P.R. Laws tit. 26, § 9171
(a)
(1) If an issuer denies individual health plan coverage to an eligible person on the basis of his/her health status or claims experience or that of his/her dependents, the issuer shall offer such person the opportunity to purchase an approved basic health plan in any of its different metal levels of coverage.
(2) Except as provided in §§ 9167 and 9168 of this title, and notwithstanding the provisions of clause (1), individual health plan issuers may not deny coverage to an applicant who is an eligible person or a federally defined eligible individual.
(b) Except as provided in subsection (c) of this section, no issuer, producer, or any other intermediary shall, directly or indirectly, engage in any of the following activities:
(1) Encourage or direct individuals to refrain from filing an application for coverage with the issuer because of the health status, claims experience, industry, occupation, or geographic location of the individual.
(2) Encourage or direct individuals to seek coverage from another issuer because of the health status, claims experience, industry, occupation, or geographic location of the individual.
(c) The provisions of subsection (b)(1) shall not apply with respect to information provided by an issuer or producer to an individual regarding the established geographic service area of the issuer or a preferred network provision of the issuer.
(d) Except as provided in subsection (e) of this section, no issuer shall, directly or indirectly, enter into any contract, agreement, or arrangement with a producer that provides for the compensation paid to a producer for the sale of a health plan to be varied because of the health status or permitted ratings characteristics of the individual or his/her dependents.
(e) Subsection (d) shall not apply with respect to a compensation arrangement to a producer on the basis of percentage of premium, provided that the percentage shall not vary because of the health status or other permitted rating characteristics of the individual or his/her dependents.
(f) Denial by an issuer of an application for coverage shall be in writing and shall state the reasons for the denial.
(g) A violation of this section by an issuer or a producer shall be an unfair trade practice under §§ 2701-2736 of this title.
(h) If an issuer enters into a contract, agreement, or other arrangement with a Third-party Administrator to provide administrative, marketing, or other services related to the offering of individual health plans in Puerto Rico, the Third- party Administrator shall be subject to this section as if it were an issuer.
(i) In addition to the provisions of this section, an issuer shall comply at all times with the applicable federal regulations.
History —Aug. 29, 2011, No. 194, added as § 10.110 on July 22, 2013, No. 69, § 1, eff. 60 days after July 22, 2013.