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1-833-779-7999

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1-866-620-2520

Monday through Sunday, from 8:00 a.m. to 8.00 p.m.

ELA Óptimo Plus (PPO)

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Send us your information and we will contact you as soon as possible.

Why choose ELA Óptimo Plus (PPO)?

This plan is designed for the Estado Libre Asociado de Puerto Rico (ELA) retirees and their dependents. It provides Original Medicare Part A and Part B benefits with a Part D prescription drug coverage without the need for referrals. With this plan, you may visit any doctor or hospital within the Triple-S Advantage provider network and the BlueCross BlueShield Network in the United States. Also, this plan has a variety of supplementary benefits such as dental, eyeglasses, erectile dysfunction medications, among others.

Who is elegible?

  • Beneficiaries with Medicare Parts A and B
  • ELA retirees or an eligible dependent. The ELA retiree should receive an employer contribution from the ELA Central Retirement System or from the Teachers’ Retirement System.
  • Residents living in one of Puerto Rico’s 78 municipalities
  • United States citizens or legal residents

For additional information about copayments, coinsurances and details about the benefits and restrictions that apply, please read the Evidence of Coverage and Summary of Benefits.

Some benefits of this plan:

  • $0 Hospital Stay
  • $0 Primary Care Physicians (PCP)
  • $5 Specialists, $0 at SALUS clinics*
  • $0 Laboratory & X-Rays
  • $0 Covered Prescription Drugs**
  • Preventive Dental Benefit
  • $2,000 every year for Comprehensive Dental Benefit
  • $500 annually for prescription eyeglasses or contact lenses
  • $1,000 every year for Hearing Aids
  • 24 one-way trips to plan-approved locations
  • 4 supplemental nutritionist visits
  • Erectile dysfunction drugs

 
* Other Providers are available in our network.
**At the Preferred Pharmacy Network in Tiers 1 & 6.

This information is not a complete description of benefits. Call: 1-888-620-1919 (TTY 1-866-620-2520) for more information. This is a brief summary for informational purposes and it does not replace or modify your Evidence of Coverage (EOC).

Important documents for you

Summary of Benefits (SB)

The Summary of Benefits tells you about some of the characteristics of the plan. It does not include all covered services or all limitations or exclusions. For a complete list of benefits, refer to the Evidence of Coverage.

DOWNLOAD SUMMARY OF BENEFITS

Evidence of Coverage (EOC)

The EOC gives you details about your Medicare health care and prescription drug coverage for the calendar year. It also explains how to get coverage for the services and prescription drugs you need. This is an important legal document.

DOWNLOAD EVIDENCE OF COVERAGE

Annual Notice of Change (ANOC)

This document is sent to members every fall to inform you about all the changes to benefits, costs, providers, and prescription drugs for the next year. The ANOC helps you compare your current health and prescription drug benefits and costs with those for next year.

DOWNLOAD ANNUAL NOTICE OF CHANGE

Provider and Pharmacy Directory 2021

Provider Directory

This document provides you with a list of all our contracted health care providers such as primary care physicians, specialists, hospitals, outpatient facilities among other health professionals. This directory contains contracted providers and preferred network providers.

DOWNLOAD PROVIDER DIRECTORY

Pharmacy Directory

The Pharmacy Directory gives you a complete list of pharmacies in our network, which means that all of these pharmacies have agreed to fill covered prescriptions for members of our plan. This directory contains contracted pharmacies and preferred network pharmacies.

DOWNLOAD PHARMACY DIRECTORY

Drugs

Drug Formulary

The Comprehensive Formulary lists all the drugs covered by our plan. These drugs were selected in consultation with a team of health care providers and represent the prescription therapies believed to be necessary for a quality treatment program.

DOWNLOAD DRUG FORMULARY

Notice of Changes to Formulary

Our plan is required to provide notice about removals or changes in the preferred or tiered cost-sharing status of any Part D drugs included in the formulary.

Prior Authorization Criteria

Our plan requires you (or your physician) to get prior authorization for certain drugs. This means you will need to get our approval before filling your prescription. If you don’t get approval, we may not cover the drug.

If you need the information contained in this document in Spanish, you may contact Member Services at 1-888-620-1919, from Monday through Sunday, from 8:00 a.m. to 8:00 p.m. TTY/TDD users should call 1-866-620-2520.

DOWNLOAD PRIOR AUTHORIZATION CRITERIA

Step Therapy Criteria

In some cases, Triple-S Advantage requires that you first try certain medications to treat your medical condition, before covering other medications for the same medical condition. For example, if medication A and medication B both treat your medical condition, Triple-S Advantage may not cover medication B unless you have tried medication A first. If medication A does not work for you, then Triple-S Advantage will cover medication B.

If you need the information contained in this document in Spanish, you may contact Member Services at 1-888-620-1919, from Monday through Sunday, from 8:00 a.m. to 8:00 p.m. TTY/TDD users should call 1-866-620-2520.

DOWNLOAD STEP THERAPY CRITERIA

Guide for Over-the-Counter (OTC) Drugs and items

This guide includes over-the-counter (OTC) medications and health-related items that do not require a prescription to help treat injuries or illnesses. It contains a list of some commonly used drugs, but does not include all the drugs covered by the plan and some items that assist in your health care. This list was selected by a team of health professionals and represents the therapies of medications and non-prescription items that we understand are important to complement your treatment program with prescription drugs.

DOWNLOAD GUIDE FOR OVER THE COUNTER (OTC) DRUGS AND ITEMS

Find the right plan for you!

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I am undecided. Please call me to provide some guidance.

By completing this form, you as a beneficiary or authorized representative agree to have one of our sales representatives contact you to discuss the products Triple-S Advantage offers under Part C. Please be aware that the person calling you is a Medicare employee or subcontractor. They do not work directly with the federal government. This person could receive compensation based on your plan enrollment.

This selection does NOT obligate you to enroll in a plan, it does not affect your current membership, and it will not enroll you in another Medicare plan.

Last update: 15/10/2020

Member Service

1-888-620-1919

TTY/TDD users

1-866-620-2520

Monday thru Sunday,
from 8:00 am to 8:00 pm

Service for Providers

1-855-886-7474

Monday thru Friday,
from 8:00 am to 5:00 pm

Teleconsulta

1-800-255-4375

Teleconsejo

1-877-879-5964
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