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Beneficiaries with special health care needs can get Special Coverage that will provide services for the care they need. The special health care needs are:

  1. Aplastic Anemia
  2. Rheumatoid Arthritis
  3. Autism
  4. Cancer
  5. Skin Cancer such as Invasive Melanoma or squamous cells with evidence of metastasis.
  6. Skin Cancer – Carcinoma IN SITU
  7. Chronic Renal Disease
  8. Scleroderma
  9. Multiple Sclerosis (MS) and Amiotrophic Lateral Sclerosis (ALS)
  10. Cystic Fibrosis
  11. Hemophilia
  12. Leprosy
  13. Systemic Lupus Erythematosus (SLE)
  14. Children with Special Health Needs
  15. Obstetric
  16. Tuberculosis (Tb)
  17. HIV/AIDS
  18. Adults with phenylketonuria (PKU)
  19. Pulmonary Hypertension
  20. Post-Transplant (Excludes cornea, bone, and skin transplant)
  21. Chronic Hepatitis C (HCV)
  22. Congestive Heart Failure (CHF): Class III & Class IV, NYHA
  23. Primary Ciliary Diskinesia (PCD), or Immotile Ciliary Syndrome, or Kartagener Syndrome
  24. Cleft palate and of Cleft lips
  25.  IBD (Inflammatory Bowel Diseases)

Your PCP or your Primary Medical Group can give you more information on which people qualify for the special coverage. If you qualify for Special Coverage, they can also help you sign up for it.

People with Special Coverage can choose any provider that works with your Preferred Provider Network or your Insurer’s General Network. People with Special Coverage can get prescription drugs, tests and other services through the Special Coverage without a referral or needing their PCP to sign off.

Triple-S Salud will let you know if you are qualified and, will if you are qualified, they must make sure that you get access to the services. Plan Vital Special Coverage will begin when the beneficiary reaches the limits of the Special Coverage for any other health plan.

The benefits under Special Coverage include the list below. Some services may have limits. For more information call Triple-S Salud at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040..

Coronary disease services and intensive care

  • Maxillary surgery
  • Neurosurgical and cardiovascular procedures
  • Peritoneal dialysis and related services
  • Clinical services and laboratory tests
  • Neonatal intensive care unit services
  • Chemotherapy, radiology and related services
  • Gastrointestinal conditions, allergies and nutritional evaluation for autistic patients
  • Procedures and diagnostic tests, when medically necessary
  • Physical therapy
  • General Anesthesia
  • Hyperbaric chamber
  • Immunosuppressive medicines and laboratory tests for patients who have received transplants
  • Treatment for specific conditions after diagnosis:
    • Positive HIV Factor and Acquired Immunodeficiency Syndrome (AIDS) – Ambulatory and hospitalization services are included. You do not need a Referral or Prior-Authorization from your Insurer or your PCP for visits and treatment at the Immunology Regional Clinics of the Health Department.
    • Tuberculosis
    • Leprosy
    • Lupus
    • Cystic fibrosis
    • Cancer
    • Hemophilia
    • Aplastics Anemia
    • Reumatoid Artritis
    • Autism
    • OBGyn Obstetricians
    • Post Organ Transplantation
    • Children with special needs. Except:
      • Asthma and diabetes (Part of the Disease Management Program)
      • Psychiatric disorders
      • Catastrophic diseases for persons with Intellectual disabilities
  • Scleroderma
  • Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS)
  • Services for the Treatment of conditions resulting from self-inflicted damage or because of a felony committed by a beneficiary or negligence
  • Chronic renal disease
  • Drugs required for the ambulatory Treatment of Tuberculosis and Leprosy
  • Hepatitis C treatment with the drug included in the Plan Vital Drug Formulary

If you have HIV or AIDS, your PCP must ask Triple-S Salud to give you Special Coverage.
Once Triple-S Salud adds you to Special Coverage, they will mail you a letter letting you know that you can get
services under Special Coverage. The letter will let you know when the Special Coverage starts and when it will

Once you have the letter, you can get all services and treatments for your condition
like prescription drugs, laboratory tests, x-rays and other services without your PCP needing to sign off.

You must get your prescription medicines for HIV/AIDS at the Department of Health’s
Centers for Prevention and Treatment of Communicable Diseases: 

Centers for the Prevention and Treatment of Communicable Diseases (CPTET, for its acronym in Spanish)

ARECIBO (787) 878-7895
Fax. (787) 881-5773
Fax. (787) 878-8288
Tel. (787) 879-3168
Antiguo Hosp. Distrito (Dr. Cayetano Coll y Toste)
Carretera 129 hacia Lares
Arecibo, PR 00614

PO Box 140370
Arecibo, PR 00614

BAYAMÓN (787) 787-5151
Ext. 2224, 2475
(787) 787-5154
Fax. (787) 778-1209
(787) 787-4211
Antigua Casa de Salud
Hosp. Regional Bayamón
Dr. Ramón Ruíz Arnau,
Ave. Laurel Santa Juanita
Bayamón, PR 00956
Ext. 1142, 1150
Fax (787) 746-2898; 744-8645
Hosp. San Juan Bautista
PO Box 8548
Caguas, PR 00726-8548
CLÍNICA SATÉLITE HUMACAO (787) 285-5660 CDT de Humacao, Dr. Jorge Franceshi
Calle Sergio Peña Almodovar
Esq. Flor Gerena
Humacao, Puerto Rico 00791
CAROLINA CLETS (787)757-1800
Ext. 454, 459
Fax (787)765-5105
Hospital UPR Dr. Federico Trilla
Carretera 3, km. 8.2

P. O. Box 6021
Carolina, PR 00984-6021

CLETS SAN JUAN (787)754-8118
P. O. Box 70184
San Juan, PR 00936-8523

Calle José Celso Barbosa
Centro Médico de PR
Bo. Monacillos, San Juan

FAJARDO (787)801-1992
Calle San Rafael # 55
Fajardo, PR 00738
MAYAGÜEZ (787)834-2115
Centro Médico de Mayagüez
Hospital Ramón Emeterio
Carr. #2 Suite 6
Mayagüez, PR 00680
PONCE (787)842-0948
Departamento de Salud
Región Ponce
Antiguo Hospital Distrito Ponce
Dr. José Gándara
Carretera Estatal 14
Bo. Machuelo
Ponce, PR 00731
CENTRAL OFFICE (787)765-2929
Ext. 4026, 4027
Fax (787)274-5523
P.O. Box 70184
San Juan, PR 00936

Antiguo Hospital Psiquiatría
Pabellón 1, primer piso, 4ta. Puerta – Terrenos de Centro Médico, Río Piedras

Some people with high needs and special conditions can receive Care Management. If you are eligible for Care Management, nurses, social workers and nutritionists are available to help you create a plan for your care. Your team will review your care plan with you at least once a year, if your health needs change, or if you ask for a review.

You can ask for help through this program by calling Triple-S Salud at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040. Your doctor, your family, your hospital may also ask for the program.

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Hours are from 7:00 a.m. to 7:00 p.m., 7 days a week.