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Participants in the government health plan, referred to as Plan Vital, who are not content with their current insurer will have the opportunity to switch to a different one under the Health Insurance Administration (ASES, in Spanish) contract starting in 2025.
Beginning January 1, when the enrollment period opens, beneficiaries can select a new insurer as per the Vital Plan, according to ASES Executive Director Roxanna Rosario Serrano.
“Any participant who wishes to switch insurers for any reason can do so from January 1 to February 14, 2025,” the director explained. “After this window, changes can only occur with a valid reason.”
Rosario Serrano pointed out that individuals happy with their insurer need not take any action and will continue to receive uninterrupted services.
The enrollment period also provides the flexibility for beneficiaries to alter their medical groups or primary care physicians without needing a specific justification. Currently, Plan Vital serves 1.4 million participants and has four insurers contracted: First Medical, MMM, Mennonite Health Plan, and Triple S.
To switch insurance providers, the director indicated that beneficiaries can utilize the ASES Vital App or reach out to an enrollment advisor at 1-833-253-7721, available Monday to Friday from 8 a.m. to 6 p.m. Changes can also be made through the website www.planvital.org.
“The procedure is straightforward,” Rosario Serrano noted. “… If a beneficiary wants to retain the same insurance provider but wishes to change their primary care group or physician, they can simply contact their insurer using the 800 Customer Service number located on the reverse side of their card.”
She also stressed that participants can change insurance providers without needing to also change their primary care physician and/or primary care group.
“The choice is ultimately the beneficiary’s,” Rosario Serrano stated. “They have the option to switch insurers, primary physicians, and primary medical groups. However, they may choose to continue seeing the same doctor or group if they are content with the services.”
Only beneficiaries who decide to switch will receive a new card corresponding to their chosen insurance provider. Once the enrollment period has ended, changes can still be initiated as long as there is a valid reason, such as issues accessing covered services or problems with the provider network, among others. Such cases will require prior approval from ASES. The ASES Customer Service center can be contacted at 787-474-3300, option 1, designated for beneficiaries.
