P.R. Laws tit. 26, § 9433
(a) A health insurance organization or issuer shall include a clear and comprehensive description of its utilization review and benefit determination procedures in the certificate of coverage or member handbook provided to covered persons or enrollees. The description shall include the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of covered persons or enrollees with respect to those procedures.
(b) A health insurance organization or issuer shall include a summary of its utilization review and benefit determination procedures in materials intended for prospective covered persons or enrollees.
(c) A health insurance organization or issuer shall print on the health plan cards of the covered person or enrollee a toll-free telephone number to call for utilization review and benefit decisions.
History —Aug. 29, 2011, No. 194, added as § 24.130 on Aug. 23, 2012, No. 203, § 5, eff. 90 days after Aug. 23, 2012.