2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9125 - Restrictions relating to premium rates

(a) Premium rates for health plans shall be subject to the following provisions:
(1) The PYMES employer issuer shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate with regards to geographic area, family composition, age, and tobacco use.
(2) Any adjustment shall be made according to the rules and conditions prescribed by the Commissioner through policy letter.
(3) Issuers shall be permitted to develop separate rates for individuals age sixty-five (65) or older notwithstanding that Medicare is the primary payer. Both rates shall be subject to the requirements of this section.
(4) As of the approval of this act, rate adjustments based on age shall be those determined by the Commissioner of Insurance.
(b) The premium charged for a health plan may not be adjusted more frequently than annually, except that the rates may be changed to reflect:
(1) Changes to the enrollment of the PYMES employer;
(2) changes to the family composition of the eligible employee, or
(3) changes to the health plan requested by the PYMES employer.
(c) Rating factors shall produce premiums for identical groups which differ only by the amounts attributable to plan design and do not reflect differences due to the nature of the groups assumed to select particular health plans.
(d) The Commissioner may establish, through policy letter, the rating practices to be used by PYMES employer issuers that are consistent with the purposes of this chapter.
(e) Each issuer shall maintain at its principal place of business, for review by the Commissioner, a complete and detailed description of its rating practices and renewal underwriting practices. In addition, such issuer shall maintain information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles. Also, issuers shall meet the following requirements:
(1) Each PYMES employer issuer shall file with the Commissioner annually, not later than March 15, an actuarial certification certifying that it is in compliance with this chapter and that the rating methods of the PYMES employer issuer are actuarially sound. The certification shall be in a form and manner, and shall contain such information, as specified by the commissioner. A copy of the certification shall be retained by the PYMES employer issuer at its principal place of business.
(2) A PYMES employer issuer shall make the information and documentation described in this subsection available to the Commissioner for inspection upon request. Except in cases of violations of this chapter, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the Commissioner to persons outside of the Office, except as agreed to by the issuer or as ordered by a court of competent jurisdiction.
(f) The requirements of this section shall apply to all health plans issued or renewed on or after the effective date of this chapter.
History —Aug. 29, 2011, No. 194, § 8.050, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 16, eff. 30 days after July 10, 2013.