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Platino Blindao (HMO-SNP)

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Why choose Platino Blindao (HMO-SNP)?

If you are looking for a plan that provides you with money savings without compromising benefits, Platino Blindao (HMO-SNP) is for you. Platino Blindao (HMO-SNP) offers a monthly reduction in the Medicare Part B premium of $148.50 without sacrificing the supplemental benefits you need, such as eyewear, dental, and hearing aids.

Medicare Platino, Plan de Salud del Gobierno

Who is elegible for this plan?

  • Beneficiaries with Medicare Parts A and B, who are also eligible for Medicaid coverage
  • 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. You may enroll in this plan during the Annual Enrollment Period or once every Special Enrollment Period*.

Some benefits of this plan:

  • $148.50 monthly reduction to Medicare Part B premium
  • $0 Hospital Stay
  • $0 Primary Care Physicians (PCP)
  • $0 Specialists
  • $0 Laboratory Tests and X-Rays
  • $0 Covered Prescription Drugs
  • Preventive Dental Benefit
  • $2,000 per year for Comprehensive Dental Benefit
  • $100 every 3 months for OTC WITHOUT PRESCRIPTION
  • $500 annually for prescription eyeglasses or contact lenses
  • $1,500 every year for Hearing Aids
  • 36 one-way trips to plan-approved locations
  • 3 supplemental nutritionist visits


SSS-A tu Lado
In-Home Support Specialized In-Home Support
Up to 48 hours of care in a calendar year (four (4) hours per day for a maximum of 12 days in the calendar year). Up to 40 hours every 3 months (quarterly) for a maximum of 160 hours in a calendar year
Benefit eligibility will be based on medical recommendation and to meet certain conditions. Benefit eligibility will be based on certain eligible condition(s) and the requirement to meet with a Care Manager at least once every 3 months (quarterly) in order to have access to the benefit.
See Evidence of Coverage for additional details on these benefits.


*Each Special Enrollment Period occurs from January to March, April to June and From July to September. If you’re in a drug management program, you may not be able to change plans.

Some Specialists may require a referral from your primary physician. 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.


Evidence of Coverage (EOC)

The EOC gives you details about your Medicare healthcare 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.


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.


List of Durable Medical Equipment (DME)

The Durable Medical Equipment (DME) lists information about brands, equipment manufacturers and medical providers in this plan, as described in your Evidence of Coverage.


Provider and Pharmacy Directory 2022

Provider Directory

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


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.



Drug Formulary

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


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.

Effective Changes at 2/1/2022

Effective Changes at 3/1/2022

Effective Changes at 7/1/2022

Effective Changes at 8/1/2022

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, Monday through Sunday from 8:00 a.m. to 8:00 p.m. TTY/TDD users should call 1-866-620-2520.


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, Monday through Sunday from 8:00 a.m. to 8:00 p.m. TTY/TDD users should call 1-866-620-2520.


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 healthcare. 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.


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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: 15/10/2021

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