First Medical Vital

PO Box 195079, San Juan, PR 00919-5079
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1-844-347-7800

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How Vital Plan works with other Health Insurance?

How Vital Plan works with Medicare?

If you have Medicare, your Vital Plan coverage works in a different way. Medicare is health insurance for people who are age sixty-five (65) and older, and for some people of any age who Social Security says are disabled. People with end stage renal disease can have Medicare too.

These are the different parts of Medicare:

  • Part A is for hospital stays, skilled nursing facility care, home health care, and hospice care.
  • Part B is for your doctor’s services and outpatient care.
  • Part D is for prescription medicines.

There are also other ways to have Medicare. These are called Medicare Health Plans (these plans are sometimes called Medicare Part C). These plans put all of the parts A, B, and D together for you in one plan.

To learn more about Medicare, call them at 1-800-633-4227. It’s a free call.

If you have Medicare, your Vital Plan coverage works differently:

  • Your Medicare is your first (primary) insurance. Hospitals, doctors and other health care providers will bill Medicare first.
  • Vital Plan is your second (secondary) insurance. After your providers bill Medicare, they will also bill Vital.

If you have Medicare Part A:

  • Vital Plan will pay once you have reached the limit of what Medicare pays for.
  • Vital Plan will not pay for your Part A deductibles.
  • You will pay copay for services depending on what type of coverage of the Vital Plan you have. See the copay chart on page twenty (20) for more information.

If you have Medicare Part A and Part B:

  • Vital Plan will pay for your pharmacy and dental services.
  • Vital Plan will not pay for your Part A deductibles.
  • Vital Plan will pay for your Part B deductibles and copayments.

If you have Medicare Part C:

  • You have the option to choose a Platino Plan, which will cover services your Medicare Health Plan doesn’t cover.

How Vital Plan works with other Insurance?

If you have other health insurance, your other insurance is your first (primary) insurance. Hospitals, doctors and other health care providers will bill your other insurance first. Vital Plan is your secondary insurance. After your providers bill your other insurance, they will bill Vital Plan.

If you have other health insurance, you must let First Medical and Medicaid Program know. Call Medicaid Program and First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805 to let them know.

When you go to your health care visits, bring your Vital Plan card and your other insurance ID card.

How Vital Plan works if you are a Public Employee or Retiree?

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If you are a public employee or a retiree from the Government of Puerto Rico, you can choose Vital Plan as your health insurance. Your employer will pay ASES and you will pay the difference, if there is one.

You can also visit your local Medicaid Office to see if you are eligible for the Vital Plan for other reasons. If you are eligible for the Vital Plan for other reasons, you will not have to pay the difference, if there is one. If you and your husband (or wife) is public employees or retirees from the Government of Puerto Rico, you can apply together for the Vital Plan. This is called “Joint Enrollment”.

If at any time you lose eligibility for the Vital Plan, you can sign up for the Vital Plan in the ELA Puro group. That way, you can continue getting your Vital Plan benefits until you can get insurance through your job. You do not have to continue as ELA Puro. It is your choice!

If you get other health insurance from your job, you have to cancel your Vital Plan benefits before you sign up for the other health insurance. Visit your local Medicaid Office to cancel your Vital Plan benefits. The change will be effective on the first day of the following month after you cancel your benefits. If you do not cancel your benefits, you will have to pay for part of the cost of the premium for the new insurance you affiliate with.

How Vital Plan works if you are a member of the Police Department of Puerto Rico?

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The members of the Police Department of Puerto Rico, their spouses and children may also enroll in the Vital Plan. The Police Department of Puerto Rico will pay.

If you are a member of the Police Department of Puerto Rico, you must visit your local Medicaid Office to sign up for the Vital Plan.

If a member of the Police Department of Puerto Rico dies, his/her widow can continue to get Vital Plan benefits until he/she remarries. Children can continue to get Vital Plan benefits up to the age of twenty-six (26).

If you need additional information, please visit ASES website through the ASES button