Quitting smoking: your health plan covers up to $400 a year

It is a mandatory coverage most people do not know they have. If you have a health plan in Puerto Rico and need treatment to quit tobacco — services and medications — the law requires the plan to cover it up to a minimum of four hundred dollars a year, if there is medical justification and the Health Department protocol’s criteria are met.

Subscribers of insurers and health insurance organizations, health plans and any entity providing health services by contract, as defined in Article 19.020 of the Puerto Rico Insurance Code, who require treatment for tobacco use and dependence. The law conditions coverage on medical justification and on the protocol’s criteria.

• That medical justification exist. The law says it literally: coverage is included “if medical justification exists”.Verified against the official source
• That the criteria established in the protocol created under Act 21-2008 be met. That protocol is established and implemented by the Health Department; we did not read it and we do not describe its criteria.Verified against the official source
• That your plan be one the law covers: insurers and health insurance organizations, health plans and any entity providing health services by contract, as defined in Article 19.020 of the Insurance Code.Verified against the official source

• The law publishes no document list or form for the subscriber. What the law does require is the medical justification, so the conversation starts with your physician and not with the plan.

1. 1

   Step 1: Start with your physician, not the plan

   The law conditions coverage on medical justification and on the protocol’s criteria. That means the piece that opens the door is your physician’s evaluation, not a call to the plan’s customer service. Ask them to document the need for treatment for tobacco use and dependence.

2. 2

   Step 2: Medications are inside the coverage

   This is the part most often lost in a conversation with a plan. Article 3 says coverage includes “the provision of services, including medications to subscribers requiring treatment for tobacco use and dependence”. It is not only counselling: medications are named in the text.

3. 3

   Step 3: The figure is a floor: $400 annually per subscriber

   The law says “up to a minimum of four hundred ($400) dollars annually per subscriber”. The wording is the legislature’s and we quote it as it stands. What is clear is the unit: it is annual and per subscriber, not per family or per lifetime.

4. 4

   Step 4: Your plan must report to the Health Department what it covers

   This is what Act 10-2026 made compulsory. Insurers, health insurance organizations, health plans and any entity providing health services by contract must annually provide the Tobacco Prevention, Control and Oral Health Division, attached to the Health Department, the information on their medical coverages for providing these services. And that information must also include the detail on the medications available to their subscribers who require the treatment.

5. 5

   Step 5: What happens to a plan that does not comply

   Act 10-2026 put teeth where there were none, and they are worth knowing. The Health Secretary shall notify the Insurance Commissioner of every health services organization, health plan or entity providing health services by contract that is in non-compliance with this article. The Insurance Commissioner may begin a revocation process of a Certificate of Authority upon the second non-compliance. And the Health Secretary shall be barred from certifying to the Insurance Commissioner that an entity meets the requirements for issuing a Certificate of Authority until that entity shows compliance.

6. 6

   Step 6: A detail of the text we prefer to flag

   The title of Act 10-2026 names the receiving office as the “Tobacco Control Division”, while the amended article — which is the governing text — calls it the “Tobacco Prevention, Control and Oral Health Division”. We use the article’s name. If you are going to write to the Health Department, that is the name in the operative law.

Coverage is claimed from your health plan. The body that receives insurers’ annual information and oversees compliance on the health side is the Tobacco Prevention, Control and Oral Health Division of the Health Department; the body that may begin revoking the Certificate of Authority is the Insurance Commissioner. The law publishes no address, phone or portal for either office, and creates no subscriber complaint procedure: we will not invent one.

• Believing quitting smoking is an out-of-pocket expense: the law requires plans to cover it up to a minimum of $400 annually per subscriber.
• Thinking the coverage is only counselling: the article says “the provision of services, including medications”.
• Asking the plan without medical justification: the law conditions coverage on medical justification and on the protocol’s criteria.
• Reading the $400 as a lifetime or per-family limit: the law sets it as annual and per subscriber.
• Assuming a plan can ignore the reporting requirement: since Act 10-2026 the Insurance Commissioner may begin revoking the Certificate of Authority upon the second non-compliance.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov