Plan Vital offers services to keep you healthy. Plan Vital works with Triple-S Salud , who coordinate with you and your doctors to help you access services you need.
You can start getting services as soon as your Medicaid Office says that you are eligible for Plan Vital . You don’t have to wait.
As a Plan Vital beneficiary , you have a variety of health care benefits and services available to you. Not everyone in Plan Vital has the same benefits. The benefits that are covered for you depend on the group you’re in. Your Plan Vital Member card will tell you what type of coverage you qualify for.
- Routine doctor office visits, checkups, and sick visits
- Well-baby visits, well-child visits, and immunizations
- Tests and studies, laboratory work, and X-rays
- Preventive services, including vaccines, mammogram, colonoscopy, and well visits for adults
- OB/GYN exams and annual Pap tests
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, including periodic preventive health screenings and other necessary diagnostic and treatment services for members ages 21 and under
- Nutritional evaluations and test
- Vision and hearing test
- Prenatal and postpartum care
- Family planning
- Health certificates
- Dental services
- Physical therapy
- Occupational therapy
- Speech therapy
- Physician home visits
- Care management and care coordination services
- Emergency services
- Post-stabilization services
- Mental health services
- Visits to specialists
- Community health clinic services
- Hospital: inpatient and/or outpatient care
- Mental health hospitalization and partial hospitalization
- Ambulatory service center services
- Surgery: inpatient and/or outpatient
- Ambulance services
- Outpatient rehabilitation services
Plan Vital offers dental services. You can see any dentist that accepts Plan Vital. You can find information about participating dentists in Triple-S Salud Provider Directory.
When you enroll with Triple-S Salud, you will be mailed the Provider Directory. You can also access the list of providers by visiting the web page at http://sssvital.com/en/ under the Provider Directory section. Your Primary Medical Group and Triple-S Salud Customer Service Offices also have copy of the list.
MENTAL HEALTH, ALCOHOL AND DRUG ABUSE SERVICES
Plan Vital offers mental health, alcohol and substances abuse services. You do not have to see your PCP first to see a doctor or other provider for mental health, alcohol, or substances abuse services. You can ask for these services whenever you feel like you need them.
Plan Vital wants to make it easy for you to get physical and mental health, alcohol, and substance abuse services in the same place. This is called integrated care.
Your Primary Medical Group is one place you can go to get mental health, alcohol or drug abuse services. Your Primary Medical Group must have a psychologist and/or a social worker available at least from 4 to 16 hours per week during regular business hours.
If you get mental health, alcohol or drug abuse services at another place (like a mental health clinic or a psychiatric hospital), they must have services from a PCP in the office at least part of the time to care for your physical health needs.
Plan Vital covers prescription drugs . If you need medicine, your provider will write you a prescription to take to a participating pharmacy. You can choose any pharmacy that works with Triple-S Salud. You can find a list of participating pharmacies in Triple-S Salud Provider Directory, or you can call us at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040.
Prescription drugs are free for children up to the age of 20 and for pregnant women that are Medicaid or CHIP beneficiaries. Other adults will need to pay for prescription drugs. For more information on copayments for prescription drugs, click here.
Your Formulary of Medications Covered (FMC) ) is the list of medicines Plan Vital covers. This list helps your doctor prescribe medicines for you. Brand-name and generic drugs are on the FMC. A generic version of a drug is the first choice. If a generic version of a drug is available, your doctor must prescribe the generic version.
If you have a chronic condition, your doctor can write a prescription for a 90-day supply of some drugs. This way, you only must pay for the drug once instead of paying three times (1 payment per month). You can access the Plan Vital Covered Drug Formulary at the following electronic address: https://www.asespr.org/beneficiarios/medicamentos/