PR| Puerto Rico Insurance Department Ruling Letter No. CN-2025-369-SR outlines the adoption of Rule 111 under Act 169-2024, which establishes the licensing process for Third-Party Administrators (TPAs) operating in Puerto Rico.
Key points:
- Licensing Requirements: TPAs must obtain a license from the Office of the Commissioner of Insurance (OCI) by submitting a completed Uniform Application, required documents, and an annual fee of $2,500.
- Nonresident TPAs must meet additional requirements, such as providing certification from their home state or designating Puerto Rico as their home state if no similar law exists in their jurisdiction.
- Compliance Obligations: Licensed TPAs must notify the OCI within 30 days of any material changes affecting their qualifications. Entities already providing TPA services in Puerto Rico must apply for a license within 30 days of March 14, 2025, unless exempted. Insurers and health service organizations are responsible for ensuring their TPAs are licensed.
- Penalties for Noncompliance: Acting as a TPA without a license constitutes a violation of Act 169-2024 and Rule 111, subjecting violators to sanctions. Insurers using unlicensed TPAs may also face penalties.
- Third Party License Application Checklist
