P.R. Laws tit. 26, § 9396
(a) Except as specified in § 9400 of this title, health insurance organizations or issuers shall receive and resolve grievances from covered persons or enrollees as provided in §§ 9397–9399 of this title.
(b) Health insurance organizations or issuers shall file a copy with the Commissioner of the procedures required under subsection (a) of this section, including all forms used to process the requests made. Any subsequent modifications to such procedures shall also be filed. The Commissioner may disapprove a filing received if it fails to comply with this chapter or the applicable regulations.
(c) In addition to the provisions of subsection (b) of this section, health insurance organizations or issuers shall file annually with the Commissioner, as part of the annual report required by § 9395 of this title, a certificate of compliance stating that such health insurance organizations or issuers have established and maintain, for each of their health plans, grievance procedures that fully comply with the provisions of this chapter.
(d) A description of the grievance procedures required under this section shall be included in the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage provided to covered persons or enrollees.
(e) The grievance procedure documents shall include a statement of a covered person or enrollee’s right to contact the Office of the Insurance Commissioner or the Office of the Patient’s Advocate for assistance at any time. The statement shall include the telephone number and address of the Office of the Insurance Commissioner and the Office of the Patient’s Advocate.
History —Aug. 29, 2011, No. 194, § 22.060, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 26, eff. 30 days after July 10, 2013.