Triple-S Management Corporation offers a portfolio of managed care and related products in the Commercial, Medicare Advantage and Medicaid markets.
In the Commercial market, the company offers products to corporate accounts, the U.S. federal government employees, local government employees, individual accounts and Medicare Supplement. It also participates in the Government of Puerto Rico Health Insurance Plan, a government of Puerto Rico and the U.S. federal government funded managed care progr...
Triple-S Management Corporation offers a portfolio of managed care and related products in the Commercial, Medicare Advantage and Medicaid markets.
In the Commercial market, the company offers products to corporate accounts, the U.S. federal government employees, local government employees, individual accounts and Medicare Supplement. It also participates in the Government of Puerto Rico Health Insurance Plan, a government of Puerto Rico and the U.S. federal government funded managed care program for the medically indigent that is similar to the Medicaid program in the U.S. (Medicaid or the Government health plan).
Products and Services
Managed Care
Through its subsidiaries Triple-S Salud, Inc. (TSS) and Triple-S Advantage, Inc. (TSA), the company offers a range of managed care products, including Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Medicare Supplement, Medicare Advantage, and Medicaid plans. The company designs its products to meet the needs and objectives of a range of customers, including employers, individuals and government entities. Its customers either contract with it to assume underwriting risk or they self-fund underwriting risk and rely on it for provider network access, medical cost management, claim processing, stop-loss insurance and other administrative services. The company’s products vary with respect to the level of benefits provided; the costs paid by employers and members, including deductibles and co-payments; and the extent to which its members' access to providers is subject to referral or preauthorization requirements.
The company offers the following managed care plans:
Health Maintenance Organization: The company offers HMO plans that provide members with health care coverage for a fixed monthly premium in addition to applicable member co-payments. Health care services could include emergency care, inpatient hospital and physician care, outpatient medical services and supplemental services, such as dental, vision, behavioral and prescription drugs, among others. Members must select a primary care physician within the network to provide and assist in managing care, including referrals to specialists.
Preferred Provider Organization: The company offers PPO managed care plans that provide its members and their dependent family members with health care coverage in exchange for a fixed monthly premium. In addition, it provides its PPO members with access to a larger network of providers than its HMO. The company also provides coverage for PPO members who access providers outside of the network. Out-of-network benefits are subject to a higher deductible and coinsurance. The company also offers national in-network coverage to its PPO members through the BlueCard program.
BlueCard: For its members who purchase its PPO and selected members under self-funded or Administrative Services Only (ASO) arrangements through its subsidiary TSS, the company offers the BlueCard program. The BlueCard program offers these members in-network benefits through the networks of the other BCBS plans in the United States and certain U.S. territories. In addition, the BlueCard worldwide program provides the company’s PPO members with coverage for medical assistance worldwide.
Medicare Supplement: The company offers Medicare Supplement products, which provide supplemental coverage for majority of the medical expenses that the Medicare Parts A and B programs do not cover, such as deductibles, coinsurance and specified losses that exceed these programs’ maximum benefits.
ASO: In addition to its fully insured plans, the company offers its PPO products on a self-funded or ASO basis, under which it provides claims processing and other administrative services to employers. Employers choosing to purchase the company’s products on an ASO basis fund their own claims, but their employees are able to access its provider network at the company’s negotiated discounted rates. The company administers the payment of claims to the providers but it does not bear any insurance risk in connection with claims costs because it is reimbursed in full by the employer, thus the company is only subject to credit risk in this business. For certain self-funded plans, the company provides stop loss insurance pursuant to which it assumes some of the medical risk for a premium.
Life Insurance
The company offers various life, accident, disability and health and annuity products in Puerto Rico through its subsidiary Triple-S Vida, Inc. (TSV). TSV markets in-home service life and supplemental health products through a network of company-employed agents. Ordinary life, cancer and dreaded diseases (Cancer line of business), and pre-need life products are marketed through independent agents. TSV is the distributor of life products in Puerto Rico. The company offers guaranteed issue, funeral and cancer policies to the lower and middle income market segments directly to people in their homes. The company also markets its group life and disability coverage through its independent producers and brokers.
Property and Casualty Insurance
The company offers a range of property and casualty insurance products through its subsidiary TSP. The company’s predominant insurance products are commercial multi-peril package, personal package, commercial auto, hospital malpractice, commercial liability, and commercial property. This segment’s commercial products mainly target small to medium size accounts.
The company maintains a reinsurance program as a means of protecting its surplus in the event of a catastrophe. It also carries reinsurance to protect the company from the impact of large unforeseen losses and prevent sudden and unpredictable changes in results of operations and equity.
Marketing and Distribution
The company distributes and markets its products through various channels, including its salaried and commission-based internal sales force, direct mail, independent brokers and agents, telemarketing staff, traditional media (including local and cable TV, national and regional press, billboards, radio and cinema) and digital media (social, search engine optimization, and search engine marketing).
Branding and Marketing
The company’s branding and marketing efforts include brand advertising, which focuses on the Triple-S name and the BCBS brand for its managed care products and services, acquisition marketing, which focuses on attracting new customers; and institutional advertising, which focuses on its overall corporate image.
Acquisition marketing consists of business-to-business marketing efforts to generate leads for brokers and the company’s sales force, as well as direct-to-consumer marketing efforts used to add new customers to its direct pay businesses. Institutional advertising promotes key corporate interests and company image and communicates its purpose. The company would continue to utilize the Triple-S name and the Blue Cross and Blue Shield (BCBS) brand for all managed care products and services in Puerto Rico, the U.S. Virgin Islands (USVI), Costa Rica, the British Virgin Islands (BVI) and Anguilla.
Sales and Marketing
The company employs various sales and marketing activities. Such activities are regulated by The Centers for Medicare and Medicaid Services (CMS), the Office of Personnel Management (OPM), the U.S. Department of Health and Human Services (HHS), Puerto Rico Office of the Insurance Commissioner (Commissioner of Insurance), Superintendencia General de Seguros de Costa Rica (Costa Rica Insurance Superintendency) and other government of Puerto Rico agencies. some of the company’s sales and marketing materials must be approved in advance by the applicable regulatory authorities, and they often impose other regulatory restrictions on its marketing activities.
Distribution
Managed Care Segment: The company relies principally on its internal sales force and a network of independent brokers and agents to market its products. Individual Commercial policies are sold entirely through independent agents who sell the company’s individual products, and Medicare Advantage and group products are sold through its 415-person internal sales force (promoters and sales representatives), as well through over 239 independent brokers and agents.
Life Segment: In its Life segment, the company offers its insurance products through its own network of company-employed home-service agency force, and approximately 300 independent agents and brokers. The majority of its premiums (63% in 2020) were placed through its home service distribution channel selling directly to customers in their homes. TSV employs approximately 700 full-time active agents and managers who, operate from 25 district offices around the island.
Property and Casualty Segment: In its Property and Casualty segment, business is primarily subscribed through approximately 13 general agencies, including the company’s insurance agency, Triple-S Insurance Agency, Inc. (TSIA), where business is placed by independent insurance agents and brokers. During the year ended December 31, 2020, TSIA placed approximately 80% of TSP’s total premium volume, respectively. General agencies contracted by TSP remit premiums net of their respective commission.
Customers
Managed Care
The company offers its products in the Managed Care segment to three distinct market sectors in Puerto Rico.
Commercial Sector
The commercial accounts sector includes corporate accounts, federal government employees, individual accounts, local government employees, and Medicare Supplement.
Corporate Accounts: Corporate accounts consist of small (2 to 50 employees) and large employers (over 50 employees).
Federal Government Employees: The company provides managed care services to federal government employees in Puerto Rico. The company provides its services to these employees under the Federal Employees Health Benefits Program pursuant to a direct contract with OPM and through the Federal Employee Program of the BCBSA.
Individual Accounts: The company provides managed care services to individuals and their dependent family members who contract these services directly with it through its network of independent brokers. The company provides individual and family contracts.
Local Government Employees: The company provides full risk managed care services to the local government of Puerto Rico employees through a government-sponsored program. Annually, the government qualifies the managed care companies that participate in this program and sets the coverage, including benefits, co-payments and amount to be contributed by the government.
Medicare Supplement: The company offers Medicare Supplement products, which provide supplemental coverage for major medical expenses that the Medicare Parts A and B programs do not cover, such as deductibles, coinsurance and specified losses that exceed the federal program’s maximum benefits.
Medicare Advantage Sector
Medicare is a federal program administered by CMS that provides various hospital and medical insurance benefits to eligible persons aged 65 and over, as well as to certain other qualified persons. Medicare, with the approval of the Medicare Modernization Act, Medicare started communicating that managed care organizations (MCO) sponsored Medicare product that offers benefits similar to or better than the traditional Medicare product, but where the risk is assumed by the MCOs. This program is called Medicare Advantage. The company has contracts with CMS to provide extended Medicare coverage to Medicare beneficiaries under its Dual and Non-Dual products. Under these annual contracts, CMS pays the company a set premium rate based on membership that is risk adjusted for health status.
The company’s Dual products target the sector of the population eligible for both Medicare and Medicaid, or dual-eligible beneficiaries. The government of Puerto Rico has implemented a plan to allow dual-eligibles enrolled in Medicaid to move to a Medicare Advantage plan under which the government, rather than the insured, would assume all of the premiums for additional benefits not included in the Medicare Advantage programs, such as deductibles and co-payments of prescription drug benefits.
Medicaid
The government of Puerto Rico has privatized the delivery of services to the Medicaid and Child Health Insurance subscribers in Puerto Rico, as defined by the government, by contracting with private managed care companies instead of providing health services directly to such population. This program is based on the Medicaid program, a joint federal and state health insurance program for medically indigent residents of the state. The Medicaid program is structured to provide states the flexibility to establish eligibility requirements, benefits provided, payment rates, and program administration rules, subject to general federal guidelines. As of December 31, 2020, this program provided healthcare coverage to over a million people.
Life Insurance
The company’s Life segment mainly targets individual life and cancer and other dreaded diseases insurance products. Its policyholders primarily consist of individuals, who hold approximately 672,000 policies. The company also insures approximately 1,700 groups.
Property and Casualty Insurance
The company’s Property and Casualty segment mainly targets small to medium size accounts with low to average exposures to catastrophic losses. The auto physical damage and auto liability customer bases are primarily of commercial accounts. Personal business is primarily generated with sales of its personal package product, ProPack, that includes coverage for residences, personal property, and automobile. In addition, a professional liability coverage is offered with hospital and medical malpractice products.
Trademarks
The company’s trademarks are Triple-S and SSS. These trademarks have been duly registered with the Department of State of Puerto Rico and the United States Patent and Trademark Office. In addition, the company has the right to use the BCBS name and marks in Puerto Rico, Costa Rica, USVI, BVI, and Anguilla.
Regulation
The company’s business operations are subject to comprehensive and detailed regulation in all the jurisdictions it conducts business. Regulatory agencies include the Commissioner of Insurance of Puerto Rico (the Commissioner of Insurance), Administracion De Seguros De Salud De Puerto Rico (ASES), which administers Medicaid, including the Medicare dual-eligible beneficiaries program, the Division of Banking and Insurance of the Office of the Lieutenant Governor of the U.S. Virgin Islands, Costa Rica Insurance Superintendency, the Insurance Division of the Financial Service Commission of British Virgin Islands, and the Financial Services Commission of Anguilla. Federal regulatory agencies that oversee the company’s operations include HHS—directly and through the Office of the Inspector General (OIG), the Office of Civil Rights (OCR), CMS, the U.S. Department of Justice (DOJ), the U.S. Department of Labor (DOL), and OPM. TSS, TSA, and Triple-S Blue, Inc. are subject to the capital and surplus licensure requirements of the Blue Cross and Blue Shield Association (BCBSA).
The company is subject to the provisions of the General Corporation Law of Puerto Rico (PRGCL), which contains certain restrictions on the declaration and payment of dividends by corporations organized pursuant to the laws of Puerto Rico. The company is required by Puerto Rico law and by the BCBSA guidelines to participate in certain guarantee associations.
Health care entities, such as TSS and TSA, are subject to laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health Act (HITECH), and their respective implementing regulations, and the Gramm-Leach-Bliley Act, that require the protection of certain health and other information.
The services the company provides to certain employee welfare benefit plans maintained by private sector employers are subject to regulation under the Employee Retirement Income Security Act of 1974 (ERISA), as amended, a complex set of laws and regulations subject to interpretation and enforcement by the Internal Revenue Service, the U.S. Department of Labor, and federal courts.
History
Triple-S Management Corporation was founded in 1959.
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