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Health Guidance Hotline, available 24 hours a day, 7 days a week.
Dedicated Teleconsulta for TTY/TDD Callers: 711 | 1-855-209-2639
Supporting you 24 hours, 7 days a week, with caregiver service.
Monday through Sunday, from 8:00 a.m. to 8.00 p.m.
Triple-S Advantage is committed to reducing and controlling the incidence of fraud, waste, and abuse in the health insurance industry. Health insurance fraud, waste, and abuse affect us all. Help us detect it!
Fraud, waste, and abuse affect you as a plan beneficiary, as well as health plans and service providers. Health resources are sometimes limited, and it is important that they be used appropriately. Using resources inappropriately may result in a lower quality of medical services.
Fraud refers to any intentional and deliberate act to deprive another of property or money, through deception and other unfair means. It involves the intent to mislead or make false representations to obtain personal gain.
Practices that directly or indirectly, result in unnecessary costs to the health care programs, caused by the misuse of resources.
It is defined as the excessive and improper use of resources or services, in a manner contrary to usual practices to obtain personal gain. This results in unnecessary costs for the health care system.
Read your service and medication history carefully. Make sure the information is correct, and refer any suspicious claim to Triple-S Advantage.
Protect your health plan ID card as if it were a credit card. Never offer information about your health plan to solicitors over the telephone or unknown persons.
Get familiarize with the terms of your coverage and keep copies of medical tests to avoid redundant services.
If you visit several doctors, save a copy of your labs and other test results, and keep a handy list of the medications that you take. This way, you won’t have to repeat time-consuming and costly tests. Take a more proactive stance in your health care!
Check the information before signing any insurance application or health service claim. Never sign a blank enrollment form. Make sure you know exactly what you are signing.
Beware of “free” medical services, as illicit entities use this lure to obtain information.
If you have any information or suspicion of a potential case of fraud, waste, or abuse, you may contact us through the following efficient communication methods:
Secure Fax: 787-625-8700
Internet Portal: https://secure.ethicspoint.com/domain/en/report_company.asp
(Once you access the portal, please select Triple-S Management Corporation)
Triple-S Advantage, Inc.
Special Investigation Unit
PO Box 363628
San Juan, PR 00936
Grupo Triple-S has a Code of Business Conduct and Ethics, which establishes the Corporation’s commitment to ethics and compliance with federal laws and regulations and the Commonwealth of Puerto Rico. In addition, it describes compliance expectations for all employees, members of the Board of Directors, subcontracted and related entities.
Read the Code of Business Conduct and Ethics, it guides you to know what to do in situations of compliance, fraud, waste or abuse.
If you are aware or suspect of compliance, fraud, waste or abuse situation, contact the Triple-S Advantage Compliance Department through the following effective lines of communication:
Ethics Point (Available 24 hours / 7 days a week)
Your call will be handled in a strictly confidential manner.We will not retaliate, intimidate, or discriminate against you in any way.
It is everyone’s responsibility to make good use of the health plan. We all pay for fraud! For more information, you may access the following links:
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.
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By clicking this link, you are leaving the website of Triple-S Advantage. If you need further assistance you may contact the Member Service Center of Triple-S Advantage at 1-888-620-1919. (TTY users should call 1-866-620-2520.) Hours are Monday through Sunday from 8:00 am to 8:00 pm.
Triple-S Advantage has a strong commitment to protecting the confidentiality of our members’ sensitive information. We take information privacy very seriously and it is important to us that our members are made fully aware of a potential privacy issue. We have learned that personal information of some of our members, including their name, health plan identification number, date of service in which treatment was provided, and treatment codes describing the service provided was mailed to the wrong address. The Social Security Numbers and date of birth of our members were NOT disclosed as a result of this incident.
On December 5, 2017, Triple-S Advantage discovered that notices sent in November 2017 to health care providers involved in the treatment of our members were mailed to the wrong address. However, we have not received any indication that the information has been accessed or used by an unauthorized individual.
Triple-S Advantage has performed an extensive investigation into why and how their personal information was disclosed. We have taken immediate steps to ensure additional notices to our members and your health care providers are sent to the correct address, such as: correction of the mailing process, completion of testings and sending the letters to the correct address of your provider. The members who may have been affected by this incident will receive first-class mail notices.
We have reported the incident to the required government agency, the Health Insurance administration of Puerto Rico (ASES) and will comply with the evaluation as required by the Office of Civil Rights within the time period established.
We are making an announcement about this incident so that affected Triple-S Advantage members can consider taking action to reduce the chances that their personal information will be misused:
If you or a family member belong to Triple-S Advantage and want additional information about the incident, you may contact our Customer Service Department from Monday through Sunday from 8:00 am to 8:00 pm at our toll-free number 1-888-620-1919, TTY users should call 1-866-620-2520 or by e-mail at: moc.e1696187208gatna1696187208vdass1696187208s@ecn1696187208ailpm1696187208ocaap1696187208ih1696187208.
You may also visit our Internet website advantage.grupotriples.com for further information.
If you are a Medicare Platino member, you can also contact the Health Insurance Administration of Puerto Rico (ASES) at or Customer and Providers Services Offices (PROBENE) at 1-800-981-2737/1-800-981-ASES from Monday through Friday 8:00 am to 4:30 pm, a Customer Services Representative will assist you. TTY users should call (787) 474- 3389. You can also contact us by email at gro.r1696187208psesa1696187208@dadi1696187208cavir1696187208pedla1696187208icifo1696187208.
Triple-S Advantage sincerely apologize and regret this situation. The privacy and security of our member’s information is very important. We are working hard to strengthen our processes for the benefit and protection of our members.
Please Note: Triple-S Advantage will NOT call or email anyone requesting any personal information as a result of this incident. If you receive an unsolicited call or email that appears to be from Triple-S Advantage, your local hospital or physician office, please do not provide any personal information in response to these calls or emails.
Triple-S Advantage, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Triple-S Advantage, Inc. cumple con las leyes federales aplicables de derechos civiles y no discrimina por razón de raza, color, origen de nacionalidad, edad, discapacidad, o sexo. Triple-S Advantage Inc. 遵守適用的聯邦民權法律規定，不因種族、膚色、民族血統、年 齡、殘障或性別而歧視任何人ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call: 1-888-620-1919 (TTY: 1-866-620- 2520). ATENCIÓN: Si usted habla español, servicios de asistencia lingüística están disponibles libre de cargo para usted. Llame al: 1-888-620-1919 (TTY: 1-866-620-2520). 注意:如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-620-1919 (TTY: 1-866-620-2520)。
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