2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1915 - Prohibited practices

(1) No health services organization or its representative may use or permit the use of untrue or deceptive advertisements, applications which are untrue or deceptive, or any form of coverage evidence that is deceptive. For the purposes of this chapter:
(a) An informative statement or article may be considered untrue if it does not correspond to facts which are or might be significant for the subscriber or person who seeks to avail himself of a health care services plan.
(b) An informative statement or article shall be considered untrue if in the whole context in which said statement or article appears it may be understood by a person who does not have special knowledge of health plans as if it indicates any benefit or advantage, or the absence of any exclusion, limitation or disadvantage which may be significant to a subscriber or person who is contemplating subscribing to a plan, when in fact the absence of limitations, exclusions or disadvantages does not exist.
(c) The coverage evidence shall be considered as deceptive if, as a whole, and taking into consideration the typography and the format, as well as the language, it leads a person who has no special knowledge of plans and coverage evidence to believe that he has benefits, services, charges or other advantages which do not arise from the coverage evidence or which are not regularly accessible to the subscribers under the health care plan which issues said coverage evidence.
(2) The provisions of this title on unfair practices shall be construed so that they apply to health services organizations, health care plan and coverage evidence, to the extent that the Commissioner may determine they are applicable to the health services organization, health care plan and coverage evidence.
(3) The coverage evidence to a subscriber shall not be cancelled, modified or renewed, except for default in payment of the coverage fees, or for other reasons that may be determined by the Commissioner, provided, that there shall be a grace period of thirty (30) days to make payment.
(4) No health services organization may use in its name, contract or literature, any of the words “insurance”, “contingency”, “guaranty”, “mutual”, or any other word describing insurance, contingency or guaranty business, deceitfully similar to the name or description of any insurance or guaranty corporation doing business in Puerto Rico.
(5) No provider shall contract the furnishing of health care services with a health service organization unless the latter is authorized pursuant to the requirements of this chapter.
(6) No health services insurance policy nor health care plan that provides coverage for the children of a family unit, may exclude foster children from said family unit. For the purposes of this provision, the term “foster child” shall have the meaning set forth in § 1633 of this title.
History —Ins. Code, added as § 19.150 on June 2, 1976, No. 113, p. 313, § 1; June 16, 1978, No. 52, p. 177; July 2, 1987, No. 88, p. 337, § 11; Aug. 31, 2000, No. 251, § 2.