CB_2018-02-08

34 SPECIAL FEATURE: 2018 PUERTO RICO INVESTMENT SUMMIT Thursday, February 8, 2018
Role of Insurance
in Health and
Economy
BY CB STAFF
Puerto Rico’s insurance industry
continues to play a
leading role in the island’s
financial services sector.
A clear indicator is the amount of
total subscribed premiums, which
in 2011 reached $10.23 billion. The
local insurance market continues
to be dominated by local insurers
and health service organizations
(HSOs), which subscribed more
than 90% of local premiums in
2011. At the end of 2010, Puerto Rico’s
insurance industry comprised
35 local and 218 nonlocal insurers,
13 HSOs and one reinsurer (See related
story, p. 8)
Additionally, there are 8,800 producers
and authorized representatives,
general agents, adjusters,
solicitors, managers and others.
The island’s insurance industry is
supervised and regulated by the
Insurance Commissioner’s Office
(OIC by its Spanish acronym),
which regulates some 9,000 individuals
and corporations that work
in Puerto Rico’s industries. Currently,
the OIC is promoting the
implementation of a Health Insurance
Code for Puerto Rico. As part
of the code, the OIC will promote
the adoption of a new law applicable
to HSOs, whereby, among
other things, new minimal capital
requirements will be enacted to be
more in tune with the market. The
OIC is also in the process of implementing
the U.S. Affordable Care
Act to determine the rationale behind
medical plan rates.
Since 1993, Puerto Rico has adopted
a Medicaid managed care
system, with a plan known as “La
Reforma.” In 2010, the island reformed
its public healthcare system
and the government’s health
plan for the medically indigent
is now called “Mi Salud.” All Mi
Salud beneficiaries are enrolled
in a managed care program. As of
2016, almost half of the population
of Puerto Rico is covered by Medicaid
(Mi Salud), with an additional
11% covered by Medicare.
According to the website medicare.gov,
Mi Salud is offered
through one local, for-profit plan,
Triple-S, and behavioral health
through a national for-profit plan,
APS, both available islandwide.
Medicare programs are offered
through several for-profit plans
including local plans such as
First Medical, MCS, MCS, MMM
Healthcare and PMC Medicare
Choice, and national plans such
as Humana and Blue Cross/Blue
Shield Associate4 Triple-S.
The government also has contracts
with pharmacy-benefit
management companies to provide
prescription drugs to Mi
Salud beneficiaries. These companies,
or managed care organizations,
are reimbursed through
a combination of capitated and
fee-for-service payments, which
cover primary and specialty care
respectively. Plans on the island
are selected through a competitive
procurement process.