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Plan Profile

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You are here: FEHB Home > 2002 Plan Comparison > Puerto Rico > Plan Profile: Triple-S

General Information
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Plan Name: Triple-S
Service Area: All of Puerto Rico
Brochure: PDF Version
Brochure: Text Version
NCQA Accreditation: No
JCAHO Accreditation: No
URAC Accreditation: No
Plan Type: POS
Enrollment Code-Self: 891
Enrollment Code-Self & Family: 892
Link to Plan Home Page: http://www.ssspr.com
Telephone: 787/749-4777
Summary results of the 2001 consumers assessment of health plans survey
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Benefits
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In Network - Doctor Care/ Primary Office Visits: $7.50 + 10%
In Network - Hospital Inpatient Room and Board Charges: None
In Network - RX/ Generic/ Retail: 25%
In Network - RX/ Brand/ Retail: 25%
In Network - RX/ Brand/ NonFormulary: 25%
Out of Network - Doctor Care/ Primary Office Visits: $7.50 + 10%
Out of Network - Hospital Inpatient Room and Board Charges: None
Out of Network - RX/ Generic/ Retail: 25%
Out of Network - RX/ Brand/ Retail: 25%
Out of Network - RX/ Brand/ NonFormulary: 25%
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Rates
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Non-Postal
___Twice Biweekly Self: $45.58 Self: & Family: $97.88
___Biweekly Self: $22.79 Self: & Family: $48.94
___Monthly Self: $49.37 Self: & Family: $106.04
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Annuitants
___Monthly Self: $49.37 Self: & Family: $106.04
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U.S. Postal Service Employees (Type A)
___Monthly Self: $22.22 Self: & Family: $47.72
___Biweekly Self: $10.25 Self: & Family: $22.02
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U.S. Postal Service Employees (Type B)
___Monthly Self: $22.22 Self: & Family: $47.72
___Biweekly Self: $10.25 Self: & Family: $22.02
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Worker's Compensation Recipients
___Twice Biweekly Self: $45.58 Self: & Family: $97.88
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Certain Temporary Employees
___Monthly Self: $197.49 Self: & Family: $424.15
___Biweekly Self: $91.15 Self: & Family: $195.76
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Former Spouse Enrollees
___Monthly Self: $197.49 Self: & Family: $424.15
___Biweekly Self: $91.15 Self: & Family: $195.76
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Temporary Continuation of Coverage
___Monthly Self: $201.44 Self: & Family: $432.63
___Biweekly Self: $92.97 Self: & Family: $199.68
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FDIC
___Biweekly Self: $10.25 Self: & Family: $22.02
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Department of Defense Demo Project
___Monthly Self: $54.25 Self: & Family: $128.43
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Department of Defense Demo Project Temporary Continuation of Coverage
___Monthly Self: $221.33 Self: & Family: $523.99
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