P.R. Laws tit. 26, § 9124
(a) This chapter shall apply to an issuer that offers health plans to the employees of PYMES employers in Puerto Rico, provided that the PYMES employer pays all or part of the premium or benefits, or the eligible employee is reimbursed for any portion of the premium, whether through wage adjustments or otherwise, as agreed upon by the parties.
(b) For the purposes of this chapter, issuers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one issuer and any restrictions or limitations imposed by this chapter shall apply as if all health plans issued for delivery to PYMES employers in Puerto Rico by such affiliated issuers were issued by one issuer.
(c) Those issuers that which to contract with the Puerto Rico Health Insurance Administration (ASES, Spanish acronym) to offer, market, or administer the Mi Salud Plan for PYMES, shall meet the requirements and legal and regulatory provisions established by ASES, the Insurance Code of Puerto Rico, and this chapter. Provided, That in the case of the Mi Salud Plan for PYMES, the rules established by ASES regarding the following shall apply to issuers:
(1) Geographic service area;
(2) the criteria to determine the eligibility of the PYMES employer, as well as the employees thereof and their dependents;
(3) the development and definition of the health plan or plans and the coverage thereof;
(4) issues related to premium rate models, methods, and practices, and premiums to be paid, and
(5) the eligibility criteria to be met by participating issuers.
It is hereby provided further that those issuers that are not offering, marketing or administering a health plan for any PYMES employer in Puerto Rico and wish to contract with ASES for the Mi Salud Plan for PYMES, shall request and obtain the approval or dispensation of the Commissioner to participate in such Mi Salud Plan for PYMES.
History —Aug. 29, 2011, No. 194, § 8.040, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 15, eff. 30 days after July 2013.