The Affordable Care Act (“ACA”) and its regulations have been incorporated into the Puerto Rico Health Insurance Code, as amended, and guidance has been issued by the Office of the Insurance Commissioner to such effect. The Department of Health & Human Services (βHHSβ), however, has recently clarified that the following requirements imposed under the ACA, will not apply to individual or group health insurance in the U.S. territories, including Puerto Rico: (i) guaranteed availability; (ii) community rating; (iii) single risk pool; (iv) rate review; (v) medical loss ratio; and (vii) essential health benefits.
Home > Federal Law Articles > Employee Benefits > Health Care Reform > The Department of Health & Human Services Clarifies Applicability of Certain Provisions of the Affordable Care Act to Health Insurance Issuers in Puerto Rico