P.R. Laws tit. 26, § 9204
(a) No policy, contract, certificate or agreement offered or issued in Puerto Rico by a health insurance organization or issuer to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services may contain a provision purporting to reserve discretion to health insurance organizations or issuers to interpret the terms of the contract, or to provide standards of interpretation or review that are inconsistent with the laws of Puerto Rico. An adverse determination by a health insurance organization or issuer, as well as disputes or controversies that may arise between a health insurance organization or issuer and a covered person or enrollee, shall be subject to the internal and external review procedures established in this Code.
(b) No policy, contract, certificate or agreement offered or issued in Puerto Rico providing for disability income protection coverage may contain a provision purporting to reserve discretion to the insurer to interpret the terms of the contract, or to provide standards of interpretation or review that are inconsistent with the laws of Puerto Rico.
History —Aug. 29, 2011, No. 194, § 12.040, eff. 180 days after Aug. 29, 2011.