P.R. Laws tit. 3, § 729d
(a) The Administration is hereby authorized to enter into contracts, with or without the requirement of competitive bidding, but shall always have two (2) or more proposals from insurers that qualify according to law and the requirements to that effect, and offer any or all the plans described in § 729e of this title. Every such contract shall be entered into for a uniform term of not less than one (1) year, but may be renewed automatically from term to term in the absence of termination by any of the parties.
The Chief Justice of the Supreme Court or his/her representative, shall negotiate and contract healthcare insurance plans, and approve regulations to such effects for the employees and officers of the Judicial Branch, pursuant to the powers conferred upon the same by §§ 521—525 of Title 4. Provided, That the Chief Justice may accept the negotiation and contracting of healthcare plans executed by the Administration for the employees of said Branch, pursuant to the provisions of §§ 729a—729n of this title.
The President of the Senate and the Speaker of the House of Representatives, respectively, or the person designated by them, may negotiate and enter directly into contract, either jointly or separately, with health insurers on behalf and for the benefit of the employees and officials of their respective Body and the offices or entities under the corresponding Body, and if they should deem it necessary, they may approve regulations to such ends pursuant to the powers and authorities delegated to them under the Constitution of the Commonwealth of Puerto Rico to adopt the laws, rules, and regulations that shall govern the operations of each Body. Provided, that they may accept the negotiation and contracting for health insurance plans executed by the Administration for the employees of the Legislative Branch, pursuant to the provisions of §§ 729a—729n of this title.
The Comptroller of Puerto Rico or the person on whom he/she delegates, may negotiate and contract directly with health insurance plans for the employees and officials of the Office of the Comptroller pursuant to the powers conferred by §§ 71 et seq. of Title 2. Furthermore, they may accept the negotiation and contracting for health insurance plans executed by the Administration for the employees of said Office, pursuant to the provisions of §§ 729a—729n of this title.
When the Chief Justice of the Supreme Court, the President of the Senate, the Speaker of the House of Representatives, the Comptroller of Puerto Rico, and the Ombudsman negotiate a health insurance plan or choose one of the plans selected by the Administration, and both the spouses and domestic partners are public employees or pensioners of any Branch of the Government of Puerto Rico, its agencies, departments, municipalities, public corporations, or the University of Puerto Rico, they may avail themselves and their family members, as defined in § 729c of this title, of their preferred plan and shall be entitled to have their employers” contribution applied thereto up to the maximum amount of such contribution.
(b) Each contract for such plans as described in § 729e of this title, shall contain a detailed statement of benefits offered, and shall include such maximums, limitations, exclusions, and other definitions or benefits as the Secretary of the Treasury may deem necessary or desirable.
(c) No contract shall be made or plan approved which excludes any person due to race, sex, marital status, health status, or, age upon first enrollment; or which denies the insured the right, in emergency cases, to receive services in a Commonwealth or municipal dispensary, health center, or public hospital, or the right of the Commonwealth or Municipal Government to recover from the plan or carrier the cost of the services rendered to the insured in the event of having entered such institution to receive services for emergency reasons. Nothing in § 729—729n of this title shall be construed as an obligation of the carrier to pay to the Commonwealth or Municipal Government a larger sum than the limit of benefits fixed in the plan for nonparticipant hospitals or institutions.
(d) No contract shall be made or plan approved which does not offer to each employer whose enrollment in the plan is terminated for any reason other than a voluntary cancellation of enrollment under any plan made under §§ 729a—729n of this title, a temporary extension of coverage, during which he may exercise the option to convert, without evidence of good health to a nongroup contract providing health benefits. An employee who exercises this option shall pay the full periodic charges of the nongroup contract, on such terms and conditions as are prescribed by the carrier and approved by the Secretary of the Treasury.
(e) The coverage and benefits made available pursuant to the provisions of subsection (d) of this section may, at the option of the employee, be noncancelable except for fraud, overinsurance or nonpayment of periodic charges. Overinsurance shall not be understood to mean such additional protection as may be provided the insured in a manner that will afford him protection beyond the benefits provided for in any plan.
(f) Rates charged under the plans described in § 729e of this title shall reasonably and equitably reflect the cost of the benefits provided. Rates determined for the first contract term shall be continued for subsequent contract terms, except that they may be readjusted for any subsequent term, based on statistical surveys performed by the Insurance Commissioner and the Secretary of Health, as hereinafter provided, and on past experience and benefit adjustments under such subsequent contract. Any readjustment in rates shall be made in advance of the contract term in which they will apply and on a basis which, in the judgment of the Secretary of the Treasury, is consistent with the general practice of carriers which issue group health benefit plans to large employers.
(g) The Secretary of the Treasury is hereby authorized to prescribe regulations fixing reasonable minimum standards for health benefit plans described in § 729e of this title, and for carriers offering such plans. Provided, That the approval of the regulation, or amendments thereto, shall take place after a public hearing held before him, or before the person to whom he may delegate, at which hearing every interested person may participate. The holding of a hearing for the purpose expressed in this subsection shall be published in a newspaper of general circulation in the Commonwealth, at least five (5) days in advance.
(h) Those employees who opted for syndication pursuant to the provisions set forth in §§ 1451 et seq. of this title, shall be entitled to have the exclusive representative negotiate directly on their behalf regarding all matters concerning health benefits and the contracting of a heath plan. The exclusive representative shall designate a health plans evaluating committee to represent the different sectors and interests of the members. This committee shall be responsible for the analysis and evaluation of all health plans in the market in order to select those that offer the lowest or most reasonable premiums, the best coverage and health services benefits, and the best medication coverage.
The exclusive representative shall call the members to an assembly in which he/she shall present the health plans selected by the committee, so that the assembly, by the express vote of the majority constituting quorum to such effects, selects the health plan that better suits its needs. Once the health plan has been selected in a legally convened assembly, it shall be compulsory for all the members represented by said exclusive representative.
The present and future members of the teaching profession and the present and future members of the Puerto Rico Teacher’s Association covered by the provisions of § 382 of Title 18, and the public employees and pensioners members of the Teacher’s Association who voluntarily prefer to continue to be covered by the provisions of §§ 7001 et seq. of Title 24, are hereby excluded from the application of §§ 729a—729n of this title.
The agencies, dependencies, and municipalities whose employees, at present or in the future opt for the right to negotiate collective bargaining agreements shall be obligated to negotiate the terms and conditions that allow for the herein provided.
Notice This section has more than one version with varying effective dates. Fifth of five versions of this section.
History —June 29, 1963, No. 95, p. 280, § 4; Mar. 25, 1976, No. 18, p. 40, §§ 2, 4; July 11, 1988, No. 79; Dec. 29, 2003, No. 324, § 2; Sept. 14, 2004, No. 280, § 1; Aug. 10, 2006, No. 158, § 1; Jan. 20, 2010, No. 11, § 2; June 7, 2011, No. 88, § 1; Dec. 24, 2011, No. 276, § 2; June 26, 2013, No. 36, § 2; Feb. 19, 2015, No. 16,; Oct. 8, 2015, No. 171, § 1; Dec. 14, 2015, No. 214, § 2.