Reglamento 7747

The Government of Puerto Rico's Office of the Commissioner of Insurance issued Rule L, effective September 21, 2009, to regulate Medicare supplement insurance policies. This comprehensive rule aims to standardize coverage, simplify terms and benefits, and enhance public understanding and comparison of such policies and contracts. Its purpose is to eliminate misleading provisions and ensure full disclosure in the sale of accident and sickness insurance to Medicare-eligible individuals. The regulation applies to all Medicare supplement policies and group certificates delivered or issued in Puerto Rico.

Rule L establishes detailed requirements for minimum benefit standards, including specific provisions for policies issued before and after certain dates, such as 1990 and 2009 standardized plans. Furthermore, it addresses critical aspects such as open enrollment, guaranteed issue for eligible persons, and standards for claims payment. The regulation also mandates loss ratio standards, filing and approval processes for policies and premium rates, and permitted compensation arrangements. It includes extensive disclosure provisions, regulates application forms, advertising, and marketing practices, and prohibits the use of genetic information or pre-existing condition clauses in replacement policies. This extensive framework ensures consumer protection and fair practices within the Medicare supplement insurance market in Puerto Rico.