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https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1401/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1401 - Definitions
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1401 - Definitions
No life, endowment, or group or blanket annuity insurance policy shall be issued for delivery in Puerto Rico unless it conforms to one of the following descriptions: (1) A policy issued to an employer, or to the trustees of a fund established by an employer, which employer or trustee shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements: (a) The employees eligible for insurance under the policy shall be all of the employees of the employer, or all of any class or classes thereof determined by conditions pertaining to their employment. The policy may provide that the term “employees” shall include the employees of one or more subsidiary corporations, and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietors or partnerships if the business of the employer and of such affiliated corporations, proprietors or partnerships is under common control through stock ownership or contract. The policy may provide that the term “employees” shall include the individual proprietor or partners if the employer is an individual proprietor or a partnership. The policy may provide that the term “employees” shall include retired employees. No director of a corporate employer shall be eligible for insurance under the policy unless such person is otherwise eligible as a bona fide employee of the corporation by performing services other than the usual duties of a director. No individual proprietor or partner shall be eligible for insurance under the policy unless he is actively engaged in and devotes a substantial part of his time to the conduct of the business of the proprietor or partnership. (b) The premium for the policy shall be paid by the policyholder, either wholly from the employer’s funds or funds contributed by him, or partly from such funds and partly from funds contributed by the insured employees, or wholly from funds contributed by the insured employees. A policy on which a part or all of the premium is to be derived from funds contributed by the insured employees may be placed in force only if at least seventy-five percent (75%) of the then eligible employees, excluding any as to whom evidence of individual insurability is not satisfactory to the insurer, elect to make the required contributions. A policy on which no part of the premium is to be derived from funds contributed by the insured employees must insure all eligible employees, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer. (c) The policy must cover at least 10 employees at date of issue. (d) The amounts of insurance under the policy must be based upon some plan precluding individual selection either by the employees or by the employer or trustees. (2) A policy issued in behalf of a creditor, who shall be deemed the policyholder, to insure debtors of the creditor, subject to the following requirements and to the provisions of Chapter 18 of this title. (a) The debtors eligible for insurance under the policy shall be all of the debtors of the creditor whose indebtedness is repayable either: (i) In installments, or (ii) in one sum at the end of a period not in excess of sixty (60) months from the initial date of debt, or all of any class or classes thereof determined by conditions pertaining to the indebtedness or to the purchase giving rise to the indebtedness. The policy may provide that the term “debtors” shall include the debtors of one (1) or more subsidiary corporations, and the debtors of one (1) or more affiliated corporations, proprietors or partnerships if the business of the policyholder and of such affiliated corporations, proprietors or partnerships is under common control through stock ownership, contract, or otherwise. No debtor shall be eligible unless the indebtedness constitutes an obligation to repay which in binding upon him during his lifetime, at and from the date the insurance becomes effective upon his life. (b) The premium for the policy shall be paid by the policyholder, either from the creditor’s funds, or from charges collected from the insured debtors, or from both. A policy on which part or all of the premium is to be derived from the collection from the insured debtors of identifiable charges not required of uninsured debtors shall not include, in the class or classes of debtors eligible for insurance, debtors under obligations outstanding at its date of issue without evidence of individual insurability unless at least seventy-five percent (75%) or more of the then eligible debtors elect to pay the required charges. A policy on which no part of the premium is to be derived from the collection of such identifiable charges must insure all eligible debtors, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer. (c) The policy may be issued only if the group of eligible debtors is then receiving new entrants at the rate of at least one hundred (100) persons yearly, or may reasonably be expected to receive at least one hundred (100) new entrants during the first policy year, and only if the policy reserves to the insurer the right to require evidence of individual insurability if less than seventy-five percent (75%) of the new entrants become insured. The policy may exclude from the classes eligible for insurance classes of debtors determined by age. (d) The amount of insurance on the life of a debtor shall at no time exceed the amount owed by him. (e) The insurance shall be payable to the policyholder. Such payment shall reduce or extinguish the debtor’s obligation up to a maximum equal to the total of such payment. (3) A policy issued to a labor union, which shall be deemed the policyholder, to insure members of such union for the benefit of persons other than the union or any of its officials, representatives or agents, subject to the following requirements: (a) The members eligible for insurance under the policy shall be all of the members of the union, or all of any class or classes thereof determined by conditions pertaining to their employment, or to membership in the union, or both. (b) The premium for the policy shall be paid by the policyholder, either wholly from the union’s funds, or partly from such funds and partly from funds contributed by the insured members specifically for their insurance, or totally from funds contributed by the insured member specifically for their insurance. A policy on which part of the premium or the total thereof is to be derived from funds contributed by the insured members specifically for their insurance may be placed in force only if seventy-five percent (75%) or more of the then eligible members, excluding any as to whom evidence of individual insurability is not satisfactory to the insurer, elect to make the required contributions. A policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance must insure all eligible members, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer. (c) The policy must cover at least twenty-five (25) members at date of issue. (d) The amounts of insurance under the policy must be based upon some plan precluding individual selection either by the members or by the union. (4) A policy issued to the trustees of a fund established by two (2) or more employers in the same industry or by one (1) or more labor unions, or by one (1) or more employers and one (1) or more labor unions, which trustees shall be deemed the policyholder, to insure employees of the employers or members of the unions for the benefit of persons other than the employers or the unions, subject to the following requirements: (a) The persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions, or all of any class or classes thereof determined by conditions pertaining to their employment, or to membership in the unions, or to both. The policy may provide that the term “employees” shall include retired employees, and the individual proprietor or partners if an employer is an individual proprietor or a partnership. No director of a corporate employer shall be eligible for insurance under the policy unless such person is otherwise eligible as a bona fide employee of the corporation by performing services other than the usual duties of a director. No individual proprietor or partner shall be eligible for insurance under the policy unless he is actively engaged in and devotes a substantial part of his time to the conduct of the business of the proprietor or partnership. The policy may provide that the term “employees” shall include the trustees or their employees, or both, if their duties are principally connected with such trusteeship. (b) The premium for the policy shall be paid by the trustees wholly from funds contributed by the employer or employers of the insured persons, or by the union or unions, or by both, or by funds totally or partially contributed by the insured individuals. A policy of which a part or the total of the premiums is to be derived from funds contributed by the insured members specifically for their insurance may be placed in force only if seventy-five percent (75%) or more of the then eligible members or employees, excluding any as to whom evidence of individual insurability is not satisfactory to the insurer, elect to make the required contribution. In the case in which the premium is not partially or totally paid by the insured individuals, the policy must insure all eligible persons, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer. (c) The policy must cover at date of issue at least one hundred (100) persons and not less than an average of five (5) persons per employer unit; and if the fund is established by the members of an association of employers the policy may be issued only if (i) (A) the participating employers constitute at date of issue at least sixty percent (60%) of those employer members whose employees are not already covered for group life insurance, or (B) the total number of persons covered at date of issue exceeds six hundred (600); and (ii) the policy shall not require that, if a participating employer discontinues membership in the association, the insurance of his employees shall cease solely by reason of such discontinuance. (d) The amounts of insurance under the policy must be based upon some plan precluding individual selection either by the insured persons or by the policyholder, employers, or unions. (5) A policy issued to a cooperative association, or an association of persons licensed by the Commonwealth of Puerto Rico to engage in a recognized profession or an association of federal, commonwealth or municipal employees, or trade association or college, to insure members of said association for the benefit of persons other than the association or any of its officers, representatives or agents, or a policy issued to a financial institution, which shall be deemed the policyholder, to insure depositors thereof, subject to the following requirements: (a) The members eligible for insurance under the policy shall be all the members of the association, or all of any class or classes thereof determined by conditions pertaining to their employment or profession, or to their membership of the association, or both. The policy may provide that the term “member” shall include retired members. (b) The premium for the policy shall be paid by the policyholder either wholly from the association fund, or partly from such funds and partly from funds contributed by the insured members specifically for their insurance or totally from funds contributed by the insured members specifically for their insurance. A policy on which part of the premium or the total thereof is to be derived from funds contributed by the insured members specifically for their insurance may be placed in force only if seventy-five percent (75%) or more of the then eligible members, excluding any as to whom evidence of individual insurability is not satisfactory to the insurer, elect to make the required contributions. A policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance must insure all eligible members, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer. (c) The policy must cover at least twenty-five (25) members at date of issue. (d) The amounts of insurance under the policy must be based upon some plan precluding the individual selection either by the members or by the association. (6) Any group life policy issued to the groups described in subsections (1), (3), (4) and (5) of this section may be extended to cover the lives of the spouse and/or dependent children of the insured employee or member, subject to the following requirements: (a) The premium of this insurance shall be paid by the policyholder, either wholly from his funds or wholly from the funds contributed by the employees or members insured, or from both. If all or part of the premium is to be derived from funds contributed by the insured employees or members, the insurance with respect to the spouse and dependent children shall be made effective only if at least seventy-five percent (75%) or more of the then eligible employees or members, excluding any whose spouse and/or dependent children show no evidence of insurability satisfactory to the insurer, decide to make the required contribution. In case the premium is not fully or partly paid by the insured persons, the policy shall have to insure all the spouses and dependent children, except any with respect to whom the evidence of individual insurability is not satisfactory to the insurer. (b) The amounts of insurance under the policy shall be based on some plan that precludes individual selection, either by the insured persons or by the policyholder. Said amounts shall not exceed, with respect to the spouse, fifty percent (50%) of the insurance on the life of the insured employee or member, and two thousand dollars ($2,000) with respect to the dependent child. (c) If the insurance on the life of the spouse and/or dependent children of the insured employee or member ceases because of the termination of his employment or membership, said spouse or dependents shall enjoy the benefit of conversion as provided in § 1410 of this title. (d) Notwithstanding the provisions of § 1409 of this title, a single certificate may be issued to the insured employee or member if the spouse and dependent children are included therein. History —Ins. Code § 14.010; June 6, 1960, No. 64, p. 98; May 21, 1969, No. 8, p. 10; May 10, 1976, No. 32, p. 84, § 14; July 20, 1979, No. 165, p. 420, § 3; July 20, 1979, No. 174, p. 456.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1403/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1403 - Standard provisions
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1403 - Standard provisions
No policy of group life insurance shall be issued to be delivered in Puerto Rico unless it contains in substance the provisions of §§ 1404–1411 of this title, inclusive, or provisions which in the opinion of the Commissioner are more favorable to the persons insured, or at least as favorable to the person insured and more favorable to the policyholder; Provided, however, That: (a) Sections 1408–1410 inclusive shall not apply to policies issued to a creditor to insure debtors of such creditor; (b) the standard provisions required for individual life insurance policies shall not apply to group life insurance policies, and (c) if the group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision or provisions which in the opinion of the Commissioner is or are equitable to the insured persons and to the policyholder, but nothing herein shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies. History —Ins. Code, added as § 14.030 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1404/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1404 - Grace period
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1404 - Grace period
A provision that the policyholder is entitled to a grace period of thirty-one days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period. History —Ins. Code, added as § 14.040 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1405/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1405 - Incontestability
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1405 - Incontestability
(1) A provision that the validity of the policy shall not be contested, except for nonpayment of premiums, after it has been in force for two years from its date of issue; and that no statement made by any person insured under the policy relating to his insurability shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of at least two years nor unless it is contained in a written instrument signed by him. (2) A provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued; that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties; and that no statement made by any person insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such person or to his beneficiary. History —Ins. Code, added as § 14.050 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1406/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1406 - Evidence of insurability
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1406 - Evidence of insurability
A provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of his coverage. History —Ins. Code, added as § 14.060 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1407/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1407 - Age falsely stated
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1407 - Age falsely stated
A provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, such provision to contain a clear statement of the method of adjustment to be used. History —Ins. Code, added as § 14.070 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1408/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1408 - Provision to facilitate payment
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1408 - Provision to facilitate payment
A provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, subject to the provisions of the policy in the event there is no designated beneficiary, as to all or any part of such sum, living at the time of the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of such sum not exceeding five hundred dollars ($500) to any person appearing to the insurer to be equitably entitled thereto by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured. History —Ins. Code, added as § 14.080 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1409/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1409 - Issuance of certificate
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1409 - Issuance of certificate
A provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which he is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in subdivisions (1), (2) and (3) of § 1410 of this title. History —Ins. Code, added as § 14.090 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1410/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1410 - Conversion clause
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1410 - Conversion clause
(1) A provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, such person shall be entitled to have issued to him by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits, provided application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one (31) days after such termination, and provided further that: (a) The individual policy shall, at the option of such person, be on any one of the forms, except term insurance, then customarily issued by the insurer at the age and for the amount applied for; (b) the individual policy shall be in an amount not in excess of the amount of life insurance which ceases because of such termination, provided that any amount of insurance which shall have matured on or before the date of such termination as an endowment payable to the person insured, whether in one sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount which is considered to cease because of such termination, and (c) the premium on the individual policy shall be at the insurers’ then customary rate applicable to the form and amount of the individual policy, to the class of risk which such person then belongs, and to his age attained on the effective date of the individual policy. (2) A provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured thereunder at the date of such termination whose insurance terminates and who has been so insured for at least three years prior to such termination date shall be entitled to have issued to him by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by subsection (1) of this section, except that the group policy may provide that the amount of such individual policy shall not exceed the smaller of: (a) The amount of the person’s life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which he is or becomes eligible under any group policy issued or reinstated by the same or another insurer within thirty-one (31) days after such termination, and (b) four thousand dollars ($4,000). (3) A provision that if a person insured under the group policy dies during the period within which he would have been entitled to have an individual policy issued to him in accordance with subsections (1) and (2) of this section and before such an individual policy shall have become effective, the amount of life insurance which he would have been entitled to have issued to him under such individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium therefor has been made. (4) If any individual insured under a group life insurance policy hereafter issued in Puerto Rico becomes entitled under the terms of such policy to have an individual policy of life insurance issued to him without evidence of insurability, subject to making of application and payment of the first premium within the period specified in such policy, and if such individual is not given notice of the existence of such right at least fifteen (15) days prior to the expiration date of such period, then in such event the individual shall have an additional period within which to exercise such right, but nothing herein contained shall be construed as continuing any insurance beyond the period provided in such policy. This additional period shall expire fifteen (15) days next after the individual is given such notice but in no event shall such additional period extend beyond sixty (60) days next after the expiration date of the period provided in such policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder shall constitute notice for the purposes of this paragraph. (5) The policy shall provide that a discount may be applied to the total conversion policy premium in the year of conversion. The discount or the method by which the discount is calculated shall be described in the policy. (6) The policy shall provide that the incontestability and suicide provisions attributable to the coverage converted will run from the date of the original policy. If the new policy includes additional coverage for which evidence of insurability was given, new incontestability and suicide provisions may apply to that coverage. History —Ins. Code, added as § 14.100 on June 6, 1960, No. 64; Nov. 9, 2007, No. 165, § 2, eff. 90 days after Nov. 9, 2007.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-14/1411/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 14 - Group Life Insurance (§§ 1401 — 1411)›§ 1411 - Special form in case of creditors’ and debtors’ insurance
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 14 - Group Life Insurance (§§ 1401 — 1411) › § 1411 - Special form in case of creditors’ and debtors’ insurance
In the case of a policy issued to a creditor to insure debtors of such creditor, the policy shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form which will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid thereunder by reason of his death shall be applied to reduce or extinguish the indebtedness. History —Ins. Code, added as § 14.110 on June 6, 1960, No. 64.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1601/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1601 - Scope
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1601 - Scope
Nothing in this chapter shall apply to or affect: (1) Any policy of workmen’s compensation insurance or any policy of liability insurance with or without supplementary coverage therein; or (2) any policy or contract of reinsurance; or (3) any blanket or group policy of insurance; or (4) life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to accident and sickness insurance as: (a) Provide additional benefits in case of death or dismemberment or loss of sight by accident, or as (b) operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract. Provided, however, That §§ 1609, 1610 and 1613 of this title shall apply to contracts supplemental to life insurance or endowment or annuity contracts. History —Ins. Code § 16.010; Mar. 18, 2008, No. 31, § 2, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1602/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1602 - Format of disability policies
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1602 - Format of disability policies
No disability policy shall be delivered or issued for delivery to any person in Puerto Rico unless it otherwise complies with this title, and complies with the following: (1) It shall purport to insure only one person, except as to family expense insurance written pursuant to § 1633 of this title. (2) The style, arrangement and over-all appearance of the policy shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lower case unspaced alphabet length not less than one hundred and twenty-point (the “text” shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and caption and subcaptions). (3) The exceptions and reductions of indemnity shall be set forth in the policy and, other than those contained in §§ 1605–1628 of this title, inclusive, shall be printed, at the insurer’s option, either included with the benefit provision to which they apply, or under an appropriate caption such as “EXCEPTIONS”, or “EXCEPTIONS AND REDUCTIONS”, except that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies. (4) Each such form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof. (5) It shall contain no provision purporting to make any portion of the insurer’s charter, rules, constitution, or bylaws a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the Commissioner. History —Ins. Code § 16.020.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1603/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1603 - Policies issued by domestic insurer for delivery elsewhere
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1603 - Policies issued by domestic insurer for delivery elsewhere
If any policy is issued by a domestic insurer for delivery to a person residing in another state or country, and if the insurance commissioner or corresponding public official of such other state or country has advised the Commissioner in Puerto Rico that any such policy is not subject to approval or disapproval by such official, the Commissioner may by ruling require that such policy meet the applicable standards set forth in this chapter and in §§ 1101–1137 of this title. History —Ins. Code § 16.030.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1604/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1604 - Standard provisions required; substitutions; captions
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1604 - Standard provisions required; substitutions; captions
Except as provided in § 1113 of this title, each such policy delivered or issued for delivery to any person in Puerto Rico shall contain the provisions as specified in §§ 1605–1623 of this title inclusive, in the words in which the same appear; except, that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the Commissioner which are in each instance not less favorable in any respect to the insured or the beneficiary. Each such provision shall be preceded by the applicable caption shown or, at the insurer’s option, by such appropriate individual or group caption or subcaption as the Commissioner may approve. History —Ins. Code § 16.040; Mar. 18, 2008, No. 31, § 3, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1605/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1605 - Entire contract; changes
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1605 - Entire contract; changes
There shall be a provision as follows: Entire contract; changes.— This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions. History —Ins. Code § 16.050.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1606/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1606 - Time limit on certain defenses
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1606 - Time limit on certain defenses
The policy shall contain a provision as follows: Time limit on certain defenses :— (a) After three (3) years from the date of [issuance] of this policy no misstatements (except fraudulent misstatements) made by the applicant in the application for such policy may be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such three (3)-year period. Fraudulent misstatements may be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such three (3)-year period, only when the act or omission in question has contributed to the loss which is the object of the cause of action. (The foregoing policy provision shall not be so construed as to affect any legal requirement for voidance of a policy or denial of a claim during such initial three (3)-year period or to limit the application of §§ 1618–1622 of this title in the event of misstatement with respect to age or occupation, or other insurance.) A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium: (1) Until at least age 50, or (2) in the case of a policy issued after age forty-four (44), for at least five (5) years from its date of issue, may contain in lieu of the foregoing, the following provision (from which the clause in parenthesis may be omitted at the insurer’s option) under the caption “INCONTESTABLE: After this policy has been in force for a period of three (3) years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.”) (b) No claim for loss incurred or disability (as defined in the policy) commencing after three years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy. History —Ins. Code § 16.060; Mar. 18, 2008, No. 31, § 4, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1607/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1607 - Grace period
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1607 - Grace period
There shall be a provision as follows: Grace period.— A grace period ____ (insert a number not less than “7” for weekly premium policies, “10” for monthly premium policies, and “31” for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force. (A policy which contains a cancellation provision may add, at the end of the above provision: “subject to the right of the insurer to cancel in accordance with the cancellation provision hereof.” A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision: “Unless not less than ten days prior to the premium due date, the insurer has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notices of its intention not to renew this policy beyond the period for which the premium has been accepted.”). History —Ins. Code § 16.070.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1608/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1608 - Reinstatement
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1608 - Reinstatement
There shall be a provision as follows: Reinstatement.— If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any producer duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy: provided, however, that if the insurer or such producer requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the forty-fifth day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty days prior to the date of reinstatement. (The last sentence of the above provision may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date of issue). History —Ins. Code § 16.080; Jan. 19, 2006, No. 10, § 9, eff. 120 days after Jan. 19, 2006.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1609/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1609 - Notice of claim
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1609 - Notice of claim
There shall be a provision as follows: Written notice of claim must be given to the insurer within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at ____ (insert the location of such office as the insurer may designate for the purpose), to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer. (In a policy providing a loss-of-time benefit which may be payable for at least two years, an insurer may at its option insert the following between the first and second sentences of the above provision: “Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, he shall, at least once in every six months after having given notice of claim, give to the insurer notice of continuance of said disability, except in the event of legal incapacity. The period of six months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured’s right to any indemnity which would otherwise have accrued during the period of six months preceding the date on which such notice is actually given.”) History —Ins. Code § 16.090.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1610/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1610 - Claim forms
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1610 - Claim forms
There shall be a provision as follows: Claim forms.— The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice, the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, and the character and extent of the loss for which claim is made. History —Ins. Code § 16.100.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1611/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1611 - Proofs of loss
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1611 - Proofs of loss
There shall be a provision as follows: Proofs of loss.— Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required. History —Ins. Code § 16.110.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1612/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1612 - Time of payment of claims
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1612 - Time of payment of claims
There shall be a provision as follows: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid ____ (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid immediately upon receipt of due written proof. History —Ins. Code § 16.120.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1613/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1613 - Payment of claims
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1613 - Payment of claims
(1) There shall be a provision as follows: Payment of claims.— Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payments which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured’s death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured. (2) The following provisions, or either of them, may be included with the foregoing provision at the option of the insurer: “If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to give a valid release, the insurer may pay such indemnity, up to an amount not exceeding $____ (insert an amount which shall not exceed $1,000), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of such payment.” “Subject to any written direction of the insured in the application or otherwise, all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical, or surgical services may, at the insurer’s option and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person.” History —Ins. Code § 16.130.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1614/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1614 - Physical examinations and autopsy
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1614 - Physical examinations and autopsy
There shall be a provision as follows: Physical examinations and autopsy.— The insurer, at its own expense, shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law. History —Ins. Code § 16.140.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1615/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1615 - Civil actions
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1615 - Civil actions
There shall be a provision as follows: Civil action.— No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the time written proof of loss is required to be furnished. History —Ins. Code § 16.150.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1616/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1616 - Change of beneficiary
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1616 - Change of beneficiary
There shall be a provision as follows: Change of beneficiary.— Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to the surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy. (The first clause of this provision, relating to the irrevocable designation of beneficiary, may be omitted at the insurer’s option.) History —Ins. Code § 16.160.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1617/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1617 - Optional standard provisions
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1617 - Optional standard provisions
Except as provided in § 1113 of this title, no such policy delivered or issued for delivery to any person in Puerto Rico may contain provisions respecting the matters set forth in §§ 1618–1628 of this title, inclusive, unless such provisions are in the words in which the same appear in the applicable section; except, that the insurer may, at its option, use in lieu of any such provision a corresponding provision of different wording approved by the Commissioner which is not less favorable in any respect to the insured or the beneficiary. Any such provision contained in the policy shall be preceded individually by the appropriate caption or, at the insurer’s option, by such appropriate individual or group caption or subcaption as the Commissioner may approve. History —Ins. Code § 16.170, renumbered as § 16.200 and amended on Mar. 18, 2008, No. 31, § 5, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1618/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1618 - Change of occupation
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1618 - Change of occupation
There may be a provision as follows: Change of occupation.— If the insured be injured or contracts sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer shall pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurer for such more hazardous occupation. If the insured changes his occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess pro rata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer prior to the occurrence of the loss for which the insurer is liable or prior to date of proof of change in occupation, with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation. History —Ins. Code § 16.180, renumbered as § 16.210 on Mar. 18, 2008, No. 31, § 1, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1619/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1619 - Misstatement of age
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1619 - Misstatement of age
There may be a provision as follows: Misstatement of age.— If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age. History —Ins. Code § 16.190, renumbered as § 16.220 on Mar. 18, 2008, No. 31, § 1, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1620/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1620 - Other insurance in this insurer
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1620 - Other insurance in this insurer
There may be a provision as follows: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for ____ (insert type of coverage or coverages) in excess of $ ____ (insert maximum limit of indemnity or indemnities), the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to his estate. Or, in lieu thereof: Insurance effective at any one time on the insured under a like policy or policies in this insurer is limited to the one such policy elected by the insured, his beneficiary or his estate, as the case may be, and the insurer will return all premiums paid for all other such policies. History —Ins. Code § 16.200, renumbered as § 16.230 on Mar. 18, 2008, No. 31, § 1, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1621/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1621 - Insurance with other insurers (provision of service or expense basis)
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1621 - Insurance with other insurers (provision of service or expense basis)
(1) There may be a provision as follows: Insurance with other insurers.— If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the “like amount” of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage. (2) If the foregoing policy provision is included in a policy which also contains the policy provision set out in § 1622 of this title, there shall be added to the caption of the foregoing provision the phrase “... EXPENSE INCURRED BENEFITS”. The insurer may, at its option, include in this provision a definition of “other valid coverage”, approved as to form by the Commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of Puerto Rico or any state of the United States or any province of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the Commissioner. In the absence of such definition, such term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workman’s compensation or employer’s liability statute), whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the insurer has had notice. In applying the foregoing policy provision, no third party liability coverage shall be included as “other valid coverage”. History —Ins. Code § 16.210, renumbered as § 16.170 and amended on Mar. 18, 2008, No. 31, § 6, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1622/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1622 - Insurance with other insurers
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1622 - Insurance with other insurers
(1) There may be a provision as follows: Insurance with other insurers.— If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurer had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined. (2) If the foregoing policy provision is included in a policy which also contains the policy provision set out in § 1621 of this title, there shall be added to the caption of the foregoing provision the phrase “... OTHER BENEFITS”. The insurer may, at its option, include in this provision a definition of “other valid coverage”, approved as to form by the Commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of Puerto Rico or any state of the United States or any province of Canada, and to any other coverage the inclusion of which may be approved by the Commissioner. In the absence of such definition, such term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workmen’s compensation or employer’s liability statute), whether provided by a governmental agency or otherwise, shall in all cases be deemed to be “other valid coverage” of which the insurer has had notice. In applying the foregoing policy provision, no third party liability coverage shall be included as “other valid coverage”. History —Ins. Code § 16.220, renumbered as § 16.180 and amended on Mar. 18, 2008, No. 31, § 7, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1623/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1623 - Relation of earnings to insurance
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1623 - Relation of earnings to insurance
(a) There may be a provision as follows: Relation of earnings to insurance.— If the total monthly amount of loss-of-time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced, or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earning of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of two hundred dollars or the sum of the monthly benefits specified in such coverages, whichever is the lesser, nor shall it operate to reduce benefits other than those payable for loss of time. (b) The foregoing policy provision may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) Until at least age 50, or (2) in the case of a policy issued after age 44, for at least five years from its date of issue. The insurer may, at its option, include in this provision a definition of “valid loss of time coverage,” approved as to form by the Commissioner, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of Puerto Rico or any state of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the Commissioner, or any combination of such coverages. In the absence of such definition, such term shall not include any coverage provided for such insured pursuant to any compulsory benefit statute (including any workmen’s compensation or employer’s liability statute), or benefits provided by union welfare plans or by employer or employee benefit organizations. History —Ins. Code § 16.230, renumbered as § 16.190 on Mar. 18, 2008, No. 31, § 1, eff. 90 days after Mar. 18, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1624/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1624 - Unpaid premium
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1624 - Unpaid premium
There may be a provision as follows: Unpaid premiums.— Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom. History —Ins. Code § 16.240.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1625/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1625 - Cancellation
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1625 - Cancellation
There may be a provision as follows: Cancellation.— The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to his last address as shown by the records of the insurer, stating when, not less than ten days thereafter, such cancellation shall be effective; and after the policy has been continued beyond its original term, the insured may cancel this policy at any time by written notice delivered or mailed to the insurer, effective upon receipt or on such later date as may be specified in such notice. In the event of cancellation, the insurer will return promptly the unearned portion of any premium paid. If the insured cancels, the earned premium shall be computed by the use of the short-rate table last filed with the state official having supervision of insurance in the state where the insured resided when the policy was issued. If the insurer cancels, the earned premium shall be computed pro rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation. History —Ins. Code § 16.250.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1626/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1626 - Conformity with state statutes
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1626 - Conformity with state statutes
There may be a provision as follows: Conformity with state statutes.— Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes. History —Ins. Code § 16.260.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1627/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1627 - Illegal occupation
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1627 - Illegal occupation
There may be a provision as follows: Illegal occupation.— The insurer shall not be liable for any loss to which a contributing cause was the insured’s commission of or attempt to commit a felony or to which a contributing cause was the insured’s being engaged in an illegal occupation. History —Ins. Code § 16.270.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1628/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1628 - Intoxicants and narcotics
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1628 - Intoxicants and narcotics
There may be a provision as follows: Intoxicants and narcotics.— The insurer shall not be liable for any loss sustained or contracted in consequence of the insured’s being intoxicated or under the influence of any narcotic unless administered on medical prescription. History —Ins. Code § 16.280.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1629/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1629 - Order of certain policy provisions
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1629 - Order of certain policy provisions
The provisions which are the subject of §§ 1605–1628 of this title, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the insurer’s option, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued. History —Ins. Code § 16.290.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1630/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1630 - Third party ownership
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1630 - Third party ownership
The word “insured,” as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein. History —Ins. Code § 16.300.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1631/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1631 - Requirements of other jurisdictions
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1631 - Requirements of other jurisdictions
(1) Any policy of a foreign insurer, when delivered or issued for delivery to any person in Puerto Rico, may contain any provision which is not less favorable to the insured or to the beneficiary than the provisions of this chapter and which is prescribed or required by the laws of the state or country under which the insurer is organized. (2) Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such other state or country. History —Ins. Code § 16.310.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1632/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1632 - Age limit
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1632 - Age limit
If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer, or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy. History —Ins. Code § 16.320.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1633/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1633 - Family expenses disability insurance
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1633 - Family expenses disability insurance
Family expenses disability insurance, is that provided under a policy issued to an insured member of the family, who will be deemed as the policyholder, covering any two or more eligible members of a family, including husband, wife, dependent children or any children of a specified age which shall not exceed nineteen years, and any other person dependent upon the policy holder; Provided, That the term “children” includes foster children. For the purposes of this section, “foster children” shall be minor children that, although they are not natural or adopted children of the insured principal, have lived since infancy under the same roof with the latter, in a normal parent/child relationship and that are, and shall continue to be, totally dependent on the family of said insured to receive support, as this term is defined in § 561 of Title 31. Any authorized disability insurer may issue family expenses disability insurance. History —Ins. Code § 16.330; Aug. 31, 2000, No. 251, § 1.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1634/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1634 - Franchise plan disability insurance
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1634 - Franchise plan disability insurance
(1) Disability insurance on a franchise plan is that issued to: (a) Five or more employees of a common employer, or (b) ten or more members of any bona fide association or labor union, which association or union was formed and exists for purposes other than that of obtaining insurance, and under which such employees or members, with or without their dependents, are issued individual policies which may vary as to amounts and kinds of coverage as applied for, under an arrangement whereby the premiums on the policies are to be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association, or by some designated employee or officer of the association acting on behalf of the employer or association members. (2) The term “employer” includes also the employer’s officers and the employer or partners if the employer is an individual or a partnership. (3) An insurer may charge different rates, provide different benefits, or employ different underwriting procedure for individuals insured under a franchise plan, if such rates, benefits, or procedures as used do not unfairly discriminate as between individuals or plans having substantially like insuring, risk, and exposure factors, or expense elements, and do not unfairly discriminate as between individuals insured under franchise plans and individuals otherwise insured under similar policies, taking into consideration the insuring, risk and exposure factors, and expense elements. History —Ins. Code § 16.340.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1635/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1635 - Incontestability after reinstatement
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1635 - Incontestability after reinstatement
The reinstatement of any policy of noncancellable disability insurance, or of any disability policy containing a provision for incontestability, or a provision of similar nature, delivered or issued for delivery in Puerto Rico while this Code is in effect, shall be contestable only on account of fraud or misrepresentation of facts material to the reinstatement and only for the same period following reinstatement as is provided in the policy with respect to the contestability thereof after the original issuance of the policy. History —Ins. Code § 16.350.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-16/1636/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 16 - Disability Insurance (§§ 1601 — 1636)›§ 1636 - Effective date of standard provision and certain other sections—Two (2)-year periods
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 16 - Disability Insurance (§§ 1601 — 1636) › § 1636 - Effective date of standard provision and certain other sections—Two (2)-year periods
A policy, rider or endorsement, which could have been lawfully used or delivered or issued for delivery to any person in Puerto Rico immediately before the effective date of this Code, may be used or delivered or issued for delivery to any such person within two (2) years after such date. History —Ins. Code § 16.360.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1701/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1702/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1703/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1704/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1705/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1706/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1707/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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)›§ 1707 - Conversion provision
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) › § 1707 - Conversion provision
(1) A provision stipulating that if the insurance upon a person covered by the policy ceases due to the termination of his employment or condition as member of a class or classes eligible for coverage under the policy, said person is entitled to an individual disability policy issued by the insurer, without evidence of insurability; Provided, That the written application for the policy shall be made, and the first premium shall be paid to the insurer, on or before 31 days after such termination; and, Provided, further, That: (a) The individual policy shall be at the option of such person, in whatever form is currently issued at the time by the insurer at the age and for the benefits applied for. (b) The premium on the individual policy shall be in accordance with the insurer’s rates then in force applicable to the form and benefits of the individual policy, pursuant to the class of risk to which said person may then belong and to his age attained on the effective date of the individual policy. The health condition at the time of the person’s conversion shall not be an acceptable basis for the classification of the risk. (c) The individual policy shall also cover the spouse and/or dependent children of the person insured if they were covered on the termination date of the group insurance. At the option of the insurer, a separate individual policy may be issued to cover the wife and/or dependent children. (d) The individual policy shall be effective upon termination of the group policy. (e) The insurer shall not be bound to issue an individual policy covering a person entitled to receive similar benefits under any insurance coverage or under the Medicare program of the Federal Social Security Act, as subsequently amended, if said benefits, jointly with those provided under the individual policy shall result in an overinsurance according to the insurer’s standards. (2) A provision in the sense that if a group policy ceases or is amended in such a manner as to terminate the insurance of any category of insureds, every person included in said group policy on the date of said cessation whose insurance terminates and who has been so insured for at least three years before the date of such cessation, shall be entitled to an individual disability insurance policy issued by the insurer, subject to the same conditions and limitations provided by subsection (1) of this section, except that the group policy may provide that the benefits of said individual policy shall not be less than the benefits of the group policy. (3) Subject to the conditions and limitations provided by subsection (1) of this section, the conversion privilege shall be granted: (a) To the spouse and/or dependent children of the insured person, whose coverage under the group policy ceases due to the death of such person. (b) To the spouse and/or dependent children of the person, whose coverage ceases because they do not qualify as members of the family under the group policy, even though the coverage of the insured person continues under the group policy. (4) A provision stipulating that if a person insured under the group policy sustains a loss covered under the individual policy described in subsection (1) of this section during the period within which he would have qualified to be issued said individual policy, and before said individual policy would have become effective, the benefits which he would be entitled to under said individual policy shall be payable as a claim under the group policy, even though an individual policy has not been applied for, nor has the first premium been paid. (5) If any individual insured under a group policy issued in Puerto Rico hereafter acquires the right to obtain an individual policy under the terms of the group policy without having insurability evidence, subject to apply for and pay the first premium within the period specified in the policy, and if that individual is not advised of the existence of that right at least 15 days before the expiration date of said period, then in such case the individual shall have an additional term during which he may exercise his right, but this in no way implies the continuation of a policy beyond the term provided therein. The additional term shall expire 15 days after the individual has been advised, but in no case shall it be extended over 60 days after the date of expiration provided in the policy. Written notice given to the individual or mailed by the policyholder to his last known address or mailed by the insurer to the last known address of the individual as underwritten by the policyholder, shall be considered notice to the effects of this paragraph. If an additional term is granted to exercise the right to convert, as herein provided, and if the written application for said individual policy together with the first premium is filed during the additional term, the effectiveness of the individual policy shall be the termination of the insurance under the group policy. (6) This section shall apply only to group policies providing medical, surgical or hospital benefits or any combination of these benefits. Provided, That if said policy contains other benefits, the conversion privilege shall always be available for the benefits above described. History —Ins. Code, added as § 17.070 on June 30, 1975, No. 115, p. 345, § 2; June 24, 1977, No. 112, p. 281, § 4, eff. 6 months after June 24, 1977.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-17/1708/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1813/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1814/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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)›§ 1814 - Definitions
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) › § 1814 - Definitions
(1) Creditor.— Means the lender or the vendor or lessor of goods, or the person who renders services or grants rights or privileges, for which payment is agreed upon through a credit transaction or any successor of the rights, titles or interest of said lenders, vendors, or lessors or persons and any affiliate, associate or subsidiary thereof, or any director, official, or employee of any of them or any other person who is otherwise related to them. (2) Insurer.— Means an insurer who is authorized to underwrite life insurance or physical disability insurance in Puerto Rico. (3) Identifiable charge.— Means a consumer credit insurance charge which is only made to debtors who have such insurance and includes any insurance charge which is stated in the credit instrument provided to the debtor. Any difference in the financing, interest, service or other similar service provided to the debtors who are in the same circumstances except for the insured or uninsured condition of the debtor or the property used as security for the credit transaction, shall be considered as an “identifiable charge.” (4) Compensation.— Means commissions, dividends, retrospective credit rates, service fees, concessions, or reimbursements for expenses, gifts, provision of equipment or fixtures, facilities, goods or services, or any other means of remuneration that is the direct result of the sale of consumer credit insurance. (5) Gross debt.— Means the total remaining payments that a debtor owes a creditor. (6) Net debt.— Means the amount required to liquidate the remaining debt on a specific date, from that date, through a single global payment, excluding all unearned interest and all unearned financing charges. (7) Debtor.— Means a person who borrows money or who purchases or leases assets, or receives services, property, rights or privileges for which payment is agreed upon through a credit transaction. (8) Rotating credit account and credit card.— Means the credit extended by a creditor under an agreement in which the creditor has a reasonable expectation that there will be repeated transactions; the creditor imposes a [finance] charge from time to time on an outstanding balance; and the amount of credit that can be extended to the debtor during the term of the agreement, up to the limit established by the creditor, is generally available in the measure that any outstanding balance is paid. (9) Consumer credit insurance.— Is the generic name that refers to life credit insurance, disability credit insurance or unemployment credit insurance. (10) Unemployment credit insurance.— Means insurance on a debtor to provide indemnity for payments pursuant to a loan or other credit transaction that falls due while the debtor is involuntarily unemployed as defined in the policy. (11) Disability credit insurance.— Means insurance on a debtor to provide indemnity for payments pursuant to a loan or other credit transaction that falls due while the debtor is disabled as defined in the policy. (12) Credit life insurance.— Means insurance on the life of a debtor pursuant to or in relation to a specific loan or other credit transaction which provides for the payment of the debt, wholly or partially, on the death of the insured debtor. (13) Credit transaction.— Means any transaction under whose terms there is an agreement to pay borrowed money or to pay for goods or services sold or leased, on one or several future dates. History —Ins. Code, added as § 18.030 on Jan. 9, 1999, No. 15, § 2, eff. 90 days after Jan. 9, 1999.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1815/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1816/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1817/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1818/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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)›§ 1818 - General provisions that apply to consumer credit insurance
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) › § 1818 - General provisions that apply to consumer credit insurance
The following provisions shall apply to all consumer credit insurance coverage: (1) For credit insurance offered to and selected by a debtor prior [to] or along with the credit transaction related to the insurance, the term of the insurance shall commence on the date the credit transaction is executed, subject to acceptance by the insurer. (2) For credit insurance coverage offered to and selected by a debtor on a date subsequent to the date the credit transaction related to the insurance is executed, the insurance shall commence on a date not prior to the date the selection was made by the debtor, nor later than thirty (30) days after said date, subject to acceptance by the insurer. (3) Notwithstanding the provisions of subsections (1) and (2) of this section, when a group insurance policy provides coverage with regard to existing debts as of the effective date of the policy, the insurance policy related to said debts shall not commence prior to the effective date of the group insurance policy. (4) In no case shall the debtor be charged for insurance, nor shall the creditor or the insurer withhold premiums for periods prior to the effective date of the policy to which said charge is related. (5) The term of any consumer credit insurance shall not extend beyond the termination date specified in the policy. The termination date of the insurance may be prior to, simultaneous with, or subsequent to the expiration date of the debt to which it is related, subject to all other provisions of this chapter. (6) The term of any consumer credit insurance shall not extend beyond fifteen (15) days from the expiration date of the debt, except when the same is extended without any additional cost to the debtor or except when it is extended pursuant to a written agreement signed by the debtor in relation to a credit transaction or debt renewal, refinancing or consolidation. If the debt is paid in full through its renewal, refinancing or consolidation prior to the date scheduled for the termination of the insurance, any insurance in effect must have terminated before any new insurance may be subscribed in relation to the renewed, refinanced or consolidated debt. (7) In any case that the insurance is terminated prior to its scheduled termination date, an appropriate refund or credit for any unearned insurance charge that the debtor has paid for periods subsequent to said termination, shall be made to the debtor, except that no such refund shall be made nor credit granted for unused insurance, if the insurance is terminated as a result of the insurer’s compliance with his/her obligation under the contract. (8) An insured debtor may terminate the consumer credit insurance at any time by giving advance notice to the insurer. The individual policy or certificate of group insurance may require for said notice to be given in writing, or for the insured to turn in the policy or certificate, or both actions. (9) In those cases of consumer credit insurance offered through group insurance policies which, in the processing thereof the creditor incurs administrative expenses (for reason of the handling thereof), it shall be allowed for the insurer to pay to the particular creditor, upon the approval of the Commissioner, a compensation for said administrative expenses, which shall not exceed twenty percent (20%) of the corresponding premium. The preceding provision shall not be construed as allowing the creditor to undertake any processing for which an insurance producer, solicitor or adjuster license is required, or as allowing for said compensation to be paid to a creditor for processing insurance which is not comprised within the scope of this chapter. Every presentation made to the Commissioner pursuant to this subsection shall be subject to requirements similar to those established in subsections (2) and (3) of § 1206 of this title regarding the registration of rates. (10) No creditor shall require the applicant for credit to acquire consumer credit insurance, as defined in this chapter, as a condition to grant credit, or if said insurance is acquired, that it be provided through a specific agent or by a specific insurer. History —Ins. Code, added as § 18.070 on Jan. 9, 1999, No. 15, § 2; July 23, 1999, No. 161, § 2; Jan. 19, 2006, No. 10, § 9; Feb. 25, 2008, No. 19, § 3, eff. 90 days after Feb. 25, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1819/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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)›§ 1819 - Disclosure to debtors and provisions of insurance policies and certificates
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) › § 1819 - Disclosure to debtors and provisions of insurance policies and certificates
(1) Before a debtor chooses to purchase consumer credit insurance, with regard to a credit transaction, the insurer who provides this insurance shall furnish the following information, in writing, to the debtor: (a) That the purchase of consumer credit insurance is optional and not a condition to obtain approval of credit. (b) If more than one kind of consumer credit insurance is being offered to the consumer, whether the debtor can purchase separate coverage or only as a package. (c) Eligibility conditions. (d) That if the consumer has another policy that covers the risk, it is possible that he/she will not need the insurance that is being offered. (e) That, within thirty (30) days after receiving the individual policy or the group insurance certificate, the debtor may cancel the coverage, and be entitled to receive reimbursement or full credit for the total unearned premium. After said term has elapsed, the debtor may cancel the policy or certificate at any time during the term of the credit transaction and receive full reimbursement or credit for the total unearned premium. (f) A brief description of the coverage, including a description of the quality, term, any exception, limitation or exclusion, the insured event, any waiting period or exclusion period, any deductible, any applicable provision for a release from the payment of premiums, to whom the benefits shall be paid, and the premium rate that applies to each coverage or to all the coverages if it is a joint coverage policy. (g) If the premium is financed in the credit transaction, it shall be subject to [finance] charges equal to those that apply to said transaction. (2) The disclosure required by subsection (1) of this section shall be provided by the insurer involved as follows: (a) With regard to consumer credit insurance offered concurrently with the extension of credit or offered through direct correspondence, the disclosure shall be made clearly and conspicuously, in writing. (b) With regard to consumer credit insurance offered subsequently to the extension of credit or which is not offered through direct correspondence, the disclosure may be verbal; provided, that the written disclosure is provided to the debtor by the insurer no later than ten (10) days after the offer, or on the date on which any other written information is provided to the debtor, whichever of the two dates occurs first. (3) All consumer credit insurance shall be evidenced by an individual policy or a group insurance certificate, which shall be remitted to the debtor. (4) The individual policy or group insurance certificate shall include the following, in addition to any other provisions required by law: (a) The name and address of the insurer’s home office. (b) The name or names of the debtor or debtors. (c) The premium that the debtor shall pay for each kind of coverage, separately, or for every coverage if it is a joint coverage policy, except that in the case of rotating credit accounts and credit card plans, the type and base rate shall be specified. (d) A full description of the coverage or coverages including the amount and term thereof as well as any exception, limitation or exclusion. (e) A statement to the effect that benefits will be paid to the creditor to reduce or extinguish the unpaid debt and that when the amount of the insurance benefit exceeds said debt, any excess shall be paid to a beneficiary who is not the creditor appointed by the debtor, or to the debtor’s estate. (f) If the term of the insurance is less than the term of the credit transaction, a statement to such effect on the cover of the individual policy, or the group insurance certificate written in boldface of a size that is not less than ten (10) points. (5) If the individual policy or the group insurance certificate is not given to the debtor upon incurring the debt, or at any other time which the debtor chooses to buy insurance coverage, then a copy of the application for the policy and a notice of the proposed insurance signed by the debtor shall be given to the latter at that time, which shall establish the following: (a) Name and address of the insurer’s home office. (b) Name or names of the debtor or debtors. (c) Premium rate or the amount that the debtor shall pay for the insurance. (d) Amount or term of the insurance. (e) A brief description of the coverage provided. The copy of the application or notice of the proposed insurance shall refer exclusively to the insurance coverage and shall be separate and distinct from any other document related to the credit transaction. Upon acceptance of the application by the insurer and within thirty (30) days from the date the debt is incurred or the purchase of insurance coverage is chosen, the insurer shall have the individual policy or group insurance certificate sent to the debtor. The application or notice of the proposed insurance shall establish that if it is accepted by the insurer the insurance shall be effective as provided in § 1818 of this title. (6) The application, the notice of the proposed insurance, or the insurance certificate may be used to meet all the requirements of subsections (1) and (4) of this section, provided they contain all the information required therein. (7) The debtor shall have thirty (30) days from the date he/she receives the individual policy or the group insurance certificate to review the coverage purchased. The debtor, at any time during said period can communicate with the creditor or the corresponding insurer and request that the coverage be cancelled. The individual policy or group insurance certificate may require that the petition for cancellation be made in writing or that the policy or certificate be returned, or both actions. (8) If the risk is not accepted, all premiums paid shall be returned or credited to the person entitled thereto within thirty (30) days subsequent to the application for insurance. (9) For the purposes of subsection (5) of this section, an individual policy or group insurance certificate that is sent together with a rotating account and credit card plan, or any consumer credit insurance requested by the debtor subsequent to the effectiveness of the debt, shall be understood to have been delivered at the time the debt was incurred, or at the time the debtor chose to purchase the insurance, if the delivery occurs within thirty (30) days from the effectiveness of the policy. (10) Any individual policy or group insurance certificate that is delivered together with the rotating account and credit card plan shall continue in effect from its effective date while said rotating account and credit card plan persists, unless the individual policy or group insurance certificate is terminated according to its terms, on a prior date. History —Ins. Code, added as § 18.080 on Jan. 9, 1999, No. 15, § 2; Feb. 25, 2008, No. 19, § 4, eff. 90 days after Feb. 25, 2008.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1820/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1821/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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)›§ 1821 - Premiums and reimbursements
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) › § 1821 - Premiums and reimbursements
(1) Each insurer that issues consumer credit insurance shall register the lists of the premium rates to be used in relation to said insurance with the Commissioner. The insurers may revise said lists from time to time, and in said case, shall be filed in the Office of the Commissioner. No insurer shall issue any consumer credit insurance coverage whatsoever for which the premium rate exceeds the rate registered before the Commissioner and which is in effect at that time. The Commissioner shall promulgate the regulations needed for the premium rates to be reasonable in relation to the benefits provided. Upon evaluating any submission pursuant to this chapter, the Commissioner shall take the following into account: (a) Present and expected loss experience. (b) General and administrative expenses. (c) Payments for claims and loss adjustment expenses. (d) Reasonable compensation to the creditor, as provided by § 1818(9) of this title. (e) Investment income. (f) Method for the payment of premiums. (g) Other acquisition, reserve, taxes, license or apportionment expenses. (h) Reasonable profit for insurer. (i) Other relevant information consistent with generally accepted actuarial methods. (2) Each individual policy or group insurance certificate shall provide for a reimbursement of premiums in the event that the insurance terminates before its normal expiration date. The unused premiums shall be promptly paid or credited to the person entitled thereto; Provided, however, That reimbursements for amounts less than an amount which is established by the Commissioner to such effect, shall not be subject to reimbursement. Any reimbursement formula that an insurer wishes to use, shall provide for reimbursements that are as favorable for the debtor, that shall be at least equal to the cost of a coverage offered by said insurer which commences on said termination date until the normal expiration date of the cancelled policy or group insurance certificate, which premium is figured according to the rates in effect on the date that the policy or group insurance certificate were originally issued. Any formula used to determine the reimbursement of premiums shall be submitted to, and approved by the Commissioner, provided it meets the above-established requirements. (3) If a debtor applies for consumer credit insurance for which he/she has made a payment or a charge has been made, and the individual policy or the group insurance certificate is not issued, the creditor shall be bound to give written notice thereof to the debtor and shall promptly give credit or the corresponding reimbursement to the person entitled thereto within fifteen (15) days of having requested it, but in no case after ninety (90) days [from] having made the payment or charge. (4) The amount charged to a debtor for any consumer credit insurance shall never be greater than the premiums charged by the insurer, as figured at the time the charge to the debtor is determined. (5) In the event of a premature termination of any consumer credit insurance, in which compensation has been paid to the creditor pursuant to § 1818(9) of this title, for administrative expenses incurred by him/her when offering the policy to the debtors, the creditor shall reimburse that part of the compensation received, equal to the percent of the premium that must be returned to the debtor as a result of said cancellation. History —Ins. Code, added as § 18.100 on Jan. 9, 1999, No. 15, § 2, eff. 90 days after Jan. 9, 1999.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1822/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-18/1823/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1901/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1902/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1903/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1903a/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1904/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 19 - Health Services Organizations (§§ 1901 — 1928)›§ 1904 - Issuance of certificate of authority
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1904 - Issuance of certificate of authority
(1) (a) Upon receiving an application for the issuance of a certificate of authority, the Commissioner shall immediately send to the Secretary of Health a copy of said application and of the accompanying documents. (b) In connection with the health care services to be provided by the applicant for a certificate of authority, the Secretary of Health shall determine whether: (i) It has the capacity, the personnel and adequate facilities to insure that the health care services shall be rendered in such a way as to guarantee the availability, accessibility and continuity of the services. (ii) It meets the requirements established in the regulations the Secretary of Health may promulgate or may have promulgated, to insure the continuous quality of the health care program as to its procedures and results. (iii) It has established a procedure in accordance with the regulations of the Secretary of Health to develop, compile, evaluate and report statistics related to the cost of operations, the pattern of utilization of the services, the availability and accessibility of the services, and any other related matter that the Secretary of Health may reasonably require. (iv) Every applicant shall comply with the provisions of §§ 331–333p of Title 24, which shall be informed by the Secretary of Health to the Commissioner. (c) Within thirty (30) days after receiving the application for the issuance of a certificate of authority, the Secretary of Health shall certify to the Commissioner if the health services organization meets the requirements of clause (b) of this subsection. If the Secretary of Health certifies that the health services organization does not meet the requirements, he shall specify in what aspects the organization is deficient. (2) The Commissioner may issue or deny a certificate of authority to any person who files an application as provided in § 1903 of this title within ninety (90) days after receiving the certification from the Secretary of Health. The issuance of the certificate of authority shall be granted subject to the payment of the application fees established in section 19.230, provided that the Commissioner determines that the applicant meets the following requirements: (a) That the persons responsible for the management of the business of the health services organization be competent, reliable and of good reputation. (b) That the Secretary of Health certify pursuant to the provisions of subsection (1) that the plan of operations proposed by the health services organization meets the requirements established in subsection (1)(b). (c) That their health care plans provide adequate mechanisms through which the health services organization will provide the basic health care services directly to the subscribers or through providers contracted directly thereby, or through insurance or other means which has previously been approved by the Insurance Commissioner by regulations. (d) That the health services organization has financial stability. In making this finding the Commissioner may consider: (i) The financial solidness of the health care plan as regards the services it will provide and the fees it will fix for said services. (ii) Adequacy of operating capital. (iii) Any agreement with any other health services organization to insure the payment of the cost of the health services or the provisions for the automatic application of a substitute coverage in the event that the health services organization does not fulfill its obligations with the subscriber. (iv) Any agreement with the providers to offer health care services; and (v) Any bond or deposit in cash or securities submitted pursuant to the provision of § 1914 of this title as guarantee that the obligations will be performed. (e) That the subscribers be granted the opportunity to participate in the direction and operation of the organization pursuant to the provision in § 1906 of this title. (f) That the proposed operating method not be contrary to the public interest, as shown in the information submitted to the Commissioner as provided in § 1903 of this title, or by independent investigations ordered by the Commissioner; and (g) That any of the deficiencies pointed out by the Secretary of Health has been corrected. (3) A certificate of authority may be denied only after having complied with the requirements established in § 1921 of this title. History —Ins. Code, added as § 19.040 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 3.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1905/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1906/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1907/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1908/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 1 - Insurance Generally (§§ 101 — 4513)›Chapter 19 - Health Services Organizations (§§ 1901 — 1928)›§ 1908 - Evidence of coverage and health services fees
2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 19 - Health Services Organizations (§§ 1901 — 1928) › § 1908 - Evidence of coverage and health services fees
(1) (a) Each subscriber is entitled to an evidence of coverage. If the subscriber obtains coverage through an insurance policy, the insurer shall issue the evidence of coverage. Otherwise, the health services organization shall issue the evidence of coverage. (b) No form of evidence of coverage or any amendment thereto shall be issued or delivered to any person in Puerto Rico unless it has first been presented to the Commissioner and approved by him. Each such presentation shall be made at least sixty (60) days prior to the issuance, delivery or use. Upon expiration of said sixty (60) days, counting from the date such presentations are received in the Commissioner’s Office, the form presented shall be deemed approved unless previously approved affirmatively or disapproved by order of the Commissioner. The approval of a form by the Commissioner shall constitute a waiver of the remaining term of the waiting period. The Commissioner may extend the period within which he may affirmatively approve or disapprove said form for not more than sixty (60) days notifying said extension before the expiration of the initial sixty (60) day period; Provided, That in case the Commissioner determines that the information furnished in the presentation is insufficient, or the forms presented do not meet any of the provisions of this title or its regulations, and therefore, requests additional information for the pertinent amendments, the term that elapses from the time the Commissioner advises of said requirement until the information or amendments requested are received by the Commissioner shall not be counted in the computation of the above terms. (c) The coverage evidence shall contain: (i) Provisions which are not uncertain, unjust, discriminatory, deceptive, disloyal, or which lead to misrepresentations, as defined in § 1915(1) of this title. (ii) A complete statement of the contract, or a summary, if it concerns a certificate of: (A) Health care services, insurance and other benefits, if any, to which the subscriber is entitled under a health care plan. (B) Any limitation on the services, kinds of services, benefits or kinds of benefits, to be offered, including any deductible or co-payments. (C) Where and in what form the information is available on how to obtain the services. (D) With relation to individual contracts, the cost, if any, that the subscriber is bound to pay for the health care services and the benefits for compensation or services. With relation to the group plans certificates, an indication of whether it is a contributing or noncontributing plan; and (E) a clear and simple description of the method used by the health services organization for the complaints of the subscribers. Any subsequent change may be evidenced in a separate document which shall be sent to the subscribers. (d) A copy of the coverage evidence form to be used in Puerto Rico, and any amendment thereto, shall be filed and approved as required in clause (b) of this subsection unless they are subject to the approval of the Commissioner under the laws regulating the health insurance, in which case the provisions for the filing and approval of said legislation shall be applicable. Insofar as said provisions do not apply to the requirements of clause (c), said requirements shall apply. (2) (a) Every health services organization shall register the rates to be used in any health care plan with the Commissioner before applying them in Puerto Rico. No registration shall be effective until sixty (60) days after the date of its presentation in the Commissioner’s office, unless they are affirmatively approved by him. Said period may be extended by the Commissioner for an additional term which shall not exceed sixty (60) days, if the Commissioner advises the presenter thereof within said waiting period. Provided, That in case the Commissioner determines that the information that was furnished in the presentation is insufficient and therefore, would require additional information, the period of time from the moment the Commissioner informs of such requirement until the information requested is received by him shall not count in the computation of the indicated terms. (b) Said rates shall be established in accordance with the actuarial principles for several categories of subscribers; Provided, That the fees applicable to a subscriber shall not be determined individually on the basis of health condition. The rates shall not be excessive, inadequate or discriminatory. A certificate by a qualified actuary on the adequacy of the rates, based on reasonable assumption, shall accompany the filing of the rates with the proper information in support of the petition. (3) The Commissioner shall, within a reasonable time, approve any form if the requirements of subsection (1) are met; and any rate, if the requirements of subsection (2) are met. If the Commissioner disapproves the filing, he shall so notify the applicant, specifying the grounds for his disapproval. Within thirty (30) days from the date of disapproval, the person affected may request a hearing as provided in § 222 of this title. After the lapse of sixty (60) days from the filing of the form or the rate, they shall be considered approved unless the Commissioner has approved or disapproved them affirmatively through order to that effect. (4) At any time after the applicable review period provided in subsections (1)(b) and (2)(a) of this section, the Commissioner may call a hearing to determine whether the registration meets the established requirements. It shall give notice, in writing, to the presenting health services organization, at least ten (10) days prior to the hearing. If after said hearing the Commissioner determines that the registration does not meet the requirements in this section, he shall issue an order specifying the reasons on which he grounds his decision and indicating the date, within a subsequent reasonable period, on which the registration shall be deemed to be ineffective. Said order shall not affect any contract granted or ratified prior to the expiration of the period stipulated in the order. (5) In order to determine whether to approve or disapprove a form or rate filed as provided in this section, the Commissioner may request that there be submitted any relevant information he may deem pertinent. History —Ins. Code, added as § 19.080 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 6.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1909/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1910/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1911/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1912/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1913/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1914/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1914a/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1914b/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1915/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1916/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1917/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1918/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1919/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1920/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1921/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1923/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1924/
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Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1925/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1926/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1927/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-19/1928/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-20/2001/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-20/2002/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-20/2003/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-20/2003a/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-1/chapter-20/2004/
PR
Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›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
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.