• Basic Coverage
  • Special Coverage
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    The GHP offers a broad Service Coverage with minimum exclusions. Your services will not be reduced, limited or will be excluded because you had a preexisting conditions before enrolling in the GHP. You will not have to comply with a waiting period to receive any of the Covered Services. Services will be covered from the moment Medicaid grants your eligibility. Services will be provided if medically necessary. Medically necessary means:

    Services related to (i) the prevention, diagnosis, and treatment of health impairments; (ii) the ability to achieve age-appropriate growth and development; or (iii) the ability to attain, maintain, or regain functional capacity. Additionally, Medically Necessary services must be:

    • Appropriate and consistent with the diagnosis of the treating provider and the omission of which could adversely affect your medical condition;
    • Compatible with the standards of acceptable medical practice in the community;
    • Provided in a safe, appropriate, and cost-effective setting given the nature of the diagnosis and the severity of the symptoms;
    • Not provided solely for your convenience or the convenience of the Provider or Hospital; and
    • Not primarily custodial care (for example, foster care).

    In order for a service to be Medically Necessary, there must be no other effective and more conservative or substantially less costly treatment, service, or setting available.

     

    Enrollee Services
    1-844-336-3331 (toll free)
    787-999-4411 TTY (hearing impaired)
    Monday through Friday
    from 7:00 a.m. to 7:00 p.m.

    Postal Address
    PO BOX 72010
    San Juan, PR 00936-7710

    Physical Address
    Fundación Ángel Ramos 
    Ave. Chardón  
    Hato Rey, PR

    Policies

    Non Discrimination