PR| Puerto Rico OCI Ruling Letter No. CN-2025-367-AS outlines the regulatory requirements for health and disability insurers in Puerto Rico submitting forms and rate filings for health insurance plans effective in 2026. It emphasizes compliance with the Health Insurance Code of Puerto Rico (HICPR) and provides detailed instructions on submission timelines, formats, and supporting documentation. Non-compliance may result in rejection of filings.
Key points:
- Rate Filing Requirements: Insurers must submit rates for individual and small group metallic plans by specific deadlines (May 31, 2025, for individual plans; July 1, 2025, for small group plans). Rate increases of 10% or more require justification and prior approval. All filings must adhere to SERFF system guidelines and include actuarial certifications, benefit maps, and other supporting documents.
- Form Filing Standards: Annual submissions for metallic plans are treated as new products requiring comprehensive reviews. Insurers must provide clear language, comply with benchmarks like essential health benefits (EHB), and ensure accessibility features such as Braille translations. Forms cannot be altered after approval.
- Public Disclosure & Compliance: Approved rates, forms, and copayment tables will be published on the Office of the Commissioner of Insurance (OCI) website. Insurers must ensure nondiscrimination in benefit design, maintain transparency in drug formularies, and adhere to federal/state laws governing coverage limits and preventive services.