2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1903 - Authorization required

(1) No person may establish or operate a health services organization in Puerto Rico, except as permitted by an authorization granted by the Commissioner provided the applicant complies with the provisions of this chapter and of §§ 331–333p of Title 24.
Foreign corporations may request the corresponding certificate of authority provided they comply with the provisions of this chapter and are duly registered in the Department of State pursuant to the law governing the establishment of corporations in the Commonwealth of Puerto Rico and comply with the provisions of §§ 331–333p of Title 24.
(2) Any health services organization which on the effective date of this act, renders health services shall submit an application for an authority certificate as provided in subsection (3) of this section within one hundred eighty (180) days, reckoning from the effective date of this act. Each one of the applicants may continue operating until the Commissioner approves the application. In the event that the Commissioner denies the application by virtue of the provisions of § 1904 of this title, the applicant shall be considered as a health services organization whose certificate has been revoked.
(3) The application for an authority certificate shall be sworn to by an officer or authorized representative of the applicant, shall be made in the forms prescribed by the Commissioner and shall be accompanied by the following documents:
(a) Copy of the organization papers, if any, of the applicant such as articles of incorporation, of association, partnership, trust agreement or other pertinent document, and their amendments.
(b) Copy of the corporate bylaws or similar document, if any, governing the internal affairs of the applicant.
(c) A list of the names, addresses, and official position of the persons responsible for the applicant’s business, including the members of the board of directors, board of trustees, executive committee or any governing board or committee, the chief officers, and the partners or members in case of a partnership or association, and any other information that the Commissioner deems pertinent to evaluate the competence and reliability thereof.
(d) A copy of any contract used or to be used between the provider or persons listed in clause (3)(c) of this subsection and the applicant.
(e) A summary describing the health services organization, its health care plan or plans, facilities and personnel; Provided, That the applicant shall show to the Commissioner authentic proof that the facilities and the personnel are sufficient to provide to the subscribers a first-rate service.
(f) A copy of the form of coverage evidence to be issued to the subscribers.
(g) A copy of the contract form, individual as well as group, if any, to be issued to the employees, unions, trustees or other organizations.
(h) Financial statement showing the applicant’s assets and liabilities as of the preceding December 31; and the procedure used to raise its capital.
(i) A description of the method to be used for marketing the plan, a financial plan which shall include a three-year projection of the advanced initial operating results, and a statement of the operating capital source, as well as any other source of operating funds.
(j) A power of attorney duly executed by the applicant, if not domiciled in Puerto Rico, designating the Commissioner and his successors in office, and the Assistant Commissioner duly authorized, as proxy to receive summons for choses of action which may arise against him in Puerto Rico.
(k) A summary describing the geographical area or areas within which the organization will render its services.
(l) A description of the procedure to be used for the prosecution of complaints, as provided in § 1912 of this title.
(m) A description of the procedures and programs to be established in order to comply with the service-quality requirements established in § 1904(1)(a), (b) of this title.
(n) A description of the mechanism by which opportunity is granted to the subscribers to participate in the direction and operation of the organization as provided in § 1906(2) of this title.
(o) Any other information that the Commissioner may request in order to make the findings provided in § 1904 of this title.
(4)
(a) A health services organization shall file before the Commissioner any change in the operations established in the information required in subsection (3) of this section. Said filing shall be made at least thirty (30) days prior to the change of operations. At the end of said thirty days after its filing, it shall be deemed approved unless before it is affirmatively approved or disapproved by order of the Commissioner. The Commissioner, upon notice, may extend for not more than thirty (30) additional days the period within which he may approve or disapprove affirmatively said change in the operations.
(b) The Commissioner may promulgate rules and regulations to exempt from the filing required in clause (a) of this subsection such items as he may deem unnecessary.
(5) Every health services organization that renders health services shall include as part of its coverage, if medically justified according to the criteria established in the protocols created by the Department of Health and according to the home care plan, for those persons who require a ventilator in order to stay alive, a minimum of one (1) daily shift of eight (8) hours [provided by] skilled nurses with knowledge of respiratory therapy.
History —Ins. Code, added as § 19.030 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 2; Sept. 21, 2007, No. 125, § 2, retroactive to July 1, 2007.