reglab/statecodes huggingface dataset:
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 29 - Corporate Powers and Procedures of Domestic Stock and Mutual Insurers (§§ 2901 — 2954) › § 2952 - Voluntary liquidation—Certificate of dissolution

(1) After the liquidation of the insurer has been completed, its obligations discharged, its remaining assets have been distributed to its stockholders, partners, or policyholders, and deposit in trust of undelivered funds, if any, has been made as provided in § 2949(6) of this title, the Commissioner shall make such examination of the insurer’s affairs as he may then deem necessary. When the report of such examination shows that such things have been properly accomplished, the insurer shall be so notified.
(2) Upon receiving such notice as to such examination, a majority of the insurer’s directors and its president and secretary shall execute in triplicate a certificate under oath setting:
(a) That the insurer has been fully liquidated.
(b) That all its obligations have been paid and discharged.
(c) That all its assets remaining after discharge of its other obligations have been distributed to its shareholders, members, partners or policyholders as entitled thereto.
(d) That as to any such shareholders, members, partners or policyholders to whom delivery of their respective portions of such assets could not be made within the ninety-day period provided therefor by law, the funds representing such undelivered assets have been deposited in trust for the benefit of, and to be delivered upon demand of and to, such shareholders, members, partners or policyholders, in a named financial institution, subject to escheat to the Commonwealth of Puerto Rico if not so demanded by the date, stated therein, as required by law.
(e) That such insurer corporation is thereby forever dissolved, such dissolution to be effective as of a date stated, which date shall be not less than ten, or more than thirty, days after date of filing of the certificate as provided in § 2953 of this title.
History —Ins. Code § 29.520; June 25, 1965, No. 86, p. 200, § 21.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 29 - Corporate Powers and Procedures of Domestic Stock and Mutual Insurers (§§ 2901 — 2954) › § 2953 - Filing certificate—Effective date of dissolution

(1) A copy of the certificate of dissolution provided for in § 2952 of this title, together with a copy of the examination report provided for in § 2952(1) of this title, certified to by the Commissioner, shall forthwith be filed with the Secretary of State, another copy of each thereof shall be filed in the office of the Commissioner, and a third copy thereof shall remain as part of the corporate records of the insurer.
(2) Following such filings and upon the effective date of dissolution as provided in the certificate of dissolution, the insurer corporation shall cease to exist.
History —Ins. Code § 29.530.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 29 - Corporate Powers and Procedures of Domestic Stock and Mutual Insurers (§§ 2901 — 2954) › § 2954 - Mutual member’s share of assets on liquidation

(1) Upon any liquidation of a mutual insurer, its assets remaining after discharge of its indebtedness, policy obligations, and expenses of administration, shall be distributed to its members who were such at any time within the three years last preceding the date of the meeting of members at which was adopted the resolution authorizing such liquidation as provided in § 2948(2)(b) of this title, or, if liquidation is pursuant to §§ 4001–4024 of this title, to those members who were such within the three years last preceding the date of commencement of delinquency proceedings against the insurer, whichever date is the earlier; except, that if the Commissioner finds, after a hearing thereon, that the affairs of the insurer have been conducted in such manner as unfairly to reduce the number of policyholders who may be entitled to participate in any such distribution, he shall have the power to require and he shall order that such additional number of months be added to the qualifying period as he deems to be equitable and practical.
(2) The distributive share of each such member shall be in the proportion that the aggregate premiums earned by the insurer on the policies of the member during the combined periods of his membership, bears to the aggregate of all premiums so earned on the policies of all such members. The insurer may make a reasonable classification of its policies so held by such members and a formula based upon such classification for determining the equitable distributive share of each such member. Such classification and formula shall be subject to the Commissioner’s approval.
History —Ins. Code § 29.540.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3001 - Definitions

For the purposes of this chapter, the following terms and phrases shall have the meaning indicated hereinbelow:
(a) Insurer.— Means an entity engaged in the business of granting health contracts, as defined in this Code.
(b) Actionable claim for payment.— Means a claim for services rendered, submitted manually or electronically by a provider to an insurer or health services organization that contains the information and documents needed for the disposition thereof in compliance with the Health Insurance Portability and Accountability Act of 1996 (P. L. 104-191 of August 21, 1996) and Article 30.050 of this act, and whose data do not require a specific finding that prevents the payment thereof within the established terms.
(c) Health care plan.— Means the one defined as a “health are plan” in § 1902 of this title; any insurance for disability or expenses for illness or any health plan operating in Puerto Rico, even though it operates as an association that includes medical benefits, regardless of the law of the Commonwealth of Puerto Rico under which it is organized or authorized to do business.
(d) Commissioner.— Means the Commissioner of Insurance of Puerto Rico.
(e) Participating provider.— Means any physician, hospital, primary services center, diagnostic and treatment center, dentist, laboratory, pharmacy, emergency or prehospitalization medical services or any other person authorized to provide health care services in Puerto Rico, that under contract with an insurer or health services organization renders health services to subscribers or beneficiaries of a health care or health insurance plan.
(f) Subscriber.— Means any person who receives the benefits of a health care or health insurance plan.
(g) Health services organization.— Means any person who renders or makes a commitment to provide a health care plan to one or more subscribers, pursuant to this Code.
(h) Health insurance.— Insurance for expenses incurred for bodily injury, disability or illness, or according to the definition of “disability insurance” provided in § 403 of this title.
History —Ins. Code, added as § 30.020 on July 7, 2002, No. 104, § 1, eff. 180 days after July 7, 2002.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3002 - Term for the payment of claims

The participating provider shall submit its claims for payment for services rendered within ninety (90) days after having rendered the same, and the insurer or health services organization is bound to pay in full any claim actionable for payment within a term of thirty (30) calendar days, counting from the date that the insurer or health services organization receives the same.
In the event that the insurer or health services organization is the secondary payer, the ninety (90) day-term shall begin to count on the date that the participating provider receives the determination of the primary payer.
After the terms indicated above have elapsed, the provisions of this chapter shall not apply to said claims. Provided, That the uniform term established herein shall not be construed to render ineffective those minor terms that may apply to the payment of claims for services rendered, if other alternate payment terms have been agreed on by free contracting.
History —Ins. Code, added as § 30.030 on July 7, 2002, No. 104, § 1; July 27, 2011, No. 150, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3003 - Payments for actionable claims

The participating providers shall submit their claims on the uniform payment form provided by the insurer or health services organization, which shall indicate the information that must be enclosed, pursuant to the provisions of the Health Insurance Portability and Accountability Act of 1996, and in the regulations of the Office of the Commissioner of Insurance. The claim shall be processed if it also complies with the following requirements:
(a) It corresponds to a health service rendered by a provider to an insured person whose service is covered by a health insurance or health care plan of the insurer or health service organization, to which the claim is addressed;
(b) it includes the complete and correct information required by the Insurer or Health Service Organization provided the insurer or health service organization have notified the required information to the participating provider, and
(c) there is no controversy regarding the amount claimed.
If the insurer or health services organization does not notify any objection to a claim for payment within a term of thirty (30) days, pursuant to § 3004 of this title, it shall be understood that said claim is actionable for payment.
The insurer or health service organization may request the reimbursement of an unprocessable claim paid to the provider, within a term of six (6) years counting from the moment that the insurer or health service organization made the payment, pursuant to the procedure established by the Commissioner through regulations, and subsequently resort to the corresponding court for judicial review, if it so desires.
History —Ins. Code, added as § 30.040 on July 7, 2002, No. 104, § 1; July 27, 2011, No. 150, § 2.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3004 - Claims non-actionable for payment

The insurer or health services organization shall notify the participating providers, in writing or electronically, of those claims that are not actionable for payment within a term of thirty (30) calendar days after receiving the claim. The notice shall clearly indicate the reasons for which the insurer or health services organization deems that the claim is not actionable for payment, indicating the documents or additional information that must be submitted so that it may be processed.
Within the following twenty (20) days of having received the notice of the insurer or health services organization, the participating provider must answer the same. The failure to do so shall be deemed to be an admission of the deficiencies notified. Once the participating provider submits the required information or documents, the insurer or health services organization shall proceed to pay the claim within the thirty (30) days following the receipt of the information or documents.
From the date that the insurer or health services organization receives a claim submitted by the participating provider, two (2) terms elapse concurrently, one thirty (30)-day term for the payment of clean claims as established in § 3002 of this title, and one thirty (30)-day term for the insurer or health services organization to remit the notice of claim payment denial to the participating provider. Any claim or part of the claim undisputed by the insurer or health services organization within the aforementioned thirty (30)-day term shall be deemed to be a clean claim. Said action entails the no interruption of the preceding thirty (30)-day term for the payment of claims. The erroneous notification of a non-actionable claim shall not interrupt the thirty (30)-day term for payment, thus, the insurer or health services organization shall proceed to pay the amount claimed, plus interest, as provided in §§ 3005 and 3006 of this title.
No insurer or health services organization shall refuse to pay a claim for services rendered because of unilateral alterations or amendments to the terms of the contract between the insurer or health services organization and the subscriber or between the insurer or health services organization and the provider, including amendments to the rates.
History —Ins. Code, added as § 30.050 on July 7, 2002, No. 104, § 1; July 27, 2011, No. 150, § 3; Sept. 25, 2012, No. 265, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3005 - Excluded claims

Claims for services rendered that correspond to providers outside of Puerto Rico or to persons who do not reside in Puerto Rico shall not be subject to the provisions of this chapter, unless there is no prior authorization for the rendering of the service; the claims that require coordination of benefits, subrogation and investigation of preexisting conditions, or that involve liability of a third party, and the claims that are submitted by the provider sixty (60) days after the date of the service, unless the parties have agreed on to a longer term.
History —Ins. Code, added as § 30.060 on July 7, 2002, No. 104, § 1, eff. 180 days after July 7, 2002.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3006 - Interest

Any actionable claim that is not paid within the term provided, shall accrue interest [on] behalf of the participating provider on the total unpaid amount of said claim or the part thereof that is actionable for payment up to the date of its full payment, according to the prevailing legal interest fixed by the Commissioner of Financial Institutions. Said interest shall be accrued from the day following the expiration of the term for payment and shall be payable to the participating provider along with the actionable claim for payment.
The interest shall be computed up to the time the payment is issued, provided said payment is remitted to the participating provider within the three (3) days following the issuing thereof. If it is not remitted within said term, the interest shall be computed up to the date that the provider receives the corresponding payment.
History —Ins. Code, added as § 30.070 on July 7, 2002, No. 104, § 1, eff. 180 days after July 7, 2002.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3007 - Powers and duties of the Commissioner

In order to ensure compliance with the provisions of this chapter, the Commissioner shall have the following powers and duties:
(a) Impose administrative fines or sanctions for violations of the provisions of this chapter, pursuant to the provisions of this Code, upon the initiative of the Commissioner or after a complaint has been filed by a participating provider due to said noncompliance. Provided, That the provider shall have a term of one (1) year to file the [complaint] counting from the date the term for the payment of an actionable claim expires.
(b) Adopt, within one hundred and eighty (180) days from the approval of this act, the regulations needed to implement the same, pursuant to §§ 2101 et seq. of Title 3, known as the “Uniform Administrative Procedures Act.”
(c) The Commissioner shall have original jurisdiction regarding the controversies that arise between participating providers and insures or health services organizations, pursuant to this chapter. The party of adversely affected by the determination of the Commissioner may resort for review before the Commonwealth of Puerto Rico Circuit Court of Appeals pursuant to the provisions of §§ 2101 et seq. of Title 3, known as the “Uniform Administrative Procedure Act.”
History —Ins. Code, added as § 30.080 on July 7, 2002, No. 104, § 1, eff. 180 days after July 7, 2002.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 30 - Prompt Payment of Claims to Health Services Providers (§§ 3001 — 3008) › § 3008 - Payment of claims in process

Every claim actionable for payment that has been submitted at the time this act becomes effective by participating providers and is pending processing, shall be paid by the insurer or health services organization within a term of fifty (50) calendar days from the effectiveness of this act. The claims that at the effectiveness date of this act are in dispute shall be subject to the provisions of this chapter.
History —Ins. Code, added as § 30.090 on July 7, 2002, No. 104, § 1, eff. 180 days after July 7, 2002.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3101 - Public policy

The Government of Puerto Rico hereby states as a public policy, that, in contracts by and between providers and health services organizations, they shall be authorized to engage in collective bargaining. This public policy seeks to establish a balance in competitiveness when contracting for health services, for the benefit of consumers, providers, third-party administrators, and the health services organizations themselves.
The Government of Puerto Rico recognizes that there are health plans which dominate the market to such an extent that fair negotiations between providers or third-party administrators and health services organizations are virtually nonexistent and unattainable. In these cases, third-party administrators and health services organizations have, in essence, the power to unilaterally establish the terms on the adhesion contracts they offer to providers. Therefore, the Government of Puerto Rico finds it appropriate and necessary to authorize collective bargaining as to fees and other matters in which an unbalance as to contracting is found.
History —Ins. Code, added as § 31.010 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3102 - Definitions

For purposes of this chapter, the following terms or phrases shall have the meaning stated below, unless other meaning is clearly inferred from their context:
(1) Health care plan.— Means that which is defined as “health care plan” in § 1902 of this title.
(2) Person.— Means a natural person, association, insurer, group, union, trust, company, partnership, organization, corporation or any other juridical entity.
(3) Provider.— Means all physicians, hospitals, primary services centers, diagnosis and treatment centers, dentists, laboratories, pharmacies, emergency medical services, pre-hospital services, medical equipment providers, or any other persons authorized in Puerto Rico to provide health care services, whether on a group or an individual basis, and which by virtue of a contract with a health services organization and third-party administrators, render health care services to subscribers or beneficiaries of a health care plan.
(4) Health services organization.— Means that which is defined as “health services organization” in § 1902 of this title. For purposes of this chapter, this definition shall include disability insurers authorized to underwrite health insurance, pursuant to §§ 301–335 of this title.
(5) Health care services providing entity.— Means any person who offers or commits to provide health services to one or more health care plans, pursuant to the Insurance Code.
(6) Provider representative.— Means a third party authorized by the provider to negotiate on its behalf with health services organizations, the terms and conditions of the contract by and between the parties and the provider, which shall have:
(a) The authority and the powers conferred thereupon.
(b) A term to discharge such a function.
(c) A valid method to attest to the delegation of such a power or authority.
(d) A person with the authority to confer powers thereupon.
(e) Validity of the contract.
(f) Enforceable civil liability, and the person upon which it is binding.
(7) Third-party administrators.— It is a public or private organization that processes claims from providers without assuming any risk. These are usually contracted by health services organizations or other self-insuring companies, so that these administer services such as: claims processing, collection of premiums, contracting of providers, payments to providers, and administrative activities.
For the purposes of this chapter, the terms shall have the meaning stated above, but in case of controversy concerning the scope thereof, the definitions stated in §§ 103, 105 and 1902 of this title shall be used in a suppletory manner.
History —Ins. Code, added as § 31.020 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3103 - Authorized collective bargaining

Providers, within the area of service of a health care plan, or provider representatives, may voluntarily assemble into groups according to specialty or geographical area. Groups or corporations authorized to engage in collective bargaining are not to exceed twenty percent (20%) of providers for such a specialty or service in said geographical area, which areas shall be defined by the Department of Health, with the advice of the Antitrust Affairs Office of the Department of Justice. Provided, however, That hospitals may only negotiate as individual corporations. These groups or corporations shall be authorized to engage in collective bargaining for the following terms and conditions in their contracts with third-party administrators and health services organizations:
(1) Fees and rates for health care services;
(2) guidelines on clinical practice and coverage criteria;
(3) administrative procedures, including methods and time of service for the payment of providers’ fees;
(4) proceedings for the resolution of controversies relative to disputes between health services organizations and providers concerning health care plans;
(5) subscriber referral procedures;
(6) establishment and application of methods to reimburse providers;
(7) quality assurance programs;
(8) reviewing procedures for the use of health care services;
(9) selection of providers in terms of health care plans and the criteria for terminating a contract, and
(10) the inclusion or alteration of the terms and conditions, to the extent these are subject to the regulations of the Government of Puerto Rico, prohibiting or requiring the particular term or condition in question; provided, however, that the aforementioned condition does not abridge the rights of providers to jointly petition that the Government of Puerto Rico modify regulations.
History —Ins. Code, added as § 31.030 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3104 - Supervision of the negotiation process

The Office of the Insurance Commissioner shall oversee and supervise negotiations between providers or provider representatives, third-party administrators, and health services organizations, in connection with health care plans, pursuant to the powers and authorities conferred by law. The Office of the Insurance Commissioner shall be responsible for ensuring that the results of the negotiation process conform to the remaining provisions of the Insurance Code. For this purpose, the Commissioner shall establish the necessary regulatory mechanisms. Provided, further, That before entering into any negotiation process, the Antitrust Affairs Office of the Department of Justice shall be notified. The minimum term of effectiveness of the agreements shall be two (2) years.
History —Ins. Code, added as § 31.040 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3105 - Method to resolve controversies and impasses in the negotiation

Providers, provider representatives, third-party administrators and health services organizations shall submit to arbitration any controversy that has reached an impasse in the collective bargaining process authorized by this chapter.
By request of any of the aforementioned parties, the Department of Health, after having notified the other party, shall appoint an Arbitration Commission, whose entire proceedings shall be governed by the regulations to be prepared by the Department of Health and the Office of the Insurance Commissioner, and shall be covered under §§ 3201 et seq. of Title 32, known as the “Puerto Rico Arbitration Act”. Each Arbitration Commission, which shall be constituted in fifteen (15) days as of the date of notice by the parties designated, shall be composed of the following three (3) arbitrators, who shall be appointed as follows:
(1) An economist, preferably with experience in the field of health or insurance, designated by the President of the Economists’ Association.
(2) An independent and neutral intervener, certified by the Alternative Dispute Resolution Bureau, attached to the Office of the Chief Justice of the Supreme Court of Puerto Rico.
(3) An expert in the area of health services, designated by the Secretary of the Department of Health, who has no conflicts of interest.
The decision issued by the panel of arbitrators may be reviewed by the Court of First Instance of Puerto Rico located, within the territorial bounds where the parties reside, and the same shall be seen summarily, after the subpoena provided for by law is served.
Payment of the arbitrators shall be the responsibility of the parties, and the Department of Health shall be responsible for the disbursement, which matter, as well as all matters pertaining to the operations of the Arbitration Commissions, shall be subject to the regulations prepared by the aforementioned three (3) agencies.
History —Ins. Code, added as § 31.050 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3106 - Health Plan and Insurance Rates Reviewing Board

A Health Plan and Insurance Rates Reviewing Board is hereby created, which shall have the power to regulate, supervise and approve the rates on account of premiums charged by persons, providers, health services organizations and health plans. If the negotiation between the parties involved should lead to an increase in deductibles or co-payments, premiums or rates, the parties shall notify the Insurance Commissioner, the Advocate for Patients, the Ombudsman, and the Department of Health, and obtain authorization for such an increase before the same is rendered effective. This panel shall also have the authority to address any unilateral act which entails an increase in premiums or a reduction in coverage and/or services, which shall be reviewable in its entirety by the Board created in this chapter. All of these entities are to approve such an increase.
History —Ins. Code, added as § 31.060 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3107 - Prohibition on certain joint actions

Any action by any of the parties which limits the services to be rendered, be it in the form of threats to boycott, go on strike or other coordinated action by the providers shall be subject to oversight by the Antitrust Affairs Office of the Department of Justice, in order to determine whether the same is in violation of the provisions of this chapter or the Antitrust Act. If the Antitrust Affairs Office should find that any of the parties has violated the provisions of §§ 257 et seq. of Title 10, civil and/or criminal liability shall be imposed pursuant to the penalties provided in said Act. Provided, further, That health services organizations may not take actions in retaliation against or which coerce providers during the negotiation process, such as withholding payments, conducting audits, and other similar actions.
Under this chapter, it is hereby prohibited for any entity that compulsorily assembles health professionals into groups to become a provider representative in the negotiation process.
History —Ins. Code, added as § 31.070 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3107a - Existing general powers

None of the provisions of this chapter shall undermine the general powers delegated unto the Secretary of the Department of Consumer Affairs or those granted under subsection (d) of § 512c of Title 1, known as the “Bill of Rights of Persons with Disabilities”.
History —Ins. Code, added as § 31.071 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 31 - Collective Bargaining of Providers and Health Services Organizations (§§ 3101 — 3108) › § 3108 - Approval of regulations

The Antitrust Affairs Office, attached to the Department of Justice, the Secretary of Health and the Insurance Commissioner shall adopt regulations as convenient and necessary for the implementation of the provisions of this chapter. Such regulations shall be approved within a term of sixty (60) days as of the date of effectiveness of this act. If these agencies should fail to comply with this mandate, the Court of First Instance may be resorted to by means of a mandamus. Likewise, they may be prosecuted for a misdemeanor, and upon conviction, a fine of up to ten thousand dollars ($10,000) may be imposed on the head of the agency in his/her personal capacity. Once these regulations have been prepared, these shall be remitted to the Legislature.
History —Ins. Code, added as § 31.080 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3301 - Reciprocal insurance, defined

Reciprocal insurance.— Is that resulting from an inter-exchange among persons, known as “subscribers”, of reciprocal agreements of indemnity, the interexchange being effectuated through an “attorney-in-fact” common to all such persons.
History —Ins. Code § 33.010.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3302 - Reciprocal insurer, defined

A reciprocal insurer.— Means an unincorporated aggregation of subscribers operating individually and collectively through an attorney-in-fact to provide reciprocal insurance among themselves.
History —Ins. Code § 33.020.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3303 - Scope of chapter

(1) All foreign reciprocal insurers shall be governed by those provisions of this chapter not expressly made applicable to domestic reciprocal insurers.
(2) Section 2932 of this title shall apply to domestic reciprocal insurers.
History —Ins. Code § 33.030.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3304 - Insuring powers

[(1)] A reciprocal insurer may, upon qualifying therefor as provided by this title, transact any kind or kinds of insurance defined by this title, other than life or title insurance.
(2) A reciprocal insurer may cede or accept reinsurance of any kind of risk which it is authorized to insure direct.
History —Ins. Code § 33.040.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3305 - Name, suit

A reciprocal insurer shall:
(1) Have and use a business name. The name shall include the word “reciprocal”, or “inter-insurer”, or “inter-insurance”, or “exchange”, or “underwriters,” or “underwriting.”
(2) Sue and be sued in its own name.
History —Ins. Code § 33.050.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3306 - Attorney, defined

Attorney.— As used in this chapter refers to the attorney-in-fact of a reciprocal insurer. The attorney may be an individual, firm, or corporation.
History —Ins. Code § 33.060.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3307 - Organization

(1) Twenty-five or more persons domiciled in Puerto Rico may organize a domestic reciprocal insurer and in compliance with this title make application to the Commissioner for a certificate of authority to transact insurance.
(2) When applying for a certificate of authority, the original subscribers and the proposed attorney shall fulfill the requirements of and shall execute and file with the Commissioner a declaration setting forth:
(a) The name of the insurer.
(b) The location of the insurer’s principal office, which shall be the same as that of the attorney and shall be maintained within Puerto Rico.
(c) The kinds of insurance proposed to be transacted.
(d) The names and addresses of the original subscribers.
(e) The designation and appointment of the proposed attorney and a copy of the power of attorney.
(f) The name and addresses of the officers and directors of the attorney, if a corporation, or of its members, if a firm.
(g) The powers of the subscribers’ advisory committee and the names and terms of office of the members thereof.
(h) A copy of the subscribers’ agreement.
(i) A statement that each of the original subscribers has in good faith applied for insurance of the kind proposed to be transacted, and that the insurer has received from each subscriber the full premium or premium deposit required for the policy applied for, for a term of not less than six months at the rate theretofore filed with and approved by the Commissioner.
(j) A statement of the financial condition of the insurer, a schedule of its assets, and a statement that the surplus as required by § 3308 of this title is on hand.
(k) A copy of each policy, endorsement, and application form it then proposes to issue or use.
(3) The declaration required by subsection (2) shall be acknowledged by each such subscriber and by the attorney before a notary public.
History —Ins. Code § 33.070.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3308 - Surplus required

A domestic reciprocal insurer shall have and hold surplus funds in the amount equal to the amount of paid-in capital required of a domestic stock insurer transacting the same kind or kinds of insurance.
History —Ins. Code § 33.080; July 20, 1979, No. 154, p. 395, § 11.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3309 - Certificate of authority

(1) The certificate of authority of a reciprocal insurer shall be issued to its attorney in the name of the insurer.
(2) The Commissioner may refuse, discontinue or revoke the certificate of authority, in addition to other grounds therefor, for failure of its attorney to comply with any provision of this title.
History —Ins. Code § 33.090.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3310 - Power of attorney

(1) The rights and powers of the attorney of a reciprocal insurer shall be as provided in the power of attorney given it by the subscribers.
(2) The power of attorney must set forth:
(a) The powers, duties and compensation of the attorney.
(b) That the attorney is empowered to obligate subscribers severally, within limits lawfully specified in the power of attorney, on contracts of insurance made with any subscriber as a policyholder through such attorney acting on behalf of all other subscribers.
(c) That the attorney is empowered to accept service of process on behalf of the insurer and to authorize the Commissioner to receive service of process in actions against the insurer upon contracts exchanged.
(d) Except as to nonassessable policies, a provision for a contingent several liability of each subscriber in a specified amount which amount shall be not less than one nor more than ten times the premium or premium deposit stated in the policy.
(3) The power of attorney may:
(a) Provide for the right of substitution of the attorney and revocation of the power of attorney and rights thereunder.
(b) Contain other lawful provisions deemed advisable.
(4) The terms of any power of attorney or agreement collateral thereto shall be reasonable and equitable, and no such power or agreement or any amendment thereof, shall be used or be effective in Puerto Rico until approved by the Commissioner.
History —Ins. Code § 33.100.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3311 - Modification of subscribers’ agreement or of power of attorney

Modification of the terms of the subscribers’ agreement or of the power of attorney of a domestic reciprocal insurer shall be made jointly by the attorney and the subscribers’ advisory committee. No such modification shall be effective retroactively, or as to any insurance contract issued prior thereto.
History —Ins. Code § 33.110.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3312 - Bond of attorney-in-fact

(1) Concurrently with the filing of the declaration provided for in § 3307 of this title, the attorney of a domestic reciprocal insurer shall file with the Commissioner a bond running to the Commonwealth of Puerto Rico. The bond shall be executed by the attorney and by an authorized corporate surety, and shall be subject to the Commissioner’s approval.
(2) The bond shall be in the penal sum of twenty-five thousand dollars ($25,000), conditioned upon the attorney’s faithfully accounting for all monies and other property of the insurer coming into his hands, and his not withdrawing or appropriating for his own use from the funds of the insurer any monies or property to which he is not entitled under the power of attorney.
(3) The bond shall provide that it is not subject to cancellation unless thirty days’ advance notice in writing of intent to cancel is given to both the attorney and the Commissioner.
History —Ins. Code § 33.120.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3313 - Deposit in lieu of bond

In lieu of such bond, the attorney may maintain on deposit with the Commissioner a like amount in cash or in value of securities qualified under this title as insurers’ investments, and subject to the same conditions as the bond.
History —Ins. Code § 33.130.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3314 - Legal process, service; judgment

(1) Legal process shall be served upon a domestic reciprocal insurer by serving the insurer’s attorney at his principal offices or by serving the Commissioner as the insurer’s attorney-in-fact.
(2) Any judgment against the insurer based upon legal process so served shall be binding upon each of the insurer’s subscribers as their respective interests may appear and in an amount not exceeding their respective contingent liabilities.
History —Ins. Code § 33.140.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3315 - Contributions to insurer

The provisions of §§ 2930 and 2931 of this title shall be applicable with respect to funds borrowed by or advanced to a domestic reciprocal insurer.
History —Ins. Code § 33.150.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3316 - Determining financial condition

In determining the financial condition of a reciprocal insurer the Commissioner shall apply the following rules:
(1) He shall charge as liabilities the same reserves as are required of incorporated insurers issuing nonassessable policies on a reserve basis.
(2) The surplus deposits of subscribers shall be allowed as assets, except that any premium deposit delinquent for ninety days shall first be charged against such surplus deposit.
(3) The surplus deposits of subscribers shall not be charged as a liability.
(4) All premium deposits delinquent less than ninety days shall be allowed as assets.
(5) An assessment levied upon subscribers, and not collected, shall not be allowed as assets.
(6) The contingent liability of subscribers shall not be allowed as an asset.
(7) The computation of reserves shall be based upon premium deposits other than membership fees and without any deduction for the compensation of the attorney.
History —Ins. Code § 33.160.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3317 - Subscribers

Any person, public or private corporation, firm, board, association, estate, trustee or fiduciary, in Puerto Rico or elsewhere, may make application, enter into agreement for and hold policies or contracts in or with and be a subscriber of any domestic or foreign reciprocal insurer. Any officer, representative, or trustee, receiver or legal representative of any such subscriber or policyholder, shall be recognized as acting for or on its behalf for the purpose of such contracts or subscribership but shall not be personally liable upon such contract by reason of acting in such representative capacity.
History —Ins. Code § 33.170.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3318 - Subscribers’ advisory committee

(1) The advisory committee exercising the subscribers’ rights of supervision in a domestic reciprocal insurer shall be selected under such rules as the subscribers adopt.
(2) Not less than three-fourths (¾) of such committee shall be composed of subscribers other than the attorney, or any person employed by, representing, or having a financial interest in the attorney.
(3) The committee shall:
(a) Supervise the finance[s] of the insurer.
(b) Supervise the insurer’s operations to such extent as to assure their conformity with the subscribers’ agreement and power of attorney.
(c) Procure the audit of the accounts and records of the insurer and of the attorney at the expense of the insurer.
(d) Have such additional powers and functions as may be conferred by the subscribers’ agreement.
History —Ins. Code § 33.180.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3319 - Subscriber’s liability

(1) The liability of each subscriber subject to assessment for the obligation of the reciprocal insurer shall not be joint, but shall be individual and separate.
(2) Each subscriber who is subject to assessment shall have a contingent assessment liability, in the amount provided for in the power of attorney or in the subscribers’ agreement, for payment of actual losses and expenses incurred while his policy was in force. Such contingent liability may be at the rate of not less than one or more than ten times the premium or premium deposit stated in the policy, and the maximum aggregate thereof shall be computed in the manner set forth in § 3323 of this title.
(3) Each assessable policy issued by the insurer shall plainly set forth a statement of the contingent liability.
History —Ins. Code § 33.190.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 33 - Reciprocal Insurers (§§ 3301 — 3328) › § 3320 - Subscriber’s liability on judgments

(1) No action shall lie against any subscriber upon any obligation claimed against the insurer until a final judgment has been obtained against the insurer and remains unsatisfied for thirty days.
(2) Any such judgment shall be binding upon each subscriber only in such proportion as his interest may appear and in amount not exceeding his contingent liability, if any.
History —Ins. Code § 33.200.