Para añadir un inciso (EE) al Artículo 2.030 y enmendar el Artículo 2.050, a los fines de añadir los subincisos (l), (m) y (n) en el inciso D, de la Ley 194-2011, según enmendada, conocida como “Código de Seguros de Salud de Puerto Rico”; para enmendar la Sección 1 del Artículo III y añadir un nuevo inciso (h), y renumerar los subsiguientes, así como enmendar la Sección 6 del artículo VI y añadir un inciso (g) del subinciso (1) del inciso “Cubierta C” de la Ley 72-1993, según enmendada, conocida como “Ley de la Administración de Seguros de Salud de Puerto Rico”; a los fines de incorporar la definición de biomarcadores y establecer la cubierta obligatoria de pruebas de biomarcadores en los planes de salud en Puerto Rico, incluyendo el Plan de Salud del Gobierno; disponer sobre su aplicabilidad, reglamentación, deber de orientación y vigencia; y para otros fines relacionados.

2025-2028 Session

Puerto Rico mandates health insurers, including government plans, cover biomarker testing without specifying which tests qualify or cost containment mechanisms.

Comisión no recomienda aprobación de la medida

Legislative bill overview

Bill PS 1097 amends Puerto Rico's health insurance laws to require mandatory coverage of biomarker testing in all health insurance plans, including the government health plan. The bill defines biomarkers and establishes regulatory frameworks for implementing this coverage requirement across the island's health system.

Why is this important

Biomarker testing can enable early disease detection and personalized treatment approaches, potentially improving health outcomes. This mandate affects all Puerto Rico residents with health insurance by expanding covered diagnostic services, which could increase both access to advanced diagnostics and overall healthcare costs for insurers and consumers.

Potential points of contention

Cost implications: Mandatory biomarker coverage increases insurance premiums and government health plan expenditures without specified cost-containment measures or approval thresholds for which biomarkers qualify

Regulatory clarity: The bill requires extensive regulations but provides limited guidance on which biomarkers are covered, who determines medical necessity, and how frequently testing is authorized

Implementation burden: Healthcare providers and insurers must rapidly implement new coverage categories, potentially creating administrative delays and inconsistent application across different plans