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Writer's pictureThe San Juan Daily Star

Plan Vital enrollees can change insurer starting Jan. 1



Health Insurance Administration Executive Director Roxanna Rosario Serrano, at center

By The Star Staff


Beneficiaries of the government health plan, known as Plan Vital, who are not satisfied with their insurer will be able to change to another one under the Health Insurance Administration (ASES by its acronym in Spanish) contract in 2025.


Starting Jan. 1, when the open subscription period begins, beneficiaries can get a new insurer under the Vital Plan, ASES Executive Director Roxanna Rosario Serrano said .


“Any beneficiary who, for any reason, wants to change insurer, can do so from January 1 to February 14, 2025,” the official said. “After this date, they can only make the change as long as there is a just cause.”


Rosario Serrano noted that those who are satisfied with their insurer’s services do not have to go through any process and will continue to receive their services as usual.


The open subscription period also allows beneficiaries to make changes to medical groups or primary physicians without any particular reason. Currently, Plan Vital, which offers services to 1.4 million beneficiaries, has four insurers under contract; First Medical, MMM, Mennonite Health Plan and Triple S.


To change insurance companies, the official said, the beneficiary can use the ASES Vital App or call an enrollment counselor at 1-833-253-7721, Monday through Friday from 8 a.m. to 6 p.m. A change can also be made via the platform www.planvital.org


“The process is simple,” Rosario Serrano said. “... Suppose the beneficiary wants to stay with the same insurance company but wants to change their primary care group or primary physician. In that case, they can contact their insurance company at the 800 Customer Service line on the back of their card.”


She also emphasized that beneficiaries can change insurance companies without having to change their primary care physician and/or primary care group.


“The decision is always up to the beneficiary,” Rosario Serrano said. “They can change insurance companies, primary physicians, and primary medical groups, too. But they can stay with the same doctor or medical group if they are satisfied with the service received.”


Only those beneficiaries who make the change will receive a new card corresponding to the selected insurance company. After the open subscription period, changes can be made as long as there is a just cause, such as difficulty in accessing covered services or problems with the provider network, among others. Those cases require prior authorization from ASES. The ASES Customer Service call center can be reached at 787-474-3300, option 1, corresponding to beneficiaries.

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