I have private insurance, can I obtain coverage from the PR Government Health Insurance Plan, Vital?

If you are eligible for the Government Health Plan, Vital, you may retain your private health insurance. Bring a copy of your private health insurance card on the appointment date. If you are a beneficiary of Medicare, Medicare Platinum or Medicare Advantage, please also bring a copy of these cards and tell the technician who will evaluate you. Note: If you are an employee of the Government of Puerto Rico, you would have to waive the employer's contribution for health insurance in order to become eligible for the Government Health Plan, Vital.beneficiary of Medicare, Platinum Medicare.

I'm a foreigner, I would like to know if I can apply for PR Government Health, Vital Insurance Plan benefits?

If you obtained your permanent residence before August 22, 1996, you can apply for the Government Health Plan, Vital benefits. If your residence was granted after this date, you will have a waiting period of 5 years from the date you were granted the residence permit.
If you are of Cuban nationality and / Or Haitian, then the waiting period does not apply. To request an appointment or orientation, please call our Call Center (787) 641-4224 , TTY (787) 625-6955; Monday through Friday from 8:00 am to 6:00 pm.

What documents should I bring on the day of the appointment?

The following documents are required:

Photo Identification Card (eg driver's license, voting card).

Original and copy of the Social Security Card (of all the members of the family unit).

If you receive income from Social Security:

• Copy of the check (of all the members of the family unit that receive Social Security).
• If is direct deposit to your bank account, copy of the account statement.
• Or bring a copy of the letter sent by the Social Security Administration at the beginning of the year.

If you receive pension income (retirement, veterans, military or disability)

• Copy of the check or pay stub.
• If is direct deposit to your bank account, copy of the account statement.

Copy of Marriage Certificate (if applicable).

Evidence of studies of children living in the home.

Water, Light or Telephone billing statements.

If you are pregnant, copy the pregnancy test.

If divorced or separated, bring evidence.

If you are a foreigner, evidence of American citizenship or legal residency.

I have more than one car (vehicle) Can I be eligible for Government Health Plan, Vital?

Each Family nucleus may have up to two vehicles. The Program will consider as resource from third vehicle forward, in accordance to the established norms.

I applied for the PR Government Health, Vital Insurance Plan but I don't agree with the evaluation results. What can I do?

You can file an appeal at the office where you were evaluated, mail it to the following address:

You have a 30-day term from the date you were assessed to file the appeal request.
In the documents section, you will find the form to request the appeal.

I moved from my place of residence. What do I have to do?

If you moved, you should visit the Medicaid office of your place of residence and notify the change of address as soon as possible to ensure continuity of services.

I started to work. Should I notify it?

Yes, it is your duty to notify it. Call the Medicaid Call Center and request an appointment to re-evaluate your case. You must present a letter from the employer stating the date of commencement of employment and the salary to be earned.

Comencé a recibir beneficios de desempleo. ¿Debo notificarlo?

Yes, it is your duty to notify. Call the Medicaid Program Call Center Tel. (787) 641-4224 TTY (787) 625-6955 and request an appointment to re-evaluate your case.

How can I report fraud?

You can report a case of fraud or suspected fraud through:

• From this page using the "Medicaid Fraud" section or clicking here
• From email to: fraudemedicaid@salud.pr.gov
• Calling the Medicaid Program at (787) 765-2929 Ext. 6725, 6726, 6727, 6722, 6719
• From our Call Center to Tel. (787) 641-4224 TTY (787) 625-6955

I have more than one property. Can I be eligible for the PR Government Health Insurance Plan?

It is necessary to present a certification of values for all the concepts that obtains it in the office of the CRIM. It will be considered as resource or income of the second property onwards in accordance with the Program Rules and Procedures. You can call CRIM at 1 (888) 770-2746 and metro area at (787) 625-4000.

I received a letter from the insurer informing me that my case will be closed in X working days

That letter is a reminder that your eligibility is about to expire. You can also verify the expiration date on the sheet that was given to you on the day you were evaluated. (Notice of Action Taken - Form MA-10). You can also check your expiration date on this page and/or by calling our Call Center: (787) 641-4224, TTY (787) 625-6955.

I don't know when my case expires

You can check your expiration date on the sheet that was given to you on the day you were evaluated. (Notice of Action Taken - Form MA-10). You can also check your expiration date on this page and / or by calling our Call Center (787) 641-4224, TTY (787) 625-6955; Monday through Friday from 8:00 am to 6:00 pm.

I'm a certified beneficiary and when I requested service it appears that my card has been cancelled.

You should contact your insurer for this situation. The number to call is displayed on your plan card.
Molina Healthcare 1-877-335-3305
MMM 1-844-336-3331
Triple-S 1-800-981-1352
First Medical 1-844-347-7800
Plan de Salud Menonita 1-866-600-4753

I'm pregnant. Should I report it to the Medicaid Office?

Yes, you must inform us as soon as possible, in this way we ensure continuity of your health coverage.

What are the office hours of operation?

Our offices are open from 7:30 am to 4:00 pm Monday through Friday.

What time should I arrive for my appointment?

If you have an appointment you should arrive 15 minutes before the appointment. If you do not have an appointment, call the Medicaid Call Center to get one. The phone number is (787) 641-4224, TTY (787) 625-6955 monday to friday from 8:00 am to 6:00 pm.

I live in the United States, and soon I will live in Puerto Rico, where do I apply for Medicaid benefits?

To apply for Medicaid Program benefits you must call our Call Center, (787) 641-4224, TTY (787) 625-6955 Monday through Friday from 8:00 am to 6:00 pm. If you are currently a Medicaid beneficiary in the United States you should proceed to close your case there before applying for benefits here.

I'm going to live in the United States. Should I close my case in Puerto Rico?

Yes, you must request the closure of your case in Puerto Rico. For this, you may visit the Medicaid office of your home town or send a letter stating: Full name, family nucleus number, or MPI number (both appear on the Notice of Action Taken [MA-10] Was given on the day of your evaluation).
You can send your letter by mail to:

I'm a beneficiary of the PR Government Health Insurance Plan, Vital and while traveling to the United States, I had to go the emergency room. Is that expense or bill covered?

Under the Government Health Plan, Vital, there are two groups of eligible: federal eligible (Medicaid or CHIP) and state eligible. If you are federally eligible (Medicaid or CHIP), those expenses are covered and you must contact your insurer. If you are state-eligible, those expenses are not covered and you would need to contact the hospital where you received the service for a payment plan.

How do I know if I'm Medicaid elegible or state elegible?

When you were evaluated by us you were given a document titled Notice of Action Taken (MA-10), the document tells you whether you are eligible for Medicaid or State. If you have any questions call or visit our office located in your home town.