2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 170 - Unfair Discrimination against Victims of Abuse (§§ 10371 — 10377) › § 10374 - Unfairly discriminatory acts relating to health plans

(a) It is unfairly discriminatory to:
(1) Deny, refuse to issue, renew or reissue, cancel or otherwise terminate a health plan, or restrict a health plan coverage or add a premium differential or surcharge to any health plan on the basis of the covered person or enrollee's abuse status, or
(2) exclude, limit coverage, or deny a claim on the basis of the covered person or enrollee's abuse status;
(b) When the health insurance organization or issuer or insurance professional has information in its possession that clearly indicates that the current of potential covered person or enrollee is a victim of abuse, the disclosure or transfer of the confidential abuse information, as defined in this chapter, by a health insurance organization or issuer or insurance professional for any purpose or to any person is unfairly discriminatory, except:
(1) To the victim of abuse or an individual specifically designated in writing by the victim of abuse;
(2) to a healthcare provider for the direct provision of healthcare services;
(3) to a physician identified and designated by the victim of abuse;
(4) when ordered by the Commissioner or a court of competent jurisdiction or otherwise required by law, or
(5) when necessary for a valid business purpose to transfer information that includes confidential abuse information that cannot reasonably be segregated without undue hardship. Confidential abuse information may be disclosed only if the recipient has executed a written agreement to be bound by the prohibitions of this chapter and to be subject to the enforcement of this chapter by the courts of Puerto Rico. Disclosure of confidential abuse information for valid business purposes is hereby authorized under this section only to the following persons:
(A) A reinsurer that shall indemnify all or any part of a policy covering a victim of abuse, provided that the reinsurer cannot underwrite or satisfy its obligations under the reinsurance agreement without that disclosure;
(B) a party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the health insurance organization or issuer or insurance professional;
(C) medical or claims personnel contracting with the health insurance organization or issuer or insurance professional, only when such disclosure is necessary to process an application or perform its duties under the policy, or
(D) with respect to the address and telephone number of the victim of abuse, to entities with whom the health insurance organization or issuer or insurance professional transacts business when the business cannot be transacted without the address and telephone number.
(6) to an attorney who needs the information to represent the health insurance organization or issuer or insurance professional effectively, provided the health insurance organization or issuer or insurance professional notifies the attorney of its obligations under this chapter and requests that the attorney exercise due diligence to protect the confidential abuse information;
(7) to the policy owner or assignee, in the course of delivery of the policy, if the policy contains information about abuse status, or
(8) to any other entities deemed appropriate by the Commissioner.
(c) It is unfairly discriminatory to request information relating to acts of abuse or a current or potential covered person or enrollee's abuse status, or make use of that information, however obtained, except for the limited purposes of complying with legal obligations or verifying a person's claim to be a victim of abuse.
(d) It is unfairly discriminatory to terminate group coverage for a victim of abuse because coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the victim of abuse, or the abuser's coverage has terminated voluntarily or involuntarily. Nothing in this subsection prohibits the health insurance organization or issuer or insurance professional from requiring the victim of abuse to pay the full premium for coverage under the health plan or from requiring as a condition of coverage that the victim of abuse reside or work within the health plan service area, if the requirements are applied to all existing or potential covered persons or enrollees.
The health insurance organization or issuer may terminate group coverage after the continuation coverage required by this subsection has been in force for eighteen (18) months, if it offers conversion to an equivalent individual plan. The continuation coverage required herein shall be satisfied by coverage required under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), and shall not be in addition to coverage provided under COBRA.
(e) The provisions of subsection (b) of this section shall not preclude a victim of abuse from obtaining his/her insurance records.
(f) The provisions of subsection (d) of this section shall not prohibit a health insurance organization or issuer or insurance professional from asking about a medical condition or from using medical information to underwrite or to carry out its duties under the policy, even if the medical information is related to a medical condition that the issuer or insurance professional knows or has reason to know is abuse-related, to the extent otherwise permitted under this chapter and other applicable law.
History —Aug. 29, 2011, No. 194, added as § 72.040 on Aug. 23, 2012, No. 203, § 9, eff. 90 days after Aug. 23, 2012.