P.R. Laws tit. 26, § 9280
(a) The rates for a limited health service plan to be used by a limited health service organization shall be filed with the Commissioner, before applying them in Puerto Rico. No filing shall be effective until sixty (60) days after the receipt thereof in the Office of the Commissioner, unless it is expressly approved by the Commissioner. The Commissioner may extend such period for an additional term that shall not exceed sixty (60) days, if the Commissioner notifies the applicant within such waiting period. If the Commissioner determines that the information provided in the filing is not sufficient and, therefore, requires additional information, the period of time from the notification of the Commissioner of such requirement to the receipt of the requested information by the Commissioner shall not be counted for purposes of computing the aforementioned terms. To determine whether a rate is approved or disapproved, the Commissioner may require the submittal of any relevant information that he/she may deem pertinent.
(b) Rates shall be established in accordance with the actuarial principles for various categories of subscribers. Charges applicable to a subscriber shall not be individually determined based on health status. Rates shall not be excessive, inadequate, or discriminatory. A certification by a qualified actuary, to the appropriateness of the rates, based on reasonable assumptions shall be enclosed with the filing, along with adequate supporting information.
(c) If the Commissioner disapproves the filing, the Commissioner shall notify the applicant and shall specify the reasons for disapproval. The affected party shall have twenty (20) days from the date of receipt of the notice to request a hearing.
Any time after the applicable review period as provided in subsection (a) of this section, the Commissioner may hold a hearing to determine whether the filing meets the established requirements. The Commissioner shall provide a notice in writing to the limited health service organization that made the filing at least ten (10) days before the hearing. If, after the hearing, the Commissioner determines that the filing does not meet the requirements of this Section, he/she shall enter an order specifying the reasons for disapproval and the date, within a reasonable subsequent period, on which the filing shall be deemed to be ineffective. Such order shall not affect any agreement executed or ratified before the expiration of the term specified in the order.
History —Aug. 29, 2011, No. 194, added as § 16.100 on Aug. 23, 2012, No. 203, § 2, eff. 90 days after Aug. 23, 2012.