May 3, 2016

On April 26, 2016, the Puerto Rico Office of the Commissioner of Insurance issued Ruling Letter No.: CN-2016-198-AS, which states that insurers in the individual and small group major medical health insurance markets can choose to renew transitional policies through Sept. 30, 2017, although they must expire by Dec. 31, 2017. As discussed in the March 8, 2016, edition of Compliance Corner, CMS announced an extension for small group transitional policies. Such policies are not required to be in compliance with certain PPACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. The policy must have been in place on Jan. 1, 2014.

Additionally, insurers that offer this short term extension of coverage are required to send each policyholder a renewal notice that explains the offer to continue the transition policy to the end of 2017. The compulsory notice is included with this Letter.

Ruling Letter No.: CN-2016-198-AS »