Administración de Seguros de Salud de Puerto Rico
Plan Vital Special Coverage · About this organization
What you get
Cancer care coverage: chemotherapy, radiation, tests, pharmacy, specialists, hospital care, surgery, rehabilitation, child health services and care coordination.
How to start
Your doctor sends the cancer registry request. Arrange Medicaid certification and Plan Vital enrollment, and give the requested household, income and insurance documents.
Good to know
- Some covered services may have limits, network rules, referrals, registration steps, or prior-authorization requirements.
The details, as published
Puerto Rico’s Plan Vital lists cancer as a condition for Special Coverage and covers medically necessary services for enrolled members. Published benefits include chemotherapy, radiology, diagnostic procedures and tests, treatment after diagnosis, specialists, laboratory work, pharmacy benefits, hospital care, surgery, rehabilitation, and care coordination. EPSDT diagnostic and treatment services apply to enrolled people under age 21, while Medicaid eligibility depends on a household evaluation and current program rules. A parent or guardian can request a Medicaid evaluation online, by phone, or through a local Medicaid office and then ask the health plan to register the child’s cancer under Special Coverage.
What help you may get
Household Bills And Cash Assistance
Plan Vital Special Coverage — household bills and cash assistance
Puerto Rico’s Plan Vital lists cancer as a condition for Special Coverage and covers medically necessary services for enrolled members. Published benefits include chemotherapy, radiology, diagnostic procedures and tests, treatment after diagnosis, specialists, laboratory work, pharmacy benefits, hospital care, surgery, rehabilitation, and care coordination. EPSDT diagnostic and treatment services apply to enrolled people under age 21, while Medicaid eligibility depends on a household evaluation and current program rules. A parent or guardian can request a Medicaid evaluation online, by phone, or through a local Medicaid office and then ask the health plan to register the child’s cancer under Special Coverage.
Amount not published · Recurring
Can cover
- Care management and care-coordination services
- Chemotherapy, radiology, and related services
- EPSDT diagnostic and treatment services for enrolled people under age 21
- Inpatient and outpatient hospital care
- Inpatient and outpatient surgery
- Medically necessary diagnostic procedures and tests
- Outpatient rehabilitation
- Pharmacy benefits
- Specialist visits, laboratory services, imaging, and hospitals within the applicable network
- Treatment for covered conditions after diagnosis
Does not cover
- Non-network services unless the plan’s rules authorize them
- Services that are not covered or medically necessary under the member’s Plan Vital benefit
- The official pages publish covered service categories but no dollar maximum for cancer care.
- Coverage applies to medically necessary covered services while the child remains enrolled, subject to plan rules and service limits.
Medical And Insurance Costs
Plan Vital Special Coverage — medical and insurance costs
Puerto Rico’s Plan Vital lists cancer as a condition for Special Coverage and covers medically necessary services for enrolled members. Published benefits include chemotherapy, radiology, diagnostic procedures and tests, treatment after diagnosis, specialists, laboratory work, pharmacy benefits, hospital care, surgery, rehabilitation, and care coordination. EPSDT diagnostic and treatment services apply to enrolled people under age 21, while Medicaid eligibility depends on a household evaluation and current program rules. A parent or guardian can request a Medicaid evaluation online, by phone, or through a local Medicaid office and then ask the health plan to register the child’s cancer under Special Coverage.
Amount not published · Recurring
Can cover
- Care management and care-coordination services
- Chemotherapy, radiology, and related services
- EPSDT diagnostic and treatment services for enrolled people under age 21
- Inpatient and outpatient hospital care
- Inpatient and outpatient surgery
- Medically necessary diagnostic procedures and tests
- Outpatient rehabilitation
- Pharmacy benefits
- Specialist visits, laboratory services, imaging, and hospitals within the applicable network
- Treatment for covered conditions after diagnosis
Does not cover
- Non-network services unless the plan’s rules authorize them
- Services that are not covered or medically necessary under the member’s Plan Vital benefit
- The official pages publish covered service categories but no dollar maximum for cancer care.
- Coverage applies to medically necessary covered services while the child remains enrolled, subject to plan rules and service limits.
Navigation Guides And Advocacy
Plan Vital Special Coverage — navigation guides and advocacy
Puerto Rico’s Plan Vital lists cancer as a condition for Special Coverage and covers medically necessary services for enrolled members. Published benefits include chemotherapy, radiology, diagnostic procedures and tests, treatment after diagnosis, specialists, laboratory work, pharmacy benefits, hospital care, surgery, rehabilitation, and care coordination. EPSDT diagnostic and treatment services apply to enrolled people under age 21, while Medicaid eligibility depends on a household evaluation and current program rules. A parent or guardian can request a Medicaid evaluation online, by phone, or through a local Medicaid office and then ask the health plan to register the child’s cancer under Special Coverage.
Amount not published · Recurring
Can cover
- Care management and care-coordination services
- Chemotherapy, radiology, and related services
- EPSDT diagnostic and treatment services for enrolled people under age 21
- Inpatient and outpatient hospital care
- Inpatient and outpatient surgery
- Medically necessary diagnostic procedures and tests
- Outpatient rehabilitation
- Pharmacy benefits
- Specialist visits, laboratory services, imaging, and hospitals within the applicable network
- Treatment for covered conditions after diagnosis
Does not cover
- Non-network services unless the plan’s rules authorize them
- Services that are not covered or medically necessary under the member’s Plan Vital benefit
- The official pages publish covered service categories but no dollar maximum for cancer care.
- Coverage applies to medically necessary covered services while the child remains enrolled, subject to plan rules and service limits.
Why this may help
Navigation Guides And Advocacy: Care coordination helps you arrange the specialists, tests and treatment included in Special Coverage.
Check the main eligibility rules
Diagnosis
B-ALL is in scope. The official Plan Vital page expressly lists cancer under Special Coverage and EPSDT diagnostic and treatment services for insured people under age 21, so pediatric B-ALL is within the published diagnosis and age scope for an enrolled child.
Age
Age 0 to age 20, measured at treatment period.
- The official benefits page states that EPSDT diagnostic and treatment services are available to insured people under age 21; Special Coverage itself does not publish a separate cancer age limit.
- 2026-09-07 F01: The under-21 band applies to EPSDT benefits; Special Coverage has no separately published cancer age limit.
Treatment status
Active Treatment
- A provider must verify the patient or diagnosis.
- The member must use covered services and applicable provider networks, subject to the plan’s referral and authorization rules.
- The Medicaid application requires citizenship or legal-residence evidence from foreign applicants.
- Applicants must disclose other health insurance.
- The child must be certified for Puerto Rico Medicaid and enrolled in Plan Vital.
Financial need is required.
- Puerto Rico Medicaid evaluates household composition, employment and other income, and applicable eligibility categories.
- The reviewed official pages direct each applicant to a Medicaid eligibility evaluation and do not publish a complete current household-income table for all child eligibility groups.
- Eligibility is determined by the Puerto Rico Medicaid Program after reviewing the household’s circumstances and documents.
Where you live and where your child is treated
Where your family lives
You must live in: PR.
- The applicant must be evaluated and certified for Puerto Rico Medicaid and Plan Vital.
Where your child is treated
Treatment must be through: Covered services are ordinarily provided through Plan Vital’s contracted insurer and provider network..
- Covered services are ordinarily provided through Plan Vital’s contracted insurer and provider network.
How to get started
Does a social worker or care team need to start it? Yes. Ask your child’s social worker or care team to begin the request.
Who can start: Caregiver, Parent Or Guardian
- Ask the child's PCP, hematologist/oncologist, or other treating specialist to submit the complete cancer registry request.
- Ask the child’s treating provider and insurer to register the cancer diagnosis under Special Coverage and confirm authorizations for leukemia care.
- If certified, select or enroll in a Plan Vital managed-care insurer.
- Provide the required identity, household, income, residence, and insurance information and documents.
- Request a Puerto Rico Medicaid eligibility evaluation online, by telephone, or through a local office.
- The insurer must approve or deny a complete request within 72 hours and notify the member and physician in writing.
Ways to apply or ask
- Online Portal · Open form or page
- Online Portal · Open form or page
- Online Portal · Open form or page
- Phone · Open form or page · 787-641-4224 — Call the Medicaid Program for an evaluation appointment or local-office information; TTY/TDD is 787-625-6955.
Documents to prepare
- Citizenship or legal-residence evidence for foreign applicants
- Divorce or separation evidence, when applicable
- Information about a second property and savings accounts
- Information about employment and other income
- Information about medication expenses
- Information about other health insurance
- Marriage certificate, when applicable
- Original and copy of Social Security cards for household members
- Photo identification
- Proof of Social Security or pension income, when applicable
- School evidence for minors in the home
- Water, electric, or telephone bill
- Covered medical claims are paid through the member’s contracted Plan Vital insurer and participating providers.
Availability and timing
| Program | Active |
|---|---|
| Applications | Open |
| Funding or space | Not Published |
| Application window | Rolling |
| Last checked | Aug 24, 2026 |
- Puerto Rico Medicaid accepts applications for eligibility evaluation on a rolling basis.
- The current ASES page identifies the contracted Plan Vital insurers and displays updated 2026 program information.
- The reviewed pages do not separately publish a funding-status label for Special Coverage.
- The current official pages state that anyone may voluntarily apply for evaluation and publish no seasonal deadline.
Limitations and things to confirm
- Current income and resource standards vary by eligibility group and are not fully published on the reviewed pages.
- Some covered services may have limits, network rules, referrals, registration steps, or prior-authorization requirements.
- The child must first be certified for Puerto Rico Medicaid and enrolled in Plan Vital.
- The reviewed public pages do not list every covered leukemia drug or service.
- How long do Medicaid eligibility and Special Coverage registration decisions usually take?
- What current household-income and resource standards apply to the child’s Medicaid eligibility group?
- What documentation must the family or oncology team provide to register B-ALL under Special Coverage?
- Which cancer services are excluded or subject to visit, network, or formulary limits?
- Which leukemia medicines, oncology providers, and services require prior authorization?
Official sources
Program details were last verified Aug 24, 2026. Availability can change, so check the official program before applying.
- Plan Vital — Administración de Seguros de Salud de Puerto Rico · checked Aug 24, 2026
- Plan Vital — Administración de Seguros de Salud de Puerto Rico · checked Aug 23, 2026
- Puerto Rico Medicaid Online Consultation Portal · checked Aug 24, 2026
- Puerto Rico Medicaid Online Consultation Portal · checked Aug 23, 2026
- Programa Medicaid — Departamento de Salud de Puerto Rico · checked Aug 24, 2026
- Programa Medicaid — Departamento de Salud de Puerto Rico · checked Aug 23, 2026