The Centers for Medicare and Medicaid Services (CMS) has informed the U.S. Territories of American Samoa, Puerto Rico, American Samoa and the Virgin Islands that most Affordable Care Act (ACA) provisions do not apply to them.
The provisions that do not apply to the territories are guaranteed issue, the community rating rules, the essential health benefits rule and the minimum medical loss ratio (MLR) limitation on insurance companies' administrative charges, among other rules.
In other words, it's business pre-Obamacare for health insurance in the territories.