marginal, Vega Baja
our provider network.
100 Ave Laurel, Bayamón Tel. 787-369-9900
Tel. 787-269-0988Employee
Assistance Program
Through the Employee Assistance Program
you can get professional help for you and
your family in these areas:
• Emotional, finance and legal
• Interpersonal and marital relationships
• Drug and alcohol dependency
• Poor motivation and anguish
• Work related stress management counseling,
among others
BENEFITS OF GETTING PROFESSIONAL HELP
• Handling problems at an early stage prevents them from becoming more serious.
• Improved quality of life.
• Increased productivity and job satisfaction.
HATO REY Hostos Ave. #405
RÍO PIEDRAS Hospital Auxilio Mutuo Medical Tower, Office #410
CAGUAS Gautier Benítez Ave. #242 Consolidated Mall, Anexo B-5
BAYAMÓN Centurión building 3rd floor, #2 street Km 11.8
GUAYAMA Fuente Town Center, Marginal street #706
RÍO GRANDE Industrial Park Las Flores, #3 street K.M. 23.9
COAMO Coamo Plaza Shopping Center, #153 street KM. 13.7
HUMACAO #10 Building, 3 and 4 Local Commercial Center, Font Martelo Ave.
YAUCO Comerío street #55
CIDRA Ramón Baldorioty de Castro street, #12
Clinics contact numbers:
1-800-284-9515 or (787) 704-0705
imental@inspirapr.com
www.inspirapr.com The Employee Assistance Program is managed by Inspira.Your Pharmacy
Program
Understanding your pharmacy benefits and programs will help you
maintain an optimal state of health and will save you time and money.
PHARMACY NETWORK DISPENSING/SUPPLY
Our network includes retail Acute Drugs
pharmacies throughout the Used to treat a sudden illness of
Island, including most short duration that have a clearly
independent pharmacies, as well defined time of start and end. In
as drugstore chains. You can also general, we cover up to a maximum
purchase your prescriptions in supply of fifteen (15) days with no
the United States and US Virgin refills.
Islands.
To find a participating pharmacy
Maintenance Drugs
near you:
Are those that treat a life-long health
• Visit our online site ssspr.com
problems such as diabetes, thyroid,
• Access our app Triple-S Salud, asthma, and Parkinson's Disease,
available for Apple and Android. among others.
These drugs are covered for 30 days
supply and up to a maximum of five
(5) refills. Some of these drugs may
also be filled in an extended 90
days supply (and one refill).
There are pharmacy coverages that
require the dispensing of generic
drugs as a first choice.90 Days Extended Supply Program
at participating pharmacies
You can get a 90-day supply PROGRAM ADVANTAGES
for certain maintenance • Save time and visits to the
drugs in our Program drugstore
pharmacies. • Savings in copayments or
coinsurances
Ask your doctor for a
• Improve your life-long health
90 day prescription plus
problems with a higher supply on
one (1) refill of your hand
maintenance drugs.
For more information about the Program, call to (787) 774-6060.Triple-S Salud Pharmacy
Mail Order Program
You can get certain SEND THE PRESCRIPTION TO
THE PHARMACY BY:
maintenance drugs • Facsimile
through the mail, • E-prescribe
in the comfort of IF YOU NEED THE MEDICATION
IMMEDIATELY
your home; up to a Ask your doctor for two prescriptions,
90-day supply. one for the first 30 days that you can fill
it in your local pharmacy and another
for 90 days with one refill for our mail
order pharmacy to dispense.
HOW TO BEGIN USING THE CONTACT INFORMATION
SERVICES OF PHARMACY MAIL www.alliancerxwp.com/home-delivery
ORDER PROGRAM Telephones: 1 (800) 345-1985 (English)
Request your prescription drugs by mail
1 (800) 778-5427/
in the following way:
TTY 1 (877) 220-6173 (Spanish)
INTERNET
Fax: 1 (800) 332-9581
• Signup in
Mail:
www.alliancerxwp.com/home-delivery
PO Box 29061 Phoenix, AZ 85038-9061
• Once registered, follow the
Opening Hours:
instructions in the confirmation page
24 hours / 7 days a week
to submit your prescription.
TELEPHONE
Call Customer Service Center at
1-800-778-5427Specialty Drug Management
Program through our Exclusive
Pharmacy Network
An integrated care of specialized
medications for high risk and chronic
conditions.
You or your doctor may call one of these pharmacies and be guided with the steps to
follow for ordering and getting your specialty drugs. You should remind your doctor to
write two prescriptions, one for specialty drugs and the other for the non-specialty drugs.
Some of the health conditions handled through these pharmacies are:
• Cancer (oral) • HIV (human immunodeficiency virus)
• Crohn's Disease • Multiple Sclerosis
• Antihemophilic Factor • Hepatitis C
• Rheumatoid Arthritis
Pharmacy Address Telephone
WALGREENS #15191 AVE 65 INFANTERIA, T: 787-777-1120
ESQ. BARBOSA SAN JUAN F: 787-777-1124
ALIVIA SPECIALTY 355 DE DIEGO AVE T: 787-723-6869
PHARMACY 3RD FLOOR, SAN JUAN F: 787-723-6987
FARMACIA PUREMED 107 EL TUQUE INDUSTRIAL PARK, T: 787-651-8070
PONCE F: 787-651-1188
CVS CAREMARK JESUS T PINERO AVE #278-280 T: 787-758-2700
STE B, RIO PIEDRAS F: 787-758-2737
BEST OPTION PUERTO RICO INC 359 AVE DE DIEGO, SAN JUAN T: 787-723-6868
F: 787-721-6475
You will get your drugs at your place of choice in Puerto Rico or USVI. You may arrange to
have them sent to your home, physician’s office, or any other place for pick-up.
If you have questions or need help, call (787) 774-6060.OTC Program
Triple-S Salud has added in most of its
prescription drug coverages some OTC
drug alternatives; without $0 copay to you.
These choices are of great benefit for you because you can have access
to effective drugs with a lower cost in your pharmacological therapy.
To take advantage of this program and to ensure that you are using an
appropriate therapy, you must submit a prescription from your doctor
for dispensing of the OTC drug.
Tell your doctor that he needs to write in the prescription the name of
the drug followed by OTC.
These are the OTC drug alternatives available:
Category Available OTC drugs
ULCERS AND Omeprazole DR Tab 20 mg, Omeprazole Mag DR
REFLUX Cap 20.6 mg: Prilosec OTC®*
(Protom pump Omeprazole-Sodium Bicarbonate Cap 20-1100 mg:
inhibitors) Zegerid OTC®*
Lanzoprazole DR Cap 15 mg: Prevacid 24hr®*
Esomeprazole MAG DR Tab 20 mg, Esomeprazole
MAG DR Cap 20 mg: Nexium 24hr®*
ALERGIES Cetirizine Hcl Cap 10 mg, Cetirizine HCI Tab 5 mg,
(Non-sedative Cetirizine HCL Tab 10 mg, Cetirizine HCI Chew Tab
antihistamines) 5 mg, Cetirizine HCI Chew Tab 10mg, Cetirizine HCI
Oral Sol 1 mg/ml (5 mg/5ml) Cetirizine HCI
Desintegrating Tab 10 mg: Zyrtec®*
Tabla continúa en la siguiente página.Category Available OTC drugs
ALERGIES Fexofenadine HCL Tab 60 mg, Fexofenadine HCI
(Non-sedative Tab 180 mg, Fexofenadine HCI Susp 30 mg/5ml (6
antihistamines) mg/ml), Fexofenadine HCI Desintigrating Tab 30
mg: Allegra®*
Levocetirizine Tab 5 mg, Levocetirizine Soln 2.5
mg/5ml (0.5 mg/ml): Xyzal®*
Loratadine Cap 10 mg, Loratadine Tab 10 mg,
Loratadine Chew Tab 5 mg, Loratadine Syrup 5
mg/5ml, Loratadine Desintegrating Tab 5 mg,
Loratadine Desintegrating Tab 10 mg: Claritin®*
Cetirizine-Pseudoephedrine Tab ER 12hr 5-120
mg: Zyrtec-D®*
Loratadine & Pseudoephedrine ER 12hr 5-120 mg:
Claritin-D®*
Loratadine & Pseudoephedrine Tab Er 24hr 10-240
mg: Claritin-D®*
Fexofenadine-Pseudoephedrine Tab Er 12hr
60-120 mg: Allegra-D®*
Fexofenadine-Pseudoephedrine Tab 24hr 180-240
mg: Allegra-D®*
EYE ALLERGIES Ketotifen Fumarate Ophthalmic Solution 0.025%:
Zaditor®*
NASAL Budesonide Nasal Suspension 32 mcg/act:
ALLERGIES Rhinocort Allergy®*
Fluticasone Furoate Nasal Suspension 27.5
mcg/spray: Flonase Sensimist®*
Fluticasone Propionate Nasal Suspension
50mcg/act: Flonase Allergy Relief®*
Triamcinolone Acetonide Nasal Aerosol
Suspension 55 mcg/act: Nasacort Allergy 24hr®*
*Trade name of product as referenceStep Therapy for Prescription Drugs
A pharmacy program designed to help you use safe and cost effective drugs.
1 Access to dr ugs that have
been proven to work well
STEP THERAPY
STEP BY STEP
and be safe.
1 You start treatment with a first step
drug, that works well and is safe, but
2 Lower or even zero copayments
at a lower cost*.
2 If the first step drug does not give you
the expected therapeutic benefit, you
use a second step drug.
3 Savings in d rugs helps you
comply with the therapy Ask your doctor about Step Therapy benefits.
* Applies only if you are using the drug for the first time or have not used it for the last six (6) months. Included OTC drugs belong to Triple-S Salud OTC program. Check your Drug List for more detail. The
program is subject to the exclusions of the pharmacy plan. The drugs may change by coverage.
ST Group Desc Step 1 Drugs Step 2 Drugs
Proton Pump Inhibitors Prevacid-OTC Prevacid Rx
Lansoprazole (gen for Prevacid)-OTC/Rx Prilosec Rx
Prilosec- OTC Protonix
Omeprazole (gen for Prilosec)-OTC/Rx Dexilant
Pantoprazole (gen for Protonix) Nexium
Zegerid-OTC Esomeprazole (gen for Nexium)
Nexium-OTC Rabeprazole (gen for Aciphex)
Non-sedative Levocetirizine tablets (gen for Xyzal) Clarinex
Antihistamines Zyrtec/ Cetirizine -OTC Clarinex-D
Zyrtec D/Cetirizine- Pseudoephedrine-OTC Desloratadine (gen for Clarinex)
Allegra/Fexofenadine-OTC
Allegra D/Fexofenadine-Pseudoephedrine-OTC
Claritin/Loratadine-OTC
Claritin D/Loratadine-Pseudoephedrine-OTC
Xyzal-OTC
Ocular Allergies Ketotifen Fumarate Ophthalmic Solution 0.025 % - OTC Emadine
Azelastine Oph (gen for Optivar)
Olopatadine (gen for Patanol and Pataday)
Statins Atorvastatin (gen for Lipitor) Fluvastatin (gen for Lescol)
Lovastatin (generic for Mevacor) Simvastatin-Ezetimibe (gen for Vytorin)
Simvastatin (generic for Zocor)
Pravastatin (generic for Pravachol)
Rosuvastatin (gen for Crestor)
Biphosphonates Alendronate (gen for Fosamax) Fosamax
Ibandronate (gen for Boniva)
Risedronate (gen for Actonel)
Risedronate DR (gen for Atelvia)
Fluticasone (generic for Flonase and Veramyst)-Rx & OTC mometasone (gen for nasonex)
Nasal Corticosteroids Budesonide (gen for Rhinocort) Flunisolide (gen for Nasarel)
Nasacort Allergy- OTC Beconase AQ
Rhinocort Allergy- OTC Qnasl
Flonase Allergy -OTC Triamcinolone Acetonide
Developed by doctors and pharmacists for certain therapeutic classes.Benefit coordination
WHAT IS COORDINATION OF HOW DO I PAY THE DEDUCTIBLES
BENEFITS? AND COINSURANCES?
• Avoids payments in excess when a. Traditional way (Medicare) -
health care is covered by two or Triple-S Salud pays the
more health plan policies. deductibles and coinsurances left
to pay for Medicare, applying the
• The payment of deductibles and
payment policy.
coinsurances left to pay by the
primary plan, will be assumed by b. Triple- S Salud with another
your secondary plan when the Triple-S Salud plan or an external
payment does not outpace the Net private plan - the payment of
Payment Amount if only you had a deductibles and coinsurances left
primary plan. The payment policy to pay for the primary plan, will be
will apply as stated by the contract. assumed by the secondary plan
when and when this payment
• This also applies to any request of
does not outpace the amount of
reimbursements you have made
the net payment that would have
where you could recover the whole
made this same policy if only this
or the maximum possible of the
were your primary plan. The
cost of the care received.
payment policy applies.
c. Preserving benefits - payment for
the secondary takes as its basis
the comparison of the net
payment of your primary with the
net payment of your secondary
plan, as if the latter is primary
WHO PAYS FIRST?
See table on next page.
—
Coordination with Government
Health Plan
The government health plan will
always be secondary to any other
insurance.Primary Secondary Tertiary
Dependent / Where you are the policy Where you are
Non dependent mainholder a dependent
Birthdays First birthday of the year Second
or Oldest policy (in case birthday of the
both birthdays are on the year
same day)
Custody Who has custody of the Spouse of Parent without
child custodian custody
Active/inactive Active Employee Retired
(mainholder) insurance employee
insurance
Active/inactive Retired employee Active
(as dependent) insurance Employee
insurance
Active/inactive Active Employee Medicare Retired
(retired as insurance employee
dependient) and insurance
Medicare
Antiquity Oldest policy Newest policy
Medicare Reason* Primary Secondary
A. AGE (OVER 65 YEARS OLD)
Less than 20 employees Medicare Triple-S
20+ employees Triple-S Medicare
B. DISABILITY (UNDER 65 YEARS)
Less than 100 employees Medicare Triple-S
100+ employees Triple-S Medicare
C. CHRONIC RENAL DISEASE
Doesn’t contemplate number of employees Triple-S Medicare
* Triple-S will always be your secondary plan if you belong to a group insurance classified as: Retired, Disabled, COBRA, Direct pay individual policy.NOTICE
Informing individuals about nondiscrimination and accessibility requirements
and nondiscrimination statement: Discrimination Is Against The Law.
Triple S Salud, Inc. complies with If you believe that Triple S Salud, Inc. has
applicable federal civil rights laws failed to provide these services or has
and does not discriminate, exclude discriminated in another way on the
people or treat individuals basis of race, color, national origin, age,
differently because of race, color, disability, or sex, you can file a grievance
national origin, age, disability, or sex. with:
Service Representative
P.O. Box 11320, San Juan, PR
00922-9905
1. Provides free aids and services to Telephone: (787) 774-6081 or
people with disabilities to 1-800-716-6081
communicate effectively with us, TTY: (787) 792-1370 or 1-866-215-1999
such as: TSACompliance@sssadvantage.com
—
• Qualified sign language
You can file a grievance in person or by
interpreters
mail, fax, or email. If you need help filing
• Written information in other a grievance, a Service Representative is
formats (large print, audio, available to help you.
accessible electronic formats,
You can also file a civil rights complaint
other formats)
with the U.S. Department of Health and
2. Provides free language services to Human Services, Office for Civil Rights
people whose primary language is electronically, through the Office of Civil
not English, such as: Rights Portal available at
• Qualified interpreters https://ocrportal.hhs.gov/ocr/portal/lo
bby.jsf or by mail or phone at: 200
• Information written in other
Independence Ave, SW Room 509F, HHH
languages
Building, Washington, D.C. 20201
If you need these services, contact a
Telephone: 1-800-368-1019,
customer a Service Representative.
TDD: 1-800-537-7697Call the customer service number on your ID card for assistance. 請撥打您 ID 卡上的客服號碼以尋求中文協助。 Gọi số dịch vụ khách hàng trên thẻ ID của quý vị để được hỗ trợ bằng Tiếng Việt. Para sa tulong sa Tagalog, tumawag sa numero ng serbisyo sa customer na nasa inyong ID card. Обратитесь по номеру телефона обслуживания клиентов, указанному на Вашей идентификационной карточке,для помощи на русском языке. ةيبرعلا ةغللاب ةدعاسملا ىلع لوصحلل كتيُوه ةقاطب ىلع دوجوملا ءالمعلا ةمدخ مقرب لصتا. Rele nimewo sèvis kliyantèl ki nan kat ID ou pou jwenn èd nan Kreyòl Ayisyen. Pour une assistance en français du Canada, composez le numéro de téléphone du service à la clientèle figurant sur votre carte d’identification. Ligue para o número de telefone de atendimento ao cliente exibido no seu cartão de identificação para obter ajuda em português. Aby uzyskać pomoc w języku polskim, należy zadzwonić do działuobsługi klienta pod numer podany na identyfikatorze. 日本語でのサポートは、IDカードに記載のカスタマーサービス番号までお電話でお問い合 わせください。 Per assistenza in italiano chiamate il numero del servizio clienti riportato nella vostra scheda identificativa. Rufen Sie den Kundendienst unter der Nummer auf Ihrer ID-Karte an, um Hilfestellung in deutscher Sprache zu erhalten. یسراف نابز هب ییامنهار تفایرد یارب، جرد امش ییاسانش تراک یور رب هک یرتشم تامدخ هرامش اب دیریگب سامت تسا هدش.
Independent Licensee of BlueCross BlueShield Association TSS-DVAC-1647-2020-B
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