2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9274 - Application for certificate of authority

An application for a certificate of authority to operate as a limited health service organization shall be filed with the Commissioner on a form prescribed by him/her. The application shall be sworn by an officer or authorized representative of the applicant and shall set forth or enclose the following documents:
(a) A copy of the applicant's basic organizational document, such as the articles of incorporation, articles of association, partnership agreement, trust agreement, or other applicable documents and all amendments thereto.
(b) A copy of all corporate bylaws or similar documents, regulating the conduct of the applicant's internal affairs.
(c) A list of the names, addresses, official positions, and biographical information of the individuals who are responsible for conducting the applicant's affairs, including the members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers, and any person or entity owning or having the right to acquire ten percent (10%) or more of the voting securities of the applicant, and the partners or members in the case of a partnership or association.
(d) A statement generally describing the applicant, its facilities, personnel, and the limited health services to be offered.
(e) A copy of the form of any contract made or to be made between the applicant and any providers regarding the provision of limited health services to subscribers.
(f) A copy of the form of any contract made, or to be made between the applicant and any person listed in subsection (c) of this section.
(g) A copy of the form of any contract made or to be made between the applicant and any person, corporation, partnership or other entity for the performance on the applicant's behalf of any functions including administration, enrollment, investment management, and subcontracting for the provision of limited health services to subscribers.
(h) A copy of the form of any group contract that is to be issued to employers, unions, trustees, or other organizations and a copy of any form of evidence of coverage to be issued to subscribers.
(i) A copy of the applicant's most recent financial statements audited by independent certified public accountants. If the financial affairs of the applicant's parent company are audited by independent certified public accountants but those of the applicant are not, then a copy of the most recent audited financial statements of the applicant's parent company, enclosed with the consolidating financial statements of the applicant.
(j) A copy of the applicant's financial plan, including a three (3)-year projection of anticipated operating results, a statement of the sources of working capital, and any other sources of funding and provisions for contingencies.
(k) A description of the proposed method of marketing.
(l) A statement duly executed by the applicant, if not domiciled in Puerto Rico, designating the Commissioner and his/her successors in office as proxy to receive summons for causes of action that may arise against the applicant in Puerto Rico.
(m) A description of the grievance procedures to be established and maintained as required under § 9283 and §§ 9391 et seq. and 9501 et seq. of this title.
(n) A description of the quality assessment and utilization review procedures to be used by the applicant in accordance with §§ 9351 et seq. and 9421 et seq. of this title respectively.
(o) A description of how the applicant will comply with § 9288 of this title.
(p) The fee for issuance of a certificate of authority provided in § 9294 of this title.
(q) Such other information as the Commissioner may reasonably require to make the determinations required by this chapter.
History —Aug. 29, 2011, No. 194, added as § 16.040 on Aug. 23, 2012, No. 203, § 2, eff. 90 days after Aug. 23, 2012.