Puerto Rico Government Health Plan

Description

Puerto Rico Government Health Plan

Molina Healthcare of Puerto Rico

Telephone
Member Services (877) 335-3305
Nurse Advice Line (888) 620-1515
TTY (787) 522-8281
Provider Services (888) 558-5501
Mailing Address
P.O. Box 364988
San Juan, P.R.
00936-4988

Physical Locations

Regional Offices Southwest Region
Avenida Hostos 111
Edificio Reliable
Ponce, PR

Calle 25 de Julio #53
Urb. Villa Milagros
Yauco, PR

Regional Office East
Professional Office Bldg.
Carr. PR 908 Km. 0.4
Barrio Tejas
Humacao, PR

Eligibility and Enrollment
AM I ELIGIBLE FOR GOVERNMENT HEALTH PLAN?

Those eligible are :
American citizens.
Persons with low or no income.
Population of Federal Medicaid Program: persons over age 65, persons that are blind or disabled and pregnant women.
Children under the CHIP Program.
Government employees, retirees and their dependents whose payroll is processed by the Treasury Department.
Members of the Police Department of Puerto Rico, their widows/ers and children that survive them.
Veterans.
Children under State custody through the Family and Children Administration (ADFAN, for its acronym in Spanish).
Survivors of domestic violence through the Women’s Advocate Office.
The Medicaid program will determine whether you are eligible for the GHP. Once you are certified eligible for Medicaid, they will give you form MA-10 entitled “Notice of Action Taken on Application and/or Re-Assessment” which indicates that you have been certified eligible. The MA-10 form includes the dates of your eligibility period. The Medicaid Program will also give you the welcome letter to the GHP, from the Health Plan in your region.
You will receive your ID card by mail within five (5) business days after being certified eligible for Medicaid. If you do not receive the card during that period and you need medical services, you can show the MA-10 form to the GHP contracted service provider to confirm that your name is on the MA-10, that it is signed and you are authorized to receive services.​​​

What’s Covered
The Government Health Insurance Plan offers a broad Service Coverage with minimum exclusions. Your services will not be reduced, limited or excluded because you had a preexisting conditions before enrolling in the Government Health Plan. 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. Please contact us if you need information of what is a medically necessary service.
Preventive Services.
Dental Services.
Diagnostic Testing Services.
Medical and Surgical Services.
Ambulance Services.
Maternity and Prenatal Services.
Emergency Room Services.
Post-Stabilization Services.
Hospitalization Services.
Mental Health Services.
Mental Health Hospitalization Services.
Pharmacy Services.
Special Coverage Services.
Medicare Coverage Services.
Understanding and Emergency versus Urgency.