PR OCI issues Ruling Letter relating to Health insurer Form and Rate submissions

On March 9^th, the Puerto Rico Office of the Commissioner of Insurance (“OCI”), issued a Ruling Letter directed toward Disability and Health insurers that write group health plans in Puerto Rico. Pursuant to Section 19.080(2)(a) of the Puerto Rico Insurance Code, the Puerto Rico OCI requires a submission of form/rate filings for all metallic plans, even if no changes have been made, and a submission for plans with rate increases greater than 10%.

Rate filings for non-grandfathered Individual plans that will be effective on January 1, 2022 must be submitted to the OCI on or before May 31, 2021. Rate filings for non-grandfathered Small Group plans, including small group health plans for bona fide associations, must be submitted to the OCI on or before July 1, 2021

Every filing must be submitted through the SERFF system, including all the information required in this ruling letter and its attachments. In compliance with Act No. 162 of December 30, 2020, the insurer shall submit the required translated Evidence of Coverage or Policy form to the Braille System for blinded persons along with a Certification of translation within the next sixty (60) days from the date of approval of this filing via new SERFF filing under the Supporting Documentation tab

All Health insurers are also required to complete and submit the Supplemental Health Care Exhibit to the NAIC and the Puerto Rico OCI before March 30 of each year for Disability insurers, and before March 31 of each year for HMOS.

The contents of this Wire represent only a portion of the requirements outlined in the Ruling Letter. For more details regarding this matter, please review the Ruling Letter HERE.

For any other information on this Ruling Letter, or any other regulatory compliance matter, please contact Westmont Associates, Inc.