P.R. Laws tit. 24, § 7036a
(1) Insurance companies shall be responsible for the implementation, publication and distribution of informative brochures, at their own expense, in Spanish, including a description of the health coverage and the benefits included in same. Said brochures shall be distributed to each beneficiary, along with their identification cards.
(2) Insurance companies shall be responsible for the implementation and disclosure, at their own expense, of an orientation program for the community that covers the aspects of logistics regarding the structure, use, benefits and accessibility of the health services plan for the beneficiaries in each health region.
(3) The brochures shall serve as certificates and guarantees of the benefits to which the beneficiaries are entitled, and should include, as a minimum, the following:
(a) A list of the coverage benefits.
(b) Limitations and exclusions of the benefits program.
(c) Rights of the beneficiaries.
(d) Instructions on access to the benefits for the beneficiaries.
(e) List of health care organizations and other providers-participants available to render health care services covered by the benefits program.
(f) Description of the procedures for claims.
(g) Signature of the beneficiary upon delivery and explanation of the brochure.
(h) Right to free selection of service provider.
(4) The contents of the informative brochures, as well as the plan for their distribution, shall be approved by the Administration prior to their publication and distribution.
(5) The participating providers, primary care providers, and primary services of the Government’s Healthcare system shall display an information, legible, and noticeable sign to all persons who use their facilities, that notifies that the Primary Medical Group has a Preferred Network that includes specialists, laboratories, imaging services (x-rays), and hospitals that may be used by beneficiaries without referral or copayment, as well as any other information related to the healthcare system deemed pertinent by the Administration. The contents of the sign shall be prepared and approved by the Administration.
(6) Every participating provider, primary care provider, and primary services that fails to comply with the provisions of this section or the regulations promulgated thereunder shall be subject to an administrative fine to be determined by the Administration, which under no circumstance shall exceed ten thousand dollars ($10,000).
History —Sept. 7, 1993, No. 72, added as Art. VI, § 13 on June 1, 2003, No. 133, § 1; June 13, 2012, No. 112, § 1.