Compare plans

Menonita Directo

Explore our health plans designed to meet your medical needs and those of your family, with access to a wide network of providers across Puerto Rico.

Benefits

View details

Annual Medical Deductible / MOOP

Annual limit on the member’s medical expenses

Individual

N/A

Family

N/A

Annual Prescription Drug Deductible

Annual amount before prescriptions are covered

Individual

N/A

$250

N/A

Family

N/A

$250 per subscriber

N/A

Combined MOOP (medical and prescriptions)

Total maximum out-of-pocket expenses per year

Individual

$3,500

$6,350

Family

$7,000

$12,700

Emergency Services

Immediate emergency care

Accident / Illness

$25

$0 / $50 Out-of-Network

$0 / $75 Out-of-Network

$0 / $50 Out-of-Network

Outpatient Services

Consultations and treatments without hospitalization

Primary Care Physician

$5

$10

$5

Specialist

$10

$12

$15

$12

Sub-specialist

$15

$17

$20

Psychiatrist

$10

$12

$15

$12

Psychologist

$10

$12

$15

$12

Podiatrist

$10

$12

$15

$12

Chiropractor

$10

$12

$15

$12

Audiologist

$10

$12

$15

$12

Optometrist

$10

$12

$15

$12

Ambulatory Surgery Center

$50

$0 / $150 Out-of-Network

$0 / $250 Out-of-Network

$0 / $200 Out-of-Network

In-office diagnostic / surgical procedures

20%

50%

35%

Endoscopic procedures

20%

50%

35%

Laboratory and X-Ray Services

Diagnostic tests and medical studies

Laboratory

20%

$0 / 50% Out-of-Network

$0 / 35% Out-of-Network

X-Ray

20%

$0 / 50% Out-of-Network

$0 / 35% Out-of-Network

Ultrasound

20%

$0 / 50% Out-of-Network

$0 / 40% Out-of-Network

PET Scan, CT Scan, MRI o PET CT

20%

50%

40%

Hospitalization

Hospital stays and inpatient care

Partial (including Mental Health)

$30

$100

$150

$100

With preauthorization
(including Mental Health)

$50

$0 / $150 Out-of-Network

$0 / $250 Out-of-Network

$0 / $200 Out-of-Network

Without preauthorization
(including Mental Health)

$50

$150

$250

$200

Skilled nursing care

$50

50%

Surgical assistant

Subscriber pays 20%

Subscriber pays 50%

Rehabilitation and Medical Equipment

Therapies and necessary medical equipment

Physical therapy

$10

$12

$15

$12

Respiratory therapy

$10

$12

$15

$12

Home health care

20%

50%

Durable medical equipment

20% up to $5,000, excess 80%

50% up to $5,000, excess 80%

Chiropractic Manipulations

$10

$12

$15

$12

Mental Health

Group therapy and emotional support

Group therapy

$10

$12

$15

$12

Collateral visits

$10

$12

$15

$12

Pharmacy

Covered prescription medications

Generic Bioequivalent – Level 1

$5

$7

Preferred Brand – Level 2

20% min $20 ($0-$1,200), over $1,201: 60%

25% ($0-$1,000), over $1,001: 80%

25% ($251-$1,000), over $1,001: 80%

25% ($0-$750),
over $751: 80%

Non-Preferred Brand – Level 3

30% min $30 ($0-$1,200), over $1,201: 60%

50% ($0-$1,000), over $1,001: 80%

50% ($251-$1,000), over $1,001: 80%

35% ($0-$750),
over $751: 80%

Specialty Drugs – Level 4

50% ($0-$1,200), over $1,201: 60%

50% ($0-$1,000), over $1,001: 80%

50% ($251-$1,000), over $1,001: 80%

50% ($0-$750), over $751: 80%

Over-the-Counter (OTC) medications

$1

Prevention, Wellness, and Chronic Conditions

Preventive care and ongoing management

Preventive services
including women’s services

0%

Preventive vaccines

0%

Respiratory Syncytial Virus vaccine

20%

50%

35%

Vision Services

Exams, lenses, and vision benefits

Adult refraction exam

$10

$12

$15

$12

Adult reimbursement coverage

100% reimbursement up to $125 for lenses and frames

Pediatric refraction exam

0%

Pediatric vision – corrective lenses

20% coinsurance up to $250 for lenses

Other Services

Visión, Ambulancia aérea, cobertura en EE. UU.

Air ambulance
in Puerto Rico

$10

$12

$15

$12

Emergency services
in the U.S.

20% coinsurance

Services in the U.S.
(not available in Puerto Rico)

20% coinsurance

Bariatric Surgery for Morbid Obesity

Procedure for severe obesity management

Bariatric surgery procedure

$50

$0 / $150 Out-of-Network

$0 / $250 Out-of-Network

$0 / $200 Out-of-Network

Included Programs

Nutritionist and support programs

Nutritionist

Reimbursement
up to $20 per visit

(max. 4 per year)

Dental Coverage

Accessible medical care when you need it

Preventive Diagnostics

0%

Minor Restorative

20%

Major Restorative

50%

Space maintainers

Not covered

Benefits

Benefit / Service Category

Annual Medical Deductible / MOOP

Annual limit on the member’s medical expenses

Individual
Platino	N/A
Gold 1	N/A
Gold 2	N/A
Gold 3	N/A
Family
Platino	N/A
Gold 1	N/A
Gold 2	N/A
Gold 3	N/A

Annual Prescription Drug Deductible

Annual amount before prescriptions are covered

Individual
Platino	N/A
Gold 1	N/A
Gold 2	$250
Gold 3	N/A
Family
Platino	N/A
Gold 1	N/A
Gold 2	$250 por suscriptor
Gold 3	N/A

Combined MOOP (medical and prescriptions)

Total maximum out-of-pocket expenses per year

Individual
Platino	$3,500
Gold 1	$6,350
Gold 2	$6,350
Gold 3	$6,350
Family
Platino	$7,000
Gold 1	$12,700
Gold 2	$12,700
Gold 3	$12,700

Emergency Services

Immediate emergency care

Accident / Illness
Platino	$25
Gold 1	$0 / $50 Out-of-Network
Gold 2	$0 / $75 Out-of-Network
Gold 3	$0 / $50 Out-of-Network

Outpatient Services

Consultations and treatments without hospitalization

Primary Care Physician
Platino	$5
Gold 1	$5
Gold 2	$10
Gold 3	$5
Specialist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Sub-specialist
Platino	$15
Gold 1	$17
Gold 2	$20
Gold 3	$20
Psychiatry
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Psychologist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Podiatrist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Chiropractor
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Audiologist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Optometrist
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Ambulatory Surgery Center
Platino	$50
Gold 1	$0 / $150 Out-of-Network
Gold 2	$0 / $250 Out-of-Network
Gold 3	$0 / $200 Out-of-Network
In-office diagnostic / surgical procedures
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	35%
Endoscopic procedures
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	35%

Laboratory and X-Ray Services

Diagnostic tests and medical studies

Laboratory
Platino	20%
Gold 1	$0 / 50% Out-of-Network
Gold 2	$0 / 50% Out-of-Network
Gold 3	$0 / 35% Out-of-Network
X-Ray
Platino	20%
Gold 1	$0 / 50% Out-of-Network
Gold 2	$0 / 50% Out-of-Networkera
Gold 3	$0 / 35% Out-of-Network
Ultrasound
Platino	20%
Gold 1	$0 / 50% Out-of-Network
Gold 2	$0 / 50% Out-of-Network
Gold 3	$0 / 40% Out-of-Network
PET Scan, CT Scan, MRI o PET CT
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	40%

Hospitalization

Hospital stays and inpatient care

Partial (including Mental Health)
Platino	$30
Gold 1	$100
Gold 2	$150
Gold 3	$100
With preauthorization (including Mental Health)
Platino	$50
Gold 1	$0 / $150 Out-of-Network
Gold 2	$0 / $250 Out-of-Network
Gold 3	$0 / $200 Out-of-Network
Without preauthorization (including Mental Health)
Platino	$50
Gold 1	$150
Gold 2	$250
Gold 3	$200
Skilled nursing care
Platino	$50
Gold 1	50%
Gold 2	50%
Gold 3	50%
Surgical assistant
PlatinoSubscriber pays	20%
Gold 1Subscriber pays	50%
Gold 2Subscriber pays	50%
Gold 3Subscriber pays	50%

Rehabilitation and Medical Equipment

Therapies and necessary medical equipment

Physical therapy
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Respiratory therapy
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Home health care
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	50%
Durable medical equipment
Platino	20% up to $5,000, excess 80%
Gold 1	50% up to $5,000, excess 80%
Gold 2	50% up to $5,000, excess 80%
Gold 3	50% up to $5,000, excess 80%
Chiropractic Manipulations
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12

Mental Health

Group therapy and emotional support

Group therapy
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Collateral visits
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12

Pharmacy

Covered prescription medications

Generic Bioequivalent – Level 1
Platino	$5
Gold 1	$5
Gold 2	$5
Gold 3	$7
Preferred Brand – Level 2
Platino	20% min $20 ($0-$1,200), over $1,201: 60%
Gold 1	25% ($0-$1,000),over $1,001: 80%
Gold 2	25% ($251-$1,000),over $1,001: 80%
Gold 3	25% ($0-$750) over $751: 80%
Non-Preferred Brand – Level 3
Platino	30% min $30 ($0-$1,200),over $1,201: 60%
Gold 1	50% ($0-$1,0000),over $1,001: 80%
Gold 2	50% ($251-$1,000), over $1,001: 80%
Gold 3	35% ($0-$750), over $751: 80%
Specialty Drugs – Level 4
Platino	50% ($0-$1,200),over $1,201: 60%
Gold 1	50% ($0-$1,000),over $1,001: 80%
Gold 2	50% ($251-$1,000),over $1,001: 80%
Gold 3	50% ($0-$750), over $751: 80%
Over-the-Counter (OTC) medications
Platino	$1
Gold 1	$1
Gold 2	$1
Gold 3	$1

Prevention, Wellness, and Chronic Conditions

Preventive care and ongoing management

Preventive services including women’s services
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Preventive vaccines
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Respiratory Syncytial Virus vaccine
Platino	20%
Gold 1	50%
Gold 2	50%
Gold 3	35%

Vision Services

Exams, lenses, and vision benefits

Adult refraction exam
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Adult reimbursement coverage
Platino	100% Reimbursement up to $125 for lenses and frames
Gold 1	100% Reimbursement up to $125 for lenses and frames
Gold 2	100% Reimbursement up to $125 for lenses and frames
Gold 3	100% Reimbursement up to $125 for lenses and frames
Pediatric refraction exam
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Pediatric Vision (Lenses and Frames)
Platino	20% up to $250 for lenses; over $250: 80%
Gold 1	20% up to $250 for lenses; over $250: 80%
Gold 2	20% up to $250 for lenses; over $250: 80%
Gold 3	20% up to $250 for lenses; over $250: 80%

Other Services

Air ambulance and U.S. coverage

Air ambulance in Puerto Rico
Platino	$10
Gold 1	$12
Gold 2	$15
Gold 3	$12
Emergency services in the U.S.
Platino	20% coinsurance
Gold 1	20% coinsurance
Gold 2	20% coinsurance
Gold 3	20% coinsurance
Services in the U.S. (not available in PR)
Platino	20% coinsurance
Gold 1	20% coinsurance
Gold 2	20% coinsurance
Gold 3	20% coinsurance

Bariatric Surgery for Morbid Obesity

Procedure for severe obesity management

Bariatric surgery procedure
Platino	$50
Gold 1	$0 / $150 Out-of-Network
Gold 2	$0 / $250 Out-of-Network
Gold 3	$0 / $200 Out-of-Network

Included Programs

Nutritionist and support programs

Nutritionist
Platino	Reimbursement up to $20 per visit (max. 4 per year)
Gold 1	Reimbursement up to $20 per visit (max. 4 per year)
Gold 2	Reimbursement up to $20 per visit (max. 4 per year)
Gold 3	Reimbursement up to $20 per visit (max. 4 per year)

Dental Coverage

Diagnosis, prevention, and dental treatments

Preventive Diagnostics
Platino	0%
Gold 1	0%
Gold 2	0%
Gold 3	0%
Minor Restorative
Platino	20%
Gold 1	20%
Gold 2	20%
Gold 3	20%
Major Restorative
Platino	50%
Gold 1	50%
Gold 2	50%
Gold 3	50%
Space maintainers
Platino	Not covered
Gold 1	Not covered
Gold 2	Not covered
Gold 3	No Cubierto

Need help choosing?

Fill out the form and our team
will guide you and answer
any questions.