Exhibit 10.5
 2009-000053B
PHYSICAL HEALTH INSURANCE CONTRACT
 AGREEMENT BETWEEN
 Puerto Rico Health Insurance Administration (PRHIA) ADMINISTRATION
  TRIPLE-S SALUD, INC., ###-##-#### INSURER Ms. Socorro
Rivas
  Acting as
 THIRD PARTY ADMINISTRATOR
 IN THE METRO-NORTH REGION




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WITNESSETH
  WHEREAS:
 WHEREAS
 WHEREAS ADMINISTRATION
 WHEREAS ADMINISTRATION ADMINISTRATION ADMINISTRATION
 HENCEFORTH
 2




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Article I SECTION 8.6 Effective Date and Term
 1.
    
    This Agreement shall be in effect from November 1, 2008 starting at 12:01 AM, Puerto
Rico time, November 1, 2008, which shall be the first day that coverage begins for which
payment of service fees is due until December 31, 2009.2.
    
    ......3.
    
    ......
 Article II:
  Article III:
 seven dollars and twenty cents
($7.20) one dollar and fifty one cents ($1.51) eight dollars and seventy one cents ($8.71
pmpm one
hundred two dollars and eighty seven cents ($102.87 pmpm)
 Article IV:
 3




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/s/ Domingo Nevárez RamírezDomingo Nevárez Ramírez, MHSAExecutive DirectorPuerto Rico Health Insurance Administration/s/ Socorro RivasSOCORRO RIVASChief Executive OfficerTRIPLE-S SALUD, INC./s/ Luis A. MariniLUIS A. MARINI, DMDChief Executive OfficerTriple-C, Inc.
  4




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APPENDIX D
  A.
    
    60 days after the dated of the agreement the Company must submit to ASES Compliance Office
copy of the policies and procedures for identifying and tracking potential provider fraud
cases, for conducting preliminary and full investigation and for referring cases of suspected
fraud to an appropriate law enforcement agency.
 B.
    
    Each company must submit to the Administrations Compliance Office on a quarterly basis a
report with the following information: preliminary and full investigations, audits performed,
administrative actions against providers, overpayments identified and providers referred to
the Department of Justice (if not submit a certification signed by the Compliance Director and
the President or CFO).
 C.
    
    Each company must submit to the Compliance Office on a quarterly basis a report with the
following information: fraud investigations pending, fraud investigations in process, fraud
investigations finished and referrals to the Department of Justice or U.S. Attorneys Field
Office (if there were no investigations, submit a certification signed by the Compliance
Director and the President or CEO).
 D.
    
    Each Company has five (5) days to notify ASES about the referrals made to the US Attorneys
Field Office and HHS-OIG.
 E.
    
    Each company must submit to the Compliance Office a certification signed by the Compliance
Director and the President or CEO indicating that all full investigations are made in
accordance with 42 CFR 455.15.
 F.
    
    Each Company has five (5) days to notify ASES about any adverse or negative action that the
MCO has taken on provider application or actions which limit the ability of providers to
participate in the program.
 G.
    
    Each company must review the credentialing forms to ensure that they are in accordance with
federal regulation 42 CFR 455.104.
 H.
    
    Each company must request to providers to fulfill an ownership and control disclosures form.
The company is responsible to ensure compliance with regulation.




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APPENDIX D
 I.
    
    Each company must review providers agreement to incorporate appropriate business transaction
language to ensure accordance with federal regulation 42 CFR 455.105.
 J.
    
    Each company must request providers to fulfill a business transaction form and verify
compliance with regulation.
 K.
    
    Each company must establish a method to capture criminal conviction information on owners,
persons with control interest, agents and managing employees of providers to ensure that is in
accordance with federal regulation 42 CFR 455.106.
 L.
    
    Each company must review the enrollment packages for all provider types to request criminal
conviction information as stated before
 M.
    
    Each company should develop and implement procedures to report to HHS-OIG and ASES within 20
working days any criminal conviction disclosures made during the MCO credentialing process.
Copy of the policies should be submitted to ASES Compliance Office.
 N.
    
    Each company must submit to the Compliance Office a certification signed by the Compliance
Director and the President or CEO stating compliance with 42 CFR 455.106.
 O.
    
    ASES must include in the agreement evidence of compliance with 42 CFR 455.20 EOMB (Evidence
of Medical Benefits).
 P.
    
    Each company must comply with requirement establish in 42 CFR 455.20.
 Q.
    
    Each company must comply with requirement established in 42 CFR 455.101.
 R.
    
    Each company must review the enrollment form and credentialing packages for all provider
types to capture the identity of managing employees.