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Plans and Benefits 2014
Plans and Benefits 2013
PPO Plans 2014
PPO Plans 2013
HMO Plans 2014
HMO Plans 2013
PDP Plans 2014
PDP Plans 2013
Provider Directory 2014
Provider Directory 2013
Evidence of Coverage 2014
Evidence of Coverage 2013
Enrollment 2014
Enrollment 2013
Disenrollment
Service Area
Summary of Benefits
2014
Summary of Benefits
2013
Organization Determinations
Appeals and Grievances
Out of Network Coverage
Plan Rating 2014
Plan Rating 2013
Utilization Report
more info>>  

Highlights for PPO Plans 2013

First+Plus Advantage
MA-Only (PPO)

$0 Monthly Plan Premium
$25 monthly Medicare Part B Reduction
$100 every year for eyewear
$300 every 3 years for Hearing Aids

Click one of the following links to download the document in PDF format:
Summary of Benefits
H4011_FP_13_1061_01_I rev F&U
Evidence of Coverage
H4011_FP_13_1127_01_I F&U

Enrollment Form
H4011_FP_13_1070_01_I CMS Approved 09/13/2012

First+Plus Advantage Plus
MA-PD (PPO)

$0 Monthly Plan Premium
$100 every year for eyewear
$300 every 3 years for Hearing Aids
$500 every year for Comprehensive Dental benefits
$5 copay for Generic drugs, unlimited
$25 copay for Preferred Brand Name Drugs
$45 copay for Non-Preferred Brand Name Drugs

Click one of the following links to download the document in PDF format:
Summary of Benefits
H4011_FP_13_1061_01_I rev F&U
Evidence of Coverage
H4011_FP_13_1127_02_I F&U
Enrollment Form
H4011_FP_13_1070_01_I
CMS Approved 09/13/2012

Employer Group Health Plans

First+Plus Gobierno Premium
MA-PD (PPO Employer Group)

$50.00 Monthly Medicare Part B Reduction
$0 Copay for Hospitalization
$0 Copay for Medical Office Visits
$100 every year for eyewear
$300 every 3 years for Hearing Aids
$1000 every year for Comprehensive Dental Benefits
$35 per quarter for OTC Drugs
$2 copay for Generic drugs, unlimited

Conditions and Limitations

  • To join this plan you must be a retiree of the Goverment of Puerto Rico.

Click one of the following links to download the document in PDF format:
Summary of Benefits
H4011_FP_GOB_13_1061_01_I FYI
Evidence of Coverage
H4011_FP_GOB_13_1127_01_I FYI
Enrollment Form
H4011_FP_GOB_13_1070_01_I
FYI

First+Plus Gobierno VIP
MA-PD
(PPO Employer Group)

$65 Monthly Medicare Part B Reduction
$0 Copay for Hospitalization
$0 Copay for Medical Office Visits
$100 every year for eyewear
$400 every 3 years for Hearing Aids
$1000 every year for Comprehensive Dental Benefits
$150 a year for Acupuncture, Gym and Nutritionist
2 annual visits to the Nutritionist
$75 per quarter for OTC Drugs
$3 copay for Generic drugs, unlimited

Click one of the following links to download the document in PDF format:
Summary of Benefits
H4011_FP_GOB_13_1061_01_I
FYI
Evidence of Coverage
H4011_FP_VIP_13_1127_01_I
FYI
Enrollment Form
H4011_FP_GOB_13_1070_01_I
FYI

First+Plus Gobierno Plus
MA-PD
(PPO Employer Group)

$0 Copay for Hospitalization
$0 Copay for Primary Doctor Visits
$100 every year for eyewear
$300 every 3 years for Hearing Aids

Click one of the following links to download the document in PDF format:
Summary of Benefits
H4011_FP_GOB_13_1061_01_I FYI

Evidence of Coverage
H4011_FP_GOB_PLUS_13_1127_01_I FYI
Enrollment Form
H4011_FP_GOB_13_1070_01_I FYI