Oficina del Comisionado de Seguros (OCS)

Surprise medical bill: what you can be charged out of network

In an emergency you cannot be billed above the copay, deductible or coinsurance that would apply in network. And there is arbitration if no deal is reached.

Your plan denied your medication: the medical exception and its 48 hours

The Health Insurance Code gives the plan 48 hours to decide a medical exception, and guarantees your medication while it decides. 24 hours if controlled.

After childbirth: 48 hours of hospital, 96 if it was a C-section

Act 248-1999 requires the plan to cover a minimum 48 hospital hours after an uncomplicated vaginal birth and 96 hours if there was a C-section.

9-1-1 ambulance: your plan pays the provider directly

Act 129-2019 requires every basic plan to cover emergency ground ambulance and to pay the provider directly, minus deductibles and copays.

Public Utilities

Insurance: 15 days to acknowledge, 90 to resolve, 30 to reconsider

Article 1.120 of the Insurance Code puts dates on your claim and bars treating an unaccepted cheque as a waiver of your claims.

Breast cancer screening: what the plan covers and what your report must say

Act 10-2020 requires covering mammograms as preventive care and requires your report to state breast density with a verbatim notice.

Vehicles & CESCO

The compulsory insurance on your marbete: what it is and how not to pay twice

What the SRO covers, your Ley 245-2014 right to choose your insurer, and the Compliance Certificate that exempts you if you already carry traditional coverage.

August 15, 2026

Vehicles & CESCO

Filing a compulsory insurance claim after an accident

What the SRO pays and what it does not, the three deadlines, why the estimate must come from a registered shop, and why the police report does not decide fault.

August 15, 2026

HPV vaccine: your health plan must cover it, and not only for girls

Act 9-2010, amended in 2012, requires plans to cover the HPV vaccine for males and females, with the full set of doses the FDA requires.

Anesthesia at the dentist: when your plan cannot deny it

Act 352-1999 forbids excluding or denying general anesthesia and hospitalization for dental procedures for children and people with disabilities in six situations.

Psychology services: your health plan must include them in its coverage

Act 239-2012 orders insurers to include in their coverage services by psychology professionals trained at master’s or doctoral level.

Type 1 diabetes: the monitor, 150 monthly strips and the pump your plan must cover

Act 177-2016 requires plans to cover a glucose monitor every 3 years, glucagon, a minimum of 150 strips and 150 lancets monthly, and the insulin pump.

Bariatric surgery: what your plan must cover and the 12-month waiting period

Act 212-2008 requires every public or private plan in Puerto Rico to cover one bariatric surgery per lifetime for morbid obesity, with a BMI of 35 or higher.

Buprenorphine for opioid addiction: your plan must have it on the list

Act 140-2010 requires insurers, plans and ASES to include buprenorphine on the preferred drug list for treating opioid addiction.

Public Utilities

Pet insurance: what the insurer must disclose to you

Act 186-2026 regulates pet insurance in Puerto Rico: fifteen days to return the policy, a 30-day waiting-period cap, and no waiting period for accidents.

August 26, 2026

Coordination of benefits if you have two health plans

Act 161-2026 requires the provider and the insurer to coordinate your benefits between plans: you should not have to chase your own reimbursement.

August 26, 2026