P.R. Laws tit. 24, § 3045
All patients, consumers or users of medical and hospital health care services in Puerto Rico are entitled to:
(a) Health care plans that include in their contract or policy a provision stating that such healthcare plans may not be rescinded or amended, once the beneficiaries are covered under such plans or coverage, unless they default payment of premiums and do not comply with the grace periods granted by the Insurance Code; have performed an act that constitutes fraud; or makes an intentional misrepresentation of material facts as prohibited by such plans for the acceptance of risk or the risk assumed by such insurers.
(b) Health care plans shall contain a clause providing that in cases in which health care plan coverage is terminated or cancelled, or coverage by a provider is terminated or cancelled, the insurer shall notify the patient of such termination or cancellation thirty (30) calendar days before the date such termination or cancellation becomes effective.
(c) Subject to payment of premium as required, all health care plans must contain a clause providing that should the plan or the provider terminate coverage, the patient may continue receiving the benefits thereof for a transitional period of ninety (90) days as of the date the plan or the provider terminates coverage.
(1) In those cases in which the patient is hospitalized at the time of the date of said termination of coverage, and the release of the patient from the hospital has been scheduled for a date preceding the date of termination of coverage, the transition period shall be extended from said date to ninety (90) days after the date the patient is released.
(2) In those cases in which the patient is in her second trimester of pregnancy as of the date of termination of coverage and the provider has been offering medical treatment pertinent to the pregnancy before the date of termination of coverage, the transitional period concerning pregnancy related health care shall be extended to the date the mother is released from hospital after childbirth, or the date the newborn is released from the hospital, or both, whichever occurs later.
(3) In those cases in which the patient is diagnosed [with] a terminal condition before the date of termination of coverage and the provider has been offering medical treatment pertinent to the condition before said date, the transitional period shall be extended for the remainder of the patient’s life.
Providers that continue the treatment of the insured parties or their beneficiaries during said period must accept the payments and rates fixed by the plan as full payment for services rendered, as well as continue providing the plan with all the necessary information required by the plan for purposes of quality control, and surrender or transfer the medical records corresponding to the patients upon termination of said transitional period.
History —Aug. 25, 2000, No. 194, § 7; Nov. 1, 2010, No. 161, § 4.