Vital plan gives you access to Tags health services: more in UPS supplements

Having a medical plan at any stage of life is indispensable.As much as we take care of ourselves, there are always preventive services, such as going to the dentist, which we must receive.But, the reality is that not everyone can afford a private medical plan.The good news is that for those people with limited resources is the vital plan.

“El Plan Vital es el nombre que se le da al plan de seguro para la población médico indigente que está asegurada bajo el programa Medicaid de Estados Unidos. Medicaid es un programa conjunto donde hay aportación de fondos públicos federales y estatales para sufragar los costos de la provisión de servicios hospitalarios dirigidos a esta población médico indigente”, explicó el director de la Administración de Seguros de Salud (ASES), licenciado Jorge Galva.

If you had never heard of this benefit, you should know that you can obtain it through an eligibility verification that is done through the Medicaid Office of the Department of Health of Puerto Rico. La determinación de elegibilidad está basada esencialmente en los ingresos que recibe la persona que solicita el beneficio.

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“In Puerto Rico, since November 2020 the poverty level rose to 85%. Esto quiere decir que una persona que recibe unos $14,000 anuales es elegible para el programa”, mencionó Galva.

In addition to income, age is another factor to take into account when requesting the vital plan.

Minors are eligible to the Child Medical Insurance Program (CHIP), which is insurance aimed at child care.Those who are of legal age and under 65, who are homeless doctor and have an income level, are eligible for the vital plan. En el caso de los mayores de 65 años son la población dual, porque son elegibles a Medicare, pero, si son médico indigentes pueden tener las dos cubiertas.The difference is that Medicare would be the primary and medical cover the secondary.

Among the eligible people are the following:

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De acuerdo con el director de ASES, Puerto Rico tiene la particularidad que hace que nuestro programa de Medicaid sea diferente al del resto de los estados de Estados Unidos.

“Anywhere else in the United States we have a dual organization where the Medicaid company has two entities that are responsible for different functions.The first function is that of the Medicaid office that is responsible for eligibility and maintain the cleaning of beneficiaries to ensure that the service is not being paid to a person who is not eligible or when eligibility ceases because its income increases or because go dead.The second function is when Aes is responsible for administering the Health Coordinated Care Program under Law 72 of 1973, ”said Galva.

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Lo que esto quiere decir es que cuando una persona es elegible, ya tiene la opción de escoger una de las cuatro aseguradoras del Plan Vital, que son: Plan de Salud Menonita, Triple S, MMM y First Medical.If the person does not opt for any of them, then one of the four insurers is assigned.

If after choosing the insurer, the beneficiaries want to change to another, they can do it and, precisely, this is the best time to do so.

“Right now we are in the open registration period that extended to 45 days and run from November 1 to December 15.At that time, any beneficiary can change insurance.It doesn't matter if it takes a lot or little time with that insurer.This is what is called ‘change without just cause’.You don't have to explain reason.When the open registration period closes to change, it has to do it 'for just cause' and the reason that is mosttime and want to continue their treatment, ”Galva said.

What services does the population receive?

The director of Aces said that the benefits that the vital plan includes are all primary care (such as visits to doctors and vaccines), acute hospitable, pharmacy, dental, radiology and laboratories.

“There are medical mandatory services that Puerto Rico does not cover them yet due to lack of financing for these services.One of those is the prolonged care service.This benefit is achieved only by exception, ”added the director of Aces.

Finalmente, Galva le recomendó a los beneficiarios que hagan uso del proceso de inscripción abierta que está vigente hasta el 15 de diciembre para que puedan estar en la aseguradora de su preferencia.