2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1919 - Suspension or revocation of certificate of authority

(1) The Commissioner may suspend or revoke a certificate of authority issued to a health services organization under this chapter, if any of the following conditions are found:
(a) The health organization operates in contravention of its corporate documents, its health care plan, or in any other way contrary to the one described and which may be reasonably inferred from any other information submitted under § 1903 of this title, unless an amendment has been submitted to and is approved by the Commissioner.
(b) The health organization uses a coverage evidence or service rates which do not comply with the requirements of § 1908 of this title.
(c) The health care plan does not provide for basic health care services.
(d) The Secretary of Health certifies to the Commissioner that:
(i) The health services organization does not comply with the requirements of § 1904(1)(b), or
(ii) the health services organization can not comply with its obligations to provide health care services as required under its health care plan.
(e) The health services organization can not answer financially and it is expected that it will be unable to meet its obligations towards the subscribers or prospective subscribers.
(f) The health services organization has been unable to establish a mechanism to afford the subscribers an opportunity to participate in the direction and operation of the organization as provided in § 1906 of this title.
(g) The organization has been unable to establish and/or implement a system of complaints as required under § 1912 of this title so as to enable it to reasonably process or settle the complaints.
(h) The organization or any person in its name has published or marketed its services in a deceitful, unfair manner or through misrepresentations.
(i) To continue operating the organization would be hazardous to its subscribers.
(j) The organization would otherwise fail in substantially complying with this chapter.
(k) The organization has failed to meet or has violated any provision of this Code, rule, regulations or legal order of the Commissioner.
(2) A certificate of authority may only be suspended or revoked after complying with the provisions of § 1921 of this title.
(3) When a certificate of authority of a health services organization is suspended, the organization may not accept, during the suspension period, any new subscriber except the newly-born and any other dependent of an existing subscriber, nor shall it engage in any advertising or solicitation.
(4) When a certificate of authority is revoked, the organization shall proceed immediately after the effective date of the order of revocation, to cease its operations, shall not do business except such as may be necessary to wind up the affairs of the organization. The Commissioner may, by written order, permit subsequent operations of the organization if he determines that it will be for the benefit of the subscribers, in order that they be afforded a better opportunity to obtain the continuity of the health care coverage.
History —Ins. Code, added as § 19.190 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 14.