Constellation Health offers plans with the benefits that adapt to your needs. Each one of them is designed with the intention of bringing the adequate access you deserve. Get to know our new products so you can choose the one that will make you feel better than yesterday.
On 2019 there will be some changes to the plan’s costs and benefits. Select the link to see the booklet that explains the changes to your coverage.
The Evidence of Coverage describes in detail the benefits and processes that you need to know so you can use your health plan in an appropriate way. To see the Evidences of Coverage, select the following links:
As a Medicare Beneficiary you have the right to choose the plan with the benefit coverage that suits your needs best. To learn more about Constellation Health’s products, select the following links:
You can end your membership in our plan only during certain times of the year, known as enrollment periods. From October 15 to December 7 of each year, everyone has the opportunity to make any changes. From January 1 to February 14, any person enrolled in a Medicare Advantage plan has the opportunity to disenroll from that plan and return to Original Medicare. Anyone who disenrolls from a Medicare Advantage plan during this time, can join a Medicare Prescription Drug plan independently during the same period. If you enroll in a Medicare Prescription Drug plan, you will be automatically disenrolled from our plan and return to Original Medicare. Usually, you cannot make changes at other times unless you have special exceptions, for example you move outside the service area of the plan coverage or to enroll in a plan, in your area, with a rating of 5 stars.
You can send a letter with the reason for the disenrollment request from our plan. The letter can be sent through:
PO BOX 360493
San Juan, PR 00936
Important: The letter must be signed by the member. In case the member has a legal tutor, the letter must indicate that he/she is the member’s legal tutor and/or attach a copy of the power of attorney.
Also, you can request the disenrollment through Medicare by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
Our plan must end your membership if any of the following occurs:
- If you do not stay continuously enrolled in Medicare Part A and Part B.
- If you move out of our service area.
- If you are away from our service area for more than six months.
- If you become incarcerated (go to prison).
- If you provide incorrect withhold information about other insurance you have that provides prescription drug coverage.
- If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility in our plan.*
- If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan.*
- If you let someone else use your membership card to get medical care* If we end your membership because of this reason, Medicare may have your case investigated by the General Inspector.
*We cannot make you leave our plan for this reason unless we get permission from Medicare first.
Member can request the plan cancellation through Customer Service Center.
- 787-304-4040 Metro Area
- 1-866-714-0724 Toll Free
- 1-866-805-7777 TTY Users (people with hearing and speech difficulties); toll free
Our hours of operation are is from Monday to Sunday from 8:00AM to 8:00PM. We have interpreters for Spanish non-speakers.
PO BOX 360493
San Juan, PR 00936
Important: The letter must be signed by the member. In case the member has a legal tutor, the letter must indicate that he/she is the member’s legal tutor and or attach a copy of the power of attorney.
What are Over the Counter (OTC) items?
The Over the Counter (OTC) items include approved drugs by the Federal Drugs Administration (FDA) to treat simple conditions and that can be obtained Over the Counter. Also, personal care and healthcare items are included under this benefit.
Which Constellation Health products include the Over the Counter (OTC) items benefit?
The products that include the Over the Counter (OTC) items benefit are:
What does the Over the Counter (OTC) items benefit consist of?
You’ll have a specific amount every three months for the purchase of Over the Counter (OTC) items.
If I don’t use the amount during the three months, will they roll over?
No. You must use your benefit within the three months in which they belong to. Every three months you’ll begin with a new balance.
What can I buy with the $20 of the Over the Counter (OTC) items benefit?
You can buy any item included in our list and that is under the following categories: antiacids, antidiarrheals, antihistamines, antiseptics, antibacterials, antifungals, items for mouth care, orthopedic items for comfort, weight-loss supplements, sunscreens, decongestants, laxatives, sleep aid drugs, items to relieve pain and/or inflammation, drugs for urinary pain, hormone replacements, first-aid supplies, urinary incontinence supplies, fiber supplements, vitamins and minerals. You must make your purchase through the pharmacist counter.
Click here for a list of covered over-the-counter ítems.
Do I need a prescription from my doctor to buy these items?
For most of the product categories you don’t need a prescription. Nevertheless, for your security, some items require a prescription, for they can have reaction or interaction when they are mixed with the drugs prescribed by your doctor.
What must I do to buy Over the Counter (OTC) items?
You can visit any pharmacy of our network. Choose the item that you desire to purchase. Go to the pharmacy counter to validate the item is in our list and process it. You must present your plan card at the moment you use the benefit.