Once you sign up for Vital Plan, you can choose your Insurer. Your Insurer will work with you and your doctors to keep you healthy.

There is an enrollment counselor available in Medicaid offices and on the phone, who can help you choose an Insurer. The enrollment counselor does not work for any Insurer or any providers. They are neutral. They can give you information about Vital Plan and your benefits. They can tell you about the choices available to you and help answer your questions. They can’t choose for you.  They can help you:

• Choose a new Insurer or change Insurers;
• If you change your Insurer, they can also help you change your Primary Care Physician (PCP) or Primary Medical Group (see more information here).

You can contact the Enrollment Counselor for support:

• By phone: 1-833-253-7721
  Monday through Friday from 8:00 am to 6:00 pm
• TTY Service available: 1-888-984-0128
• Through the Internet: www.planvitalpr.com
• In the Medicaid Offices

There are Enrollment Counselor staff in each of the Medicaid Offices. The offices are open Monday through Friday from 7:30am to 4:00pm. Your Insurer can tell you the Medicaid Office that is closest to you. If you do not choose an Insurer, one will be chosen for you.

Can I change my Insurer?

Yes, you can ask to change your Insurer. Once you have chosen an Insurer or one has been chosen for you, you have 90 days to change Insurers. You can also change your Insurer once a year during the “open enrollment period”, which is from November 1 to January 31.

If you want to change your Insurer, call the Enrollment counselor at 787-641-4224 or visit your local Medicaid Office.
You can also ask to change your Insurer at any time if you have certain reasons, like:

• You are not able to access services or providers.
• You cannot get all related services you need at one time from the doctors, healthcare professionals and service facilities that work with your Insurer.
• You get poor-quality care.
• You ask for a service that your Insurer does not cover because of moral or religious reasons.
• Your Insurer does not have doctors that are experienced in dealing with your health care needs. 

If you want to change your insurer for one of these reasons, you can ask for this change from the Insurer, the enrollment counselor or ASES. ASES will decide if you can change or if you have to wait until Open Enrollment. If you do not like the decision ASES makes, you can ask them to reconsider. If the decision is still not to your liking, you can ask for a hearing.

Can my membership with my Insurer stop?

Yes, your membership with your Insurer will stop if you:

• Lose eligibility for Vital Plan.
• Move outside of Puerto Rico.
• Go to prison.
• Give your ID card to someone else to use.
• Move to a long-term care nursing facility or intermediate care facility for the developmentally disabled.
• If you request a voluntary termination of coverage
• If a termination is requested by your insurer
• In any of these situations you will lose Access to services under Vital Plan

You will not lose your membership with your Insurer if:

• You have changes in your health.
• You are using more health care services
• If you complete your recertification process on time.  The new eligibility period is generally 12 months but may vary at the sole discretion of the Medicaid Program

You also might want to stop your membership with your Insurer if you no longer need your Vital Plan benefits. If this happens, let your Medicaid Office and your Insurer know.