P.R. Laws tit. 26, § 9126
(a) An issuer providing health plans to PYMES employers shall renew the same to all eligible employees and their dependents, except in any of the following cases:
(1) Failure to pay premiums, considering the grace period.
(2) When the covered person or enrollee has performed an act that constitutes fraud. In such case the issuer may choose not to renew the health plan of such covered person or enrollee for one (1) year as of the of the [sic] coverage’s termination date.
(3) When the covered person or enrollee has or made an intentional misrepresentation of material fact under the terms of coverage. In such case the issuer may choose not to renew the health plan of such covered person or enrollee for one (1) year as of the of the [sic] coverage’s termination date.
(4) Noncompliance with the issuer’s minimum participation requirements, pursuant to the provisions of this chapter.
(5) Noncompliance with the issuer’s employer contribution requirements.
(6) When the issuer elects to discontinue offering all of its health plans to PYMES employers in Puerto Rico. In these cases, the issuer shall provide a written notice to the Commissioner, the PYMES employer, and the covered persons or enrollees, of its decision not to renew coverage at least one hundred and eighty (180) days prior to the nonrenewal of the health plans. The issuer that elects to discontinue offering health plans, as provided herein, shall be impaired from underwriting new business in the PYMES employer market in Puerto Rico for a term of five (5) years, beginning on the date in which the issuer ceased to offer such health plans.
(7) When the commissioner finds that the continuation of the coverage would not be in the best interests of the policyholders or would impair the issuer’s ability to meet its contractual obligations.
(8) In the case of health plans that are made available in the small group market through a preferred network plan, there is no longer an employee of the PYMES employer living, working, or residing within the issuer’s established geographic service area.
(b) In the case of a PYMES employer issuer doing business in one established geographic service area of Puerto Rico, the rules set forth in this section shall apply only to the issuer’s operations in that service area.
(c) In addition to comply with the provisions of this section, the issuer shall comply, at all times, with the applicable federal regulations, as codified under 45 C.F.R. Section 146.152 (Guaranteed renewability of coverage for employers in the group market).
History —Aug. 29, 2011, No. 194, § 8.060, eff. 180 days after Aug. 29, 2011.