When the President, Governor or Secretary of Health and Human Services declares an emergency, disaster or a public health emergency Triple-S Advantage takes the following actions to ensure members can get health care needed.

a) Medical Benefits (Part C)

i. Allow Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A/B benefits must, per 42 CFR § 422.204(b) (3), be furnished at Medicare certified facilities).

ii. Waive in full, requirements for referrals and prior authorizations where applicable.

iii. Temporarily reduce plan-approved out-of-network cost sharing to in-network cost-sharing amounts.

b) Pharmacy Benefits (Part D):

i. Triple-S Advantage has a process through its Pharmacy Benefit Manger (PBM), to lift “refill-too-soon” edits during a disaster or emergency as long as access to Part D drugs is provided at the point-of-sale and allows an affected enrollee to obtains the maximum extended day supply, if requested and available at the time of refill. Triple-S Advantage may lift other edits as a protection to our members for access to drugs.

ii. Triple S Advantage lifts these edits, until the termination of a public health emergency or the end of a declared disaster or emergency. In the case of a public health emergency, it terminates when it no longer exists or upon the expiration of the 90-day period beginning from the initial declaration, whichever occurs first.

iii. In the absence of a Presidential major disaster or emergency declaration or a public health emergency, Triple– S Advantage lifts the edits — for instance, in advance of an impending disaster — if they determine it is appropriate to do so to ensure pharmacy access. However, at all times, and especially in disaster and/or public health emergency situations, Triple – S Advantage ensures, that their enrollees have adequate access to covered Part D drugs dispensed at out-of-network pharmacies when those enrollees cannot reasonably be expected to obtain covered Part D drugs at a network pharmacy, and when such access is not routine.

c)      These actions remains in effect until:

i. Triple – S Advantage pay particular attention to the closure of disaster incident periods listed in the Disaster Federal Register Notice section on Federal Emergency Management Agency’s (FEMA’s Web site http://www.fema.gov/news/disasters.fema)  noting that in circumstances in which the incident period has not officially closed 30 days from the initial Presidential declaration.

ii. If, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if CMS has not indicated an end date to the disaster or emergency, Triple-S Advantage should resume normal operations 30 days from the initial declaration. Triple-S Advantage not being able to resume normal operations after 30 days should notify CMS and ASES.

d) Contact Information:

i. Members may contact Triple-S Advantage at:

• Call Center: 1-888-620-1919 (Monday to Sunday de 8:00 a.m. – 8:00 pm)
• TTY : 1-866-620-2520
• Teleconsulta (Health helpline available 24 hours a day, 7 days a week).
• Your calls to Teleconsulta are toll-free, and you may call from anywhere in Puerto Rico or the United States. The number appears on the back of your Triple-S Advantage plan membership card. Remember to always have your plan membership card at hand when you call Teleconsulta. Teleconsulta nursing professionals will be happy to answer all your health-related questions.

If you have a medical emergency:

• Get help as quickly as possible.
• Call 911 for help or go to the nearest emergency room or hospital.
• Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP.

Triple-S Advantage has a Protocol for the Prevention and Detection of Financial Exploitation of Senior Citizens and Adults with Disabilities.

According with this Protocol, Triple-S Advantage employees who have knowledge of any situation that may lead to the suspicion of this type of exploitation must notify the Compliance Department at Triple-S Advantage.

If you are victim of financial exploitation and this event is related to your health plan, you can notify the Compliance Department at Triple-S Advantage by filling out the referral form by regular mail or fax. Download the Referral From below to file your report.

Download PDF Document

Complete and send the form to:

Triple-S Advantage, Inc.
Compliance Department

PO BOX 11320
San Juan, PR 00922
Email:
Secure Fax: 787-993-3260

The Triple-S Advantage Compliance Department will refer potential cases of financial exploitation to the relevant governmental agency within no more than five (5) business days after the date of identification.

Definition

Any preventable event that may cause harm to the patient or lead to inappropriate medication use while the medication is under control of the healthcare professional, patient, or consumer.

The most common causes of medication errors are:

• Prescriptions that are not understandable
• Selection of incorrect medication
• Incorrect diagnosis
• Incorrect doses
• Miscalculated doses
• Incorrect administration method
• Samples provided by physicians

How to report medication errors

The tool provided by the FDA to report these medication errors is known as MedWatch. The MedWatch program is used to report safety information and adverse effects.

You may voluntarily report serious adverse effects, problems with product quality, and therapeutic equivalence failure of products regulated by the FDA.

To get more information or report a medication error you may access https://www.accessdata.fda.gov/scripts/medwatch or you can complete our medication error report sheet and email it to . You may also print it and send it via fax to 787-522-4005.

What is the Medication Therapy Management Program?

The Medication Therapy Management Program (MTM) is aimed at improving your health and quality of life by ensuring safe and effective medication use and preventing medication-related issues.

The Triple-S Advantage (TSA) MTM Program is managed by a diverse group of healthcare professionals, composed of case managers, health educators, pharmacists, and doctors. They will work in collaboration with you to obtain the maximum benefit from your medications, guaranteeing they are safe, appropriate and are working properly.

This Program is not part of your plan benefits package.

Who is eligible to participate in the MTM Program?

Beneficiaries who satisfy the following three (3) criteria are eligible to participate:

• Have three (3) or more chronic diseases (such as osteoporosis, rheumatoid arthritis, congestive heart failure, diabetes, dyslipidemia, asthma, COPD, and hypertension);
• Use five (5) or more Medicare Part D drugs related to chronic conditions;
• Utilize more than $5,330 in total Part D drug costs per year.

How much does the Program cost?

The MTM Program is offered at no additional cost to those beneficiaries who are eligible.

How does the MTM Program work?

With the goal of helping you learn more about your health condition, you will receive orientation and follow-up calls from our case managers and health educators.

In addition, a pharmacist will work with you, either in person or through telephone calls, to assess your medication therapy.

What services does the MTM Program provide?

• Comprehensive review of your medications, including medications prescribed by your doctor and over-the-counter medications like vitamins and herbal supplements.
• A list of your medications that will explain how to take them correctly and will help you monitor your treatment. You may print this list, fill in the information and take it with you when you visit your physician (view example).
• Evaluate the risk of potential drug interactions.
• Ensure you are not experiencing any side effects from your medications.
• Recommend more cost effective medication alternatives.
• Reach out to your healthcare provider when a potential medication related problem is identified.

How can I participate in the Program?

Once the eligible beneficiaries are identified by the TSA system, they are automatically enrolled in the program and will receive detailed information by mail.

If you have questions regarding our MTM Program or would like to receive additional information, please contact us at 1-855-831-3592, Monday through Friday from 8:00am to 5:00p.m. TTY users please call 1-855-296-8965.

Triple-S Advantage is an independent licensee of BlueCross BlueShield Association.