Some benefits of this plan: $50 Monthly Reduction to Medicare Part B Premium $225 por food and groceries shopping, housecleaning, among others* $35 Hospital Stay $0 Primary Care Physicians (PCP) $10 Specialists $5 Laboratory Tests and X-Rays Preventive Dental Benefit $1,000 every year for Comprehensive Dental Benefit. $200 annually for prescription eyeglasses or contact lenses $500 every year for Hearing Aids 24 one-way trips to plan approved locations, including to non-medical destinations* 6 supplemental nutritionist visits *Restrictions apply. This information is not a complete description of benefits. Call: 1-833-779-7999 (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 DOWNLOAD PRE-ENROLLMENT CHECKLIST Evidence of Coverage (EOC)The EOC gives you details about your Medicare health care for the calendar year. It also explains how to get coverage for the services 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 and providers for the next year. The ANOC helps you compare your current health benefits and costs with those for next year. DOWNLOAD ANNUAL NOTICE OF CHANGE Hospice Services RightsDOWNLOAD HOSPICE SERVICES RIGHTS Provider Directory 2021 Provider DirectoryThis 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 HospiceDOWNLOAD HOSPICE DOCUMENT Compare this Plan Óptimo (PPO) Find the right plan for you! Tell us more about yourself to help us find the best option for you I am undecided. Please call me to provide some guidance. Please fill the required fields: Yes, I wish to receive information about the Medicare Advantage (Part C) coverage products and services offered by Triple-S Advantage. First Name Last Name Mailing Address Personal E-mail Home Phone Cell Phone Current Plan (if apply) Message Medicare Part A Medicare Part B Government Health Plan of Puerto Rico (GHP) ELA * May we contact you? Yes No 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. CONTACT ME Last update: 15/10/2020
