reglab/statecodes huggingface dataset:
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 17 - Group and Blanket Disability Insurance (§§ 1701 — 1708) › § 1701 - Group and blanket disability insurance coverages, authorized

A disability insurer may grant or issue disability insurance coverages under the group or blanket plans, for delivery in Puerto Rico, under the following conditions:
(1) The premium rate may be lower than for similar coverages issued individually.
(2) Except as provided in § 1702 of this title, the blanket disability insurance policies shall contain such provisions, and be issued pursuant to such arrangements as may be usual and customary, and are approved or determined by the Commissioner.
(3) No group disability insurance policy shall be issued for delivery in Puerto Rico, unless it is in agreement with one of the descriptions contained in § 1401 of this title.
(4) Any group disability insurance policy issued to the groups described in subsections (1), (3), (4), and (5) of § 1401 of this title may be extended to cover the spouse and/or dependent children of the employee or insured member, subject to the following requirements;
(a) The premium corresponding to this insurance policy shall be paid by the policyholder, either wholly from his own funds, or wholly from funds contributed by the employees or insured members, or from both funds. If all or part of the premium is to be paid from funds contributed by the employees or insured members, the extension of insurance to the spouse and dependent children shall become effective only if 75% or more of those employed at that time, or eligible members, decide to pay the required contribution, excluding anyone whose spouse and/or dependent children do not show evidence of insurability satisfactory to the insurer. In the case that the premium is not paid partially or totally by the insured individuals, the policy shall have to insure all spouses and/or dependent children, except someone whose evidence of individual insurability is not satisfactory to the insurer.
(b) If the insurance coverage of the spouse and/or dependent children of the employee or insured member ceases due to the termination of his employment or membership, said spouse or dependent child shall be entitled to the conversion benefit as provided in § 1707 of this title.
(c) Notwithstanding the provisions of § 1706 of this title, a single certificate may be issued to the employee or insured member, if the spouse and dependent children are included therein.
History —Ins. Code § 17.010; June 30, 1975, No. 115, p. 345, § 1; June 24, 1977, No. 112, p. 281, § 1, eff. 6 months after June 24, 1977.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 17 - Group and Blanket Disability Insurance (§§ 1701 — 1708) › § 1702 - Uniform provisions

No group and blanket disability insurance policy shall be issued for delivery in Puerto Rico, unless it contains substantially the same provisions of §§ 1703–1708 of this title, inclusive, or provisions that in the judgment of the Commissioner are more favorable to the insured persons, or which are, at least, equally favorable to the insured persons, and more favorable to the policyholder; Provided, however, That the provisions of §§ 1706 and 1707 of this title shall not apply to policies issued in favor of a creditor to insure debtors of said creditor from disability, and that the uniform provisions required for the individual disability insurance policy shall not apply to group disability insurance policies. Provided, That §§ 1609, 1610 and 1613 of this title shall apply to contracts supplemental to life insurance and to endowment insurance or annuity contracts.
History —Ins. Code, added as § 17.020 on June 30, 1975, No. 115, p. 345, § 2; June 24, 1977, No. 112, p. 281, § 2; Mar. 18, 2008, No. 31, § 8, eff. 90 days after Mar. 18, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 17 - Group and Blanket Disability Insurance (§§ 1701 — 1708) › § 1703 - Grace period

The policy shall contain a provision granting the policyholder a grace period of not less than 31 days for the payment of any premium falling due after the first, during which period of grace the disability policy shall continue in force.
History —Ins. Code, added as § 17.030 on June 30, 1975, No. 115, p. 345, § 2.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 17 - Group and Blanket Disability Insurance (§§ 1701 — 1708) › § 1704 - Time limit for certain defenses

The policy shall have a provision reading as follows:
“Time limit for certain defenses: (a) two years after this policy is issued no false statement (except fraudulent statements) made by an insured person under the policy may be used to annul the insurance on his person or to deny a claim for loss sustained or for disability (as defined in the policy) which may begin after the said period of two years has elapsed.” (b) No claim for loss sustained or for disability (as defined in the policy) which may begin after the lapse of two years from the date of issuance of this policy shall be reduced or denied on the ground that, prior to the effective date of the coverage of this policy, there existed a disease or physical injury not excluded from the coverage by its specific name or description, effective on the date of the loss.
History —Ins. Code, added as § 17.040 on June 30, 1975, No. 115, p. 345, § 2.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 17 - Group and Blanket Disability Insurance (§§ 1701 — 1708) › § 1705 - Insurability evidence

The policy shall contain a provision stipulating the conditions, if any, under which the insurer reserves to itself the right to require a person eligible for insurance to present evidence of individual insurability satisfactory to the insurer.
History —Ins. Code, added as § 17.050 on June 30, 1975, No. 115, p. 345, § 2; Mar. 18, 2008, No. 31, § 9, eff. 90 days after Mar. 18, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 17 - Group and Blanket Disability Insurance (§§ 1701 — 1708) › § 1706 - Issuance of certificates

The policy shall contain a provision stipulating that the insurer shall issue to the policyholder, for delivery to each insured person, an individual certificate stating the protection which the insured person, who will be paid the insurance benefits and the rights and conditions established in subsections (1), (2), (3) and (4) of § 1707 of this title, is entitled to.
History —Ins. Code, added as § 17.060 on June 30, 1975, No. 115, p. 345, § 2; June 24, 1977, No. 112, p. 281, § 3, eff. 6 months after June 24, 1977.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 17 - Group and Blanket Disability Insurance (§§ 1701 — 1708) › § 1708 - Existing policies

No group disability insurance policy, lawfully issued before the effective date of this chapter, shall be affected by the provisions thereof.
History —Ins. Code, added as § 17.080 on June 30, 1975, No. 115, p. 345, § 2; June 24, 1977, No. 112, p. 281, § 5, eff. 6 months after June 24, 1977.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 18 - Consumer Credit Insurance (§§ 1801-1812 — 1823) › § 1813 - Scope

(1) Any consumer credit insurance sold or issued with regard to loans or any other credit transaction shall be subject to the provisions of this chapter, except:
(a) Insurance subscribed in relation to a credit transaction that is secured by a first mortgage or deed of trust, and made to finance the purchase of real property or the construction of a residence on said property, or to refinance a previous credit transaction made for such purpose.
(b) Insurance sold as an independent transaction by an insurer and not related to an agreement or plan to insure the debtors of a creditor.
(c) Insurance for which a debtor is not charged separately and identifiably, as defined below.
(d) Collectable account insurance.
(2) The provisions of §§ 1401–1411 of this title shall also apply to credit life insurance, in all that which is not in conflict with the provisions of this chapter.
(3) The provisions of §§ 1701–1705 of this title shall also apply to credit disability insurance in all matters not in conflict with the provisions of this chapter.
History —Ins. Code, added as § 18.020 on Jan. 9, 1999, No. 15, § 2; Feb. 25, 2008, No. 19, § 1, eff. 90 days after Feb. 25, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 18 - Consumer Credit Insurance (§§ 1801-1812 — 1823) › § 1815 - Types of consumer credit insurance; who can contract it

The types of consumer credit insurance defined in § 1814 of this title, may be underwritten in a separate or combined form in individual policies or in collective policies by insurers licensed to contract insurance pursuant to § 402 of this title, as well as by insurers licensed to contract insurance pursuant to § 403 of this title. The Commissioner may prohibit such combinations, through regulations to such effect.
History —Ins. Code, added as § 18.040 on Jan. 9, 1999, No. 15, § 2, eff. 90 days after Jan. 9, 1999.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 18 - Consumer Credit Insurance (§§ 1801-1812 — 1823) › § 1816 - Provisions applicable to credit life insurance

The following provisions shall apply exclusively to credit life insurance:
(1) The insured credit life insurance sum shall not be greater than the original debt.
(2) The credit life insurance coverage shall be subscribed so that the amount payable at the time of the death of the insured debtor shall not exceed the net debt at that time.
(3) The provisions of subsection (2) of this section notwithstanding, the insurer may underwrite, optionally, the credit life insurance coverage in such a manner that, in addition to the amount established in said subsection, three (3) months of payments pending at the time of the death of the insured may be covered, including interest and surcharges corresponding exclusively to said pending payments; Provided, That the debtor must choose the type of coverage he/she wishes to acquire in those cases whereby the creditor offers more than one type.
History —Ins. Code, added as § 18.050 on Jan. 9, 1999, No. 15, § 2; July 23, 1999, No. 161, § 1; Feb. 25, 2008, No. 19, § 2, eff. 90 days after Feb. 25, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 18 - Consumer Credit Insurance (§§ 1801-1812 — 1823) › § 1817 - Provisions that apply to disability credit insurance and unemployment credit insurance

The following provisions shall apply to disability credit insurance and unemployment credit insurance:
(1) The total number of installment payments payable by the disability credit insurance and the unemployment credit insurance in the case of claims, shall not exceed the aggregate sum of the unpaid periodic installments of the gross debt and the amount of each installment shall not exceed the amount of the original gross debt divided by the number of installments.
(2) Notwithstanding the provisions of subsection (1) of this section, the insured amount for disability and unemployment credit insurance underwritten in connection with regard to a rotating account plan and a credit card shall not exceed the gross debt corresponding to said amount if periodic installments are used. Subject to the limits established by the policy, the periodic installments shall not be less than the minimum amount the debtor should pay.
History —Ins. Code, added as § 18.060 on Jan. 9, 1999, No. 15, § 2, eff. 90 days after Jan. 9, 1999.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 18 - Consumer Credit Insurance (§§ 1801-1812 — 1823) › § 1820 - Presentation of models

Any policy form, insurance certificate, printed attachment or consumer credit insurance endorsement form to be delivered or issued for delivery, must be previously presented to the Commissioner and approved by the latter.
In addition to the grounds mentioned in § 1112 of this title, the Commissioner may disallow any consumer credit insurance policy form, application, addition or endorsement of the consumer credit insurance form if the benefits provided therein are not adequate in relation to the premium, regardless of what is provided in § 1202 of this title.
History —Ins. Code, added as § 18.090 on Jan. 9, 1999, No. 15, § 2; Feb. 25, 2008, No. 19, § 5, eff. 90 days after Feb. 25, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 18 - Consumer Credit Insurance (§§ 1801-1812 — 1823) › § 1822 - Issuance of policies

Any consumer credit insurance policy shall be delivered or issued for delivery in Puerto Rico solely by licensed life or disability insurers.
History —Ins. Code, added as § 18.110 on Jan. 9, 1999, No. 15, § 2, eff. 90 days after Jan. 9, 1999.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 18 - Consumer Credit Insurance (§§ 1801-1812 — 1823) › § 1823 - Claims

No agreements shall be made under which a person or organization, other than the insurer or his/her authorized claims representative, shall adjust or settle claims. The creditor shall not be designated as claims representative of the insurer.
(1) All claims shall be promptly reported to the insurer or his/her claims representative, who shall keep adequate files of the claims.
(2) All consumer credit insurance claims shall be subject to the provisions of § 2716 of this title.
History —Ins. Code, added as § 18.120 on Jan. 9, 1999, No. 15, § 2; Feb. 25, 2008, No. 19, § 6, eff. 90 days after Feb. 25, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1901 - Title

This chapter shall be known as “Health Services Organizations Act” and may be cited as such.
History —Ins. Code, added as § 19.010 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1902 - Definitions

For the purposes of this chapter the following terms shall have the meaning stated below:
(1) Health care basic services.— Means the health care services that may be required by the subscribers in order to maintain the best state of physical and mental health, which are contracted for between the subscriber and the organization.
(2) Subscriber.— Means any person who has subscribed to a health care plan.
(3) Coverage evidence.— Means any written certificate, document or contract issued to a subscriber which establishes the subscribers’ rights and obligations under a health care plan, as well as the rights and obligations of the person who offers such plan.
(4) Health care plan.— Means any agreement whereby a person is bound to provide certain health care services to a subscriber or group of subscribers either directly or through a provider, or to pay all or part of the cost of such services in consideration of an amount preestablished in said agreement, deemed to be earned regardless of whether the subscriber uses the health care services provided by the plan or not. Notwithstanding the above, said plan shall primarily provide health care services, as distinguished from the mere compensation for the cost of such services.
(5) Health care services.— Means medical or dental care, hospitalization or services incidental to the providing of said care or hospitalization.
(6) Health services organization.— Means any person who offers or is bound to provide one or more health plans.
(7) Provider.— Means any physician, hospital or any other person authorized in Puerto Rico to provide health care services.
History —Ins. Code, added as § 19.020 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1903a - Authority and jurisdiction of the Commissioner

(1) Aside from any other statutory provisions, and with the exception of what is provided hereinafter, any person, entity or organization which provides any type of coverage in Puerto Rico on a prepaid basis, for expenses for medical-surgical, chiropractic, physical therapy, speech pathology, audiology, mental health, and dental services, hospitalization, laboratories, optometry or any other services related to health care, shall be presumed to be subject to the jurisdiction and regulations of the Commissioner, unless the person, entity or organization proves, that by providing said services it is subject to the jurisdiction and regulations of another agency, department or public instrumentality of the Commonwealth of Puerto Rico or any of its subdivisions, or of the government of the United States of America, upon the presentation of the certificate of authority, license, or document issued by the government agency concerned, which authorizes or qualifies it to provide said health care services on a prepaid basis.
(2) The Commissioner may examine and investigate the above-stated persons, entities, and organizations, with the exception of those that prove they are exempted, as provided in this section, with the purpose of determining their organization and solvency, as well as their compliance with the provisions of this Code.
History —Ins. Code, added as § 19.031 on May 6, 1983, No. 33, p. 55.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1905 - Powers

(1) The powers of a health services organization shall include, but shall not be limited to:
(a) The purchase, lease, construction, renewal, operation, maintenance of hospitals, medical facilities, or both, and related equipment and such property as may be reasonably required for its main office or for such other purposes as may be necessary for the organization.
(b) To grant loans to groups of physicians under contract with the organization to assist it exclusively in those programs that may be related with the contract; or to grant loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical and hospital facilities or to assist it in its program to provide health care services to the subscribers.
(c) To offer health care services through providers who are under contract with or employed by the health services organization.
(d) To contract with any person to carry out on its behalf certain functions such as marketing, subscription and administration.
(e) Contract with an insurance company or any other health services organization authorized to do business in Puerto Rico, to provide insurance, compensation or reimbursement for the cost of the health care services offered by the health services organization.
(f) Offer other health care services in addition to the basic health care services.
(2)
(a) A health services organization, before exercising any of the powers conferred in clause (a) or (b) of subsection (1) of this section, and the power to contract administrative functions conferred in subsection (1)(d) of this section shall furnish to the Commissioner the adequate information to justify the exercise of said powers. The Commissioner may disapprove the exercise of any such power if, in his opinion, it substantially affects the financial status of the health services organization and prevents it from meeting its obligations. If the Commissioner does not disapprove it within thirty (30) days after its filing, it shall be deemed approved. The Commissioner may postpone said period for an additional term that shall not exceed thirty (30) days, if the Commissioner advises the health services organization of it within said waiting period.
(b) The Commissioner may promulgate the adequate regulations to exempt from the requirement established in clause (a) of this subsection those activities that have minimum effects.
History —Ins. Code, added as § 19.050 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 4.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1906 - Board of Directors

(1) The Board of Directors of any health services organization may include providers, private persons or both.
(2) Said Board of Directors shall establish a procedure that will afford the subscribers the opportunity to participate in the direction and operation of the health services organization by establishing advisory committees, the use of advice by consultation or the use of any other procedure in the fundamental decisions. Said procedures shall be submitted to the Commissioner for his approval before they are used.
History —Ins. Code, added as § 19.060 on June 2, 1976, No. 113, p. 313, § 1; June 1, 1983, No. 48, p. 84; July 2, 1987, No. 88, p. 337, § 5.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1907 - Fiduciary liability

Any director, officer or member of a health services organization who receives, collects, disburses or invests funds related to the activities of said organization, shall be fiducially liable for the funds received from the subscribers.
History —Ins. Code, added as § 19.070 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1909 - Annual report

(1) Each health services organization shall annually render to the Commissioner, with a copy to the Secretary of Health, on or before March 31, a true statement certified by an authorized public accountant and subscribed under oath by two of its main officers, covering the preceding year.
Said report shall be made in the forms prescribed by the Commissioner and shall include:
(a) The economic situation of the organization, including a statement of condition, a profit and loss statement, and a statement of sources and application of funds for the preceding year, certified by an authorized public accountant;
(b) any material change of the information submitted by virtue of § 1903(3) of this title;
(c) the number of persons subscribed during the year, the number of subscribers at the end of the year and the number of subscribers who terminated during the year;
(d) a summary of the information compiled under § 1904(1)(b)(iii) of this title in the manner provided by the Secretary of Health, and
(e) any other information related to the health services organization that may be necessary to enable the Commissioner to carry out his duties under this chapter.
History —Ins. Code, added as § 19.090 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1910 - Information to subscribers

Each health services organization shall annually provide its subscribers, if they so request:
(1) Copy of the annual financial statements;
(2) a description of the organization and of the operations of the health care plan and a summary of any change occurring since the last report;
(3) a description of the services and information as to how and when they may be obtained, and
(4) a clear and detailed description of the method used by the organization to settle the complaints of the subscribers.
History —Ins. Code, added as § 19.100 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1911 - Open registry

(1) After the health services organization has operated for 24 months, it may have an annual subscription period of at least one month during which it may accept new subscribers, to the limit of its capacity, as the health services organization may determine, in the order subscriptions are sought. A health services organization may request from the Commissioner authorization to impose such restrictions in the acceptance of subscription petitions as may be necessary to maintain its financial stability in order to prevent an excessive and adverse selection of the prospective subscribers, or to avoid unreasonably high and unmarketable fees of the health care services coverage. The Commissioner may approve or deny said petition within thirty (30) days after filing by the health services organization.
(2) The health services organization providing services exclusively for groups may limit the open subscription established in subsection (1) of this section to all the members of the group or groups covered by said contract.
History —Ins. Code, added as § 19.110 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1912 - System of complaints

(1)
(a) Every health services organization shall establish and maintain a complaints procedure approved by the Commissioner upon consultation with the Secretary of Health, which shall establish a reasonable procedure for the prompt solution of complaints filed by any subscriber or provider, and which are related to the provisions of the health care plan. Said procedure shall, at least, contemplate the solution of matters such as claims for reimbursements, cancellation, nonrenewal or denial of a health care plan or any benefit thereunder, and complaints regarding the quality of the health care services offered by the providers or the organization itself.
(b) The complaints procedure shall include the designation of a Grievance Committee which shall not exceed five (5) members and on which the subscribers of individual contracts, the subscribers of the different group plans and the providers shall be represented. The representatives shall not be employees, officials, directors or shareholders of the health services organization, and shall be members of the Committee for a period of not less than one (1), nor more than three (3) years.
The Commissioner shall establish by regulations the procedures to be used in selecting the Complaints Committee.
(c) Every health services organization shall give a reasonable answer through its Complaints Committee to each written complaint received by it, within the period of thirty (30) days after said written complaint was filed.
(d) Any complaint in which an unfair practice or a violation of any applicable provision of this Code is imputed shall be referred to the Commissioner.
(e) In addition to establishing an individual file for each complaint, each health services organization shall keep a complete registry of all the complaints it receives. Said registry shall include, at least, the complainant’s name and address, the subject of the complaint, the date the complaint was resolved, how the complaint was disposed of and how long it took to resolve it. The individual files as well as the registries mentioned in this section shall be subject to inspection by the Commissioner or the Secretary of Health.
(f) Each health service organization shall submit an annual report to the Commissioner and to the Secretary of Health, in the manner prescribed by the Commissioner on or before March 31 of the year following the report year. The fee for the filing of said annual report shall be twenty-five dollars ($25).
(2) This section shall not hinder the subscriber or complainant from seeking other remedy available in this title.
History —Ins. Code, added as § 19.120 on July 2, 1987, No. 88, p. 337, § 7.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1913 - Investments

With the exception of the investments made pursuant to the provisions of clauses (a) and (b) of subsection (1) and subsection (2) of § 1905 of this title, the investment of its funds that may be made by the health services organization shall be made only in securities or other investments permitted by the laws of Puerto Rico for the investment of assets which constitute the legal reserve of life insurance companies or such other securities or investments as the Commissioner may permit.
History —Ins. Code, added as § 19.130 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1914 - Protection against insolvency

As a guarantee of compliance with the obligations towards subscribers, providers and creditors, each health services organization shall deposit the amount of six hundred thousand dollars ($600,000) in eligible assets with the Commissioner, as provided by § 802 of this title.
History —Ins. Code, added as § 19.140 on June 2, 1976, No. 113, p. 313, § 1; July 20, 1979, No. 165, p. 420, § 5; July 2, 1987, No. 88, p. 337, § 8; Oct. 28, 2002, No. 247, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1914a - Deposit requirement; escalator provision

Every licensed health services organization which maintains a smaller deposit than what has otherwise been required under this Code may continue as such without immediately increasing its deposit, if in each of the four (4) years immediately following the effective date of any increase in the requirement, it increases its deposit by a proportional amount which is needed to reach the amount otherwise required, within said four- (4) year period.
History —Ins. Code, added as § 19.141 on July 2, 1987, No. 88, p. 337, § 9.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1914b - Liabilities

In determining a health services organization’s financial situation, it shall be deemed that its assets are impaired in the measure that its liabilities exceed its assets, both of which shall be determined as provided in Sections 5.010–5.110, but including as liabilities, the deposit required by § 1914 or § 1914a of this title, if applicable.
History —Ins. Code, added as § 19.142 on July 2, 1987, No. 88, p. 337, § 10.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1916 - Applicability; licenses required; fees

(1) For the purposes of this chapter:
(a) Agent.— means a person appointed by a health services organization to carry out soliciting and underwriting activities.
(b) Broker.— means a person who for compensation as an independent contractor negotiates in behalf of a subscriber or group of subscribers to obtain or renew a health care plan.
(2) The provisions on licenses, commissions, requirements, examinations, controlled business, bonds, citations, books, documents, reports under Chapter 9 of this Code, as well as the limitations established therein which are not in contravention with what is established in subsection (1) of this section, and which are not otherwise incompatible with this chapter, shall be deemed to apply to the health services organization’s agents and brokers.
(3) No health services organization shall do the soliciting or underwriting of a health care plan except through a licensed agent of said health services organization who resides in Puerto Rico; Provided, That nothing that is established herein shall limit the health services organization’s power to contract with the underwriter directly.
(4) Every applicant for a license shall pay the fees established in § 701 of this title.
History —Ins. Code, added as § 19.160 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 12.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1917 - Powers of insurers and hospitals or medical services corporations

(1) An insurance company authorized in Puerto Rico or a hospital or medical services corporation authorized to do business in Puerto Rico may, either directly or through a subsidiary or affiliate, organize or operate a health services organization under the provisions of this chapter. Notwithstanding the provisions of any law or part of law to the contrary, two or more insurance companies, hospitals or medical services corporations or subsidiaries or affiliates may jointly organize and operate a health services organization. Insurance business is considered as including health care by a health organization owned or operated by an insurance company or its subsidiary.
(2) [Repealed. Act July 2, 1987, No. 88, p. 337, § 13, eff. July 2, 1987.]
History —Ins. Code, added as § 19.170 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 13.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1918 - Examinations

(1) For the protection of public interest, the Commissioner may carry out, at least every three years, an examination of the affairs of any health organization and providers with which said organization has contracts, agreements or other arrangements under its plans.
(2) For the protection of public interest, the Secretary of Health shall carry out an annual examination relating to the quality of the health services as well as to determine, among other things, the utilization of the services of any health services organization and providers with which said organization has contracted by virtue of its health care plans.
(3) Each health services organization or provider shall submit its books and records relating to the health care plan for examination and shall facilitate such examination. For purposes of examination, the Commissioner and the Secretary of Health may administer oaths and examine the officers and agents of the organization and the officers of the providers related to its business.
(4) The expenses of the examination under this section shall be borne by the organization examined and shall be sent to the Commissioner or the Secretary of Health, depending on who is carrying out the examination, and shall be covered into the general fund of the Commonwealth of Puerto Rico, or as otherwise provided by the Legislature.
(5) In the case of a foreign health services organization, instead of the examination required in subsection (1) of this section, the Commissioner may accept the report of the examination carried out by the Commissioner of the state of the domicile of said organization. The examination relating to the quality of the health services as provided in subsection (2) of this section shall be carried out by the Secretary of Health of Puerto Rico.
History —Ins. Code, added as § 19.180 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1920 - Rehabilitation, liquidation or conservation

Any rehabilitation, liquidation, or conservation of the organization shall be considered as that of an insurance company and shall be conducted under the supervision of the Commissioner under the provisions of this code on rehabilitation, liquidation or administration of insurance companies. The Commissioner may request the court to issue an order of rehabilitation, liquidation, or other remedy that may lie under any one or more of the grounds established in Section 40.020 of this Code, or when, in his opinion, to continue operating the organization would be prejudicial to the subscribers or to the public interest.
History —Ins. Code, added as § 19.200 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1921 - Administrative procedure

(1) When the Commissioner believes that reasonable grounds exist to deny an application for a certificate of authority, or that grounds exist for the suspension or revocation of the certificate, he shall notify the organization and the Secretary of Health in writing of the grounds to deny, suspend or revoke and shall fix a term of at least thirty (30) days for holding a hearing.
(2) The Secretary of Health or his representative shall appear at the hearing before the Commissioner and may participate in the proceedings. After a hearing held by the Secretary of Health, as provided in §§ 331–333p of Title 24, the findings of the latter on the quality of the services rendered, in connection with any decision for the denial, suspension or revocation, shall be conclusive and binding on the Commissioner.
(3) After said hearing is held, or because of nonappearance of the organization, the Commissioner shall take whatever action he deems advisable and shall send his findings, in writing, to the organization and a copy thereof to the Secretary of Health.
The action of the Commissioner and the recommendations and findings of the Secretary of Health shall be subject to review by the Court of First Instance. The Court may, upon passing on the controversy before it, notify, affirm or reverse the order of the Commissioner in whole or in part.
History —Ins. Code, added as § 19.210 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 15.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1923 - Additional penalties for violations

(1) In addition to the suspension or revocation of the certificate of authority or in lieu thereof, any organization which violates any provision of this chapter may be imposed the penalties prescribed for the insurers.
History —Ins. Code, added as § 19.230 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1924 - Construction of act and relation to other laws

(1) The provisions of the insurance law and the provisions of the law regulating the hospitals and medical services corporations, which have not been excepted, shall govern insofar as applicable to every health services organization to which a certificate of authority is granted hereunder. The preceding provisions shall not be applicable to an insurer organized pursuant to the provisions of this title.
(2) The solicitation of subscribers by a health organization to which a certificate of authority has been granted or its representatives shall not be construed as a violation of any provision of law related to the solicitation and advertising of health professionals.
(3) A health services organization authorized by this chapter shall not be considered as practicing medicine and shall be exempt from the provisions relating to the practice of medicine.
History —Ins. Code, added as § 19.240 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1925 - Registration and reports as public documents

Every application for registration and all reports required by this chapter shall be considered as public documents.
History —Ins. Code, added as § 19.250 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1926 - Confidentiality of medical information

Any data or information related to the diagnosis, treatment or the health of any subscriber or applicant obtained by the organization from said person or from any provider shall be deemed confidential and shall not be disclosed to any person except to the extent necessary to carry out the purposes of this chapter; or with the express consent of the subscriber or applicant; or by virtue of a law or court order for the production or discovery of evidence; or in the event of a claim or suit between said person and the organization, provided said information or data be pertinent. Any organization shall be entitled to claim any statutory privilege against said discovery which the provider facilitating said information to the organization may be entitled to claim.
History —Ins. Code, added as § 19.260 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1927 - Secretary of Health, authority to contract

The Secretary of Health, in performing his duties under §§ 1904(1)(b), 1918(2) and 1919(1) of this title may contract with a capable person to advise in connection with the findings he shall make. Such advice may be accepted in whole or in part by the Secretary of Health.
History —Ins. Code, added as § 19.270 on June 2, 1976, No. 113, p. 313, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1928 - Health services organizations

All authorization certificates issued to health services organizations shall continue to be in effect until their expiration, but subject to the payment to the Commissioner of the annual fees set forth in § 701 of this title prior to midnight on the date of expiration.
History —Ins. Code, added as § 19.271 on Mar. 27, 2003, No. 96, § 8, retroactive to Jan. 1, 2003.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 20 - Casualty Insurance (§§ 2001 — 2004) › § 2001 - Insurer’s liability

The insurer issuing a policy insuring any person against loss or damage through legal liability for bodily injury, death, or damage to property of a third person, shall become liable whenever a loss covered by the policy occurs, and payment of such loss by the insurer to the extent of its liability therefor under the policy shall not depend upon payment by the insured of or upon any final judgment against him arising out of such occurrence, nor shall it depend upon said judgment.
History —Ins. Code § 20.010; Dec. 12, 2007, No. 186, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 20 - Casualty Insurance (§§ 2001 — 2004) › § 2002 - Retroactive annulment

No insurer shall retroactively annul any liability insurance policy by any agreement between the insurer and insured after occurrence of any injury, death, or damage to a third person for which the insured may be liable, and any such annulment attempted shall be void.
History —Ins. Code § 20.020.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 20 - Casualty Insurance (§§ 2001 — 2004) › § 2003 - Suits against insured, insurer

(1) Any individual sustaining damages and losses shall have, at his option, a direct action against the insurer under the terms and limitations of the policy, which action he may exercise against the insurer only or against the insurer and the insured jointly. The direct action against the insurer may only be exercised in Puerto Rico. The liability of the insurer shall not exceed that provided for in the policy, and the court shall determine not only the liability of the insurer, but also the amount of the loss. Any action brought under this section shall be subject to the conditions of the policy or contract and to the defenses that may be pleaded by the insurer to the direct action instituted by the insured.
(2) In a direct action brought against the insurer by the person who suffered the damages, the former is barred from introducing those defenses of the insured based on the protection of the family unit or other similar immunities that are recognized in the legal system of Puerto Rico.
(3) If the injured party brings suit against the insured alone, it shall not be deemed to deprive him of the right, by subrogation to the rights of the insured under the policy, to maintain action against and recover from the insurer after securing final judgment against the insured.
History —Ins. Code § 20.030; May 26, 1966, No. 21, p. 141; Dec. 12, 2007, No. 186, § 2.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 20 - Casualty Insurance (§§ 2001 — 2004) › § 2003a - Legal defense by the insurer

At the request of the insured that the insurer provide him/her the legal defense provided in the policy, the insurer shall have to respond, in accordance with § 2716b of this title, whether or not the insurer shall provide said legal representation.
History —Ins. Code, added as § 20.040 on Dec. 12, 2007, No. 186, § 3.
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 20 - Casualty Insurance (§§ 2001 — 2004) › § 2004 - Liability insurance on public bodies

(1) The obtaining of liability insurance by the Commonwealth of Puerto Rico, its agencies or entities, and by municipalities and other political subdivisions, shall not constitute or be deemed to constitute a waiver of governmental immunity, if any, from liability for actions or omissions in which there were torts committed by government agents and employees, except to the extent of the collectible indemnity actually provided by such insurance as to a particular occurrence. However, such waiver of immunity shall not be deemed to exist as to any claim or suit against such governmental entity, unless said entity expressly waives said immunity.
(2) All such insurance policies shall provide that the insurer shall not assert the defense of governmental immunity in any action brought against the insurer under or by virtue of such policy.
(3) The insurer shall have no right of subrogation against any governmental entity, its agents or employees, insured under such a policy by virtue of any loss paid by the insurer under the policy. However, it is provided that if another collectible liability insurance exists provided by another insurer, the insurer may subrogate himself/herself against this other insurer.
History —Ins. Code § 20.040, renumbered as § 20.050 and amended on Dec. 12, 2007, No. 186, § 4.