Triple S Management's Business Segments

Triple-S Management Corporation is one of the most significant players in the managed care industry in Puerto Rico, serving approximately 1,100,000 members, with a 25% market share in terms of premiums written in Puerto Rico for the nine-month period ended September 30, 2015. We have the exclusive right to use the Blue Cross and Blue Shield (“BCBS”) name and mark throughout Puerto Rico, the U.S. Virgin Islands, Costa Rica, the British Virgin Islands and Anguilla and over 50 years of experience in the managed care industry. We offer a broad portfolio of managed care and related products in the Commercial, Medicaid and Medicare markets. We market our managed care products through an extensive network of independent agents and brokers located throughout Puerto Rico as well as an internal salaried sales force. We provided administration services only or self insured (“ASO”) managed care services to the Plan de Salud del Gobierno (similar to Medicaid) (“PSG” or “Medicaid”) island-wide until March 31, 2015. Effective April 1, 2015, the government changed the Medicaid delivery model from an ASO to a risk-based model and we elected to participate in this sector as a fully-insured provider in only two of the eight regions of Puerto Rico. PSG is funded by the Government of Puerto Rico and the U.S. Government.

Overview of Triple-S Management Corporation

Triple-S Management Corporation operates as a prominent healthcare and insurance service provider in Puerto Rico, emphasizing managed care solutions, life insurance, and property and casualty insurance through its subsidiaries. The organization is strategically segmented to cater to varying customer needs, ranging from individuals and employers to governmental entities.



Managed Care Products and Services

Through its subsidiaries Triple-S Salud, Inc. (TSS) and Triple-S Advantage, Inc. (TSA), Triple-S offers a diverse selection of managed care products that represent the majority of the companys earned premiums. The key features of their managed care offerings include:

Types of Managed Care Plans:

1. Health Maintenance Organization (HMO):
- Structure: Fixed monthly premium along with applicable member co-payments.
- Services Covered: Comprehensive coverage including emergency care, inpatient and outpatient services, and additional services such as dental, vision, and behavioral health.
- Care Coordination: Members are required to choose a primary care physician (PCP) responsible for coordinating care and managing referrals to specialists.

2. Preferred Provider Organization (PPO):
- Structure: Similar to HMO regarding premiums but offers greater flexibility.
- Network Access: Access to a broader network of healthcare providers without needing a PCP or referrals for specialist care.
- Out-of-Network Coverage: PPO plans provide coverage for services rendered outside the network, typically with higher deductibles and co-insurance.
- BlueCard Program: Through this program, members can avail in-network benefits nationwide and internationally, enhancing portability and accessibility.

3. Medicare Supplement Plan:
- Purpose: Provides coverage for costs not fully covered by Medicare Parts A and B, such as co-payments, coinsurance, and deductibles.
- Target Audience: Designed specifically for senior individuals who have Medicare and need additional support for their healthcare expenses.

4. Administrative Services Only (ASO):
- Self-Funded Plans: Instead of fully insured plans, employers can self-fund their health plans while utilizing Triple-S’s provider network and administrative services.
- Claims Management: While employers take on the insurance risk, Triple-S handles claims processing and reimbursement, charging an administrative fee based on group size and services rendered.
- Stop-Loss Insurance: Available for self-funded employers to help manage high-cost claims.

Managed Care Products Characteristics:
- Risk Management: Triple-S works with employers either assuming underwriting risks or allowing self-funded arrangements, which include administrative and operational support to manage healthcare costs efficiently.
- Provider Networks: Tailored to balance the costs, quality, and accessibility of care for members.
- Medical Management: Initiatives to ensure quality assurance and optimal patient outcomes through systematic medical management practices.



Life Insurance Products

Through Triple-S Vida (TSV), the corporation provides an array of life, accident, disability, health, and annuity products, cementing its position as a leading distributor of life insurance in Puerto Rico. The notable aspects of the life insurance segment include:

- Market Focus: Primarily targets lower and middle-income customers through home service offerings and independent agents.
- Product Range:
- Ordinary Life Insurance: Comprehensive life insurance products tailored for traditional policyholders.
- Cancer and Dreaded Diseases Insurance: Specialized offerings to mitigate the financial impact of severe illnesses.
- Pre-Need Life Products: Coverage designed for funeral expenses, marketed directly to consumers in their homes.

Unique Distribution Strategies:
- Leveraging a network of company-employed agents to provide personalized services and facilitate access to products within the community.
- TSVs marketing approach allows for widespread access, particularly for underserved markets in Puerto Rico.



Property and Casualty Insurance

Triple-S Propiedad, Inc. (TSP) specializes in providing a robust suite of property and casualty insurance products. This segment covers a wide array of needs, particularly pertinent given the environmental risks present in Puerto Rico, including hurricanes and earthquakes.

- Insurance Products Offered:
- Commercial Multi-Peril: Comprehensive coverage options for businesses encompassing various risks.
- Personal Packages: Insurance tailored for individual and family needs, protecting personal property and liabilities.
- Commercial Auto and Liability: Coverage specifically for commercial vehicles and liability protections for businesses.
- Hospital Malpractice: Specialized coverage for medical professionals and healthcare facilities.

Risk Management and Reinsurance:
- Reinsurance Strategies: To manage risks associated with catastrophic events, Triple-S maintains a thorough reinsurance program. This is crucial for safeguarding the company’s financial position amidst the high likelihood of natural disasters.
- Financial Soundness: Committed to partnering with reinsurers that possess robust financial ratings, mitigating the risk of non-payment in adverse conditions.



Conclusion

Triple-S Management Corporation successfully operates in multiple sectors, providing comprehensive managed care solutions, life insurance, and property and casualty insurance. With a strong focus on serving diverse markets and addressing specific customer needs across Puerto Rico, the company stands as a significant player in the insurance and healthcare sectors. Its strategic product offerings and administrative services highlight the company’s commitment to enhancing healthcare affordability and accessibility while ensuring a robust insurance safety net.