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https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9231/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9231 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9231 - Title | This chapter shall be known and may be cited as the Chapter on Health Information Protection.
History —Aug. 29, 2011, No. 194, added as § 14.010 on Aug. 23, 2012, No. 203, § 1, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9232/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9232 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9232 - Purpose | The purpose of this chapter is to establish standards for the protection of the health information of covered persons or enrollees requiring health insurance organizations and issuers to establish procedures for the proper management of any health information generated, maintained, used or disclosed as part of their op... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9233/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9233 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9233 - Definitions | For purposes of this chapter:
(a) Disclose.— Means to release, transfer, or otherwise divulge protected health information.
(b) Health information.— Means any information or data, whether oral or recorded, in any form or medium that:
(1) Is created or received by the health service organization or issuer.
(2) Is relate... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9234/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9234 - Applicability and scope | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9234 - Applicability and scope | This chapter applies to all health insurance organizations or issuers and governs the management of health information, including the collection, use, and disclosure of protected health information by health insurance organizations or issuers.
History —Aug. 29, 2011, No. 194, added as § 14.040 on Aug. 23, 2012, No. 203... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9235/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9235 - Health information policies, standards and procedures | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9235 - Health information policies, standards and procedures | (a) A health insurance organization or issuer shall develop and implement written policies, standards, and procedures for the management of health information, in order to guard against the unauthorized collection, use, or disclosure of protected health information. It shall meet the applicable requirements of the Fede... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9236/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9236 - Notice of health information policies, standards, and proc... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9236 - Notice of health information policies, standards, and procedures | (a) A health insurance organization or issuer shall draft a written notice of its health information policies, standards, and procedures, which shall be made available for review and inspection by the Commissioner. The notice shall include:
(1) The collection, use, and disclosure of protected health information prohibi... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9237/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9237 - Right to access protected health information | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9237 - Right to access protected health information | (a) Subject to the exceptions listed in subsection (b)(3) of this section, an individual who is the subject of the protected health information has the right to examine or receive a copy of the protected health information that is in the possession of the health insurance organization or issuer.
(b) An individual who i... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9238/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9238 - Right to amend protected health information | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9238 - Right to amend protected health information | (a) An individual who is the subject of protected health information has the right to submit a written request to the health insurance organization or issuer to amend such information to correct any inaccuracies. The individual must present attesting evidence that justifies such amendment.
(b) Not later than sixty (60)... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9239/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9239 - List of disclosures of protected health information | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9239 - List of disclosures of protected health information | (a) A health insurance organization or issuer shall provide, upon request, to an individual who is the subject of the protected health information, information regarding disclosure of that individual's protected health information that is sufficient to exercise the right to amend the information pursuant to § 9238 of t... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9240/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9240 - Authorization for collection, use or disclosure of protect... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9240 - Authorization for collection, use or disclosure of protected health information | (a) A health insurance organization or issuer shall not collect, use or disclose protected health information without a valid authorization from the subject of the protected health information, except as permitted by § 9241 of this title or as required by law or court order. An authorization for the disclosure of prote... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9241/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9241 - Collection, use, and disclosure of protected health inform... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9241 - Collection, use, and disclosure of protected health information without authorization | (a) A health insurance organization or issuer may, without authorization, engage in the activities related to the payment of services and treatment, and the coordination thereof, as well as healthcare operations, as these terms are defined under HIPPA, including, but not limited to the following activities with regard ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9242/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9242 - Collection, use, or disclosure of protected health informa... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9242 - Collection, use, or disclosure of protected health information without authorization for scientific, medic... | (a) A health insurance organization or issuer may disclose protected health information with authorization from the individual who is the subject of such information to research organizations conducting scientific, medical, or public policy research as provided in this section.
(b)
(1) A health insurance organization o... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9243/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9243 - Unauthorized collection, use or disclosure of protected he... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9243 - Unauthorized collection, use or disclosure of protected health information | An unauthorized collection, use, or disclosure of protected health information by a health insurance organization or issuer is hereby prohibited. Such collection, use, or disclosure shall be subject to the penalties set forth in § 9245 of this title. An unauthorized collection, use, or disclosure shall include:
(a) Una... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9244/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9244 - Right to limit disclosures | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9244 - Right to limit disclosures | (a) A health insurance organization or issuer shall limit disclosure of information, including protected health information, if the individual subject of such information clearly states in writing that disclosure to specified individuals of all or part of that information could jeopardize his/her safety. Disclosure of ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-112/9245/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 112 - Health Information Protection (§§ 9231 — 9245)›§ 9245 - Sanctions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 112 - Health Information Protection (§§ 9231 — 9245) › § 9245 - Sanctions | (a) Civil sanctions.—
(1) Whenever the Commissioner has reason to believe that a person has committed negligence in violation of the provisions of this chapter and that an action is in the public interest, the Commissioner may bring an action to enjoin such violations. An injunction issued under this section shall be i... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9271/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9271 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9271 - Title | This chapter shall be known and may be cited as the chapter on Limited Health Service Organizations.
History —Aug. 29, 2011, No. 194, added as § 16.010 on Aug. 23, 2012, No. 203, § 2, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9272/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9272 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9272 - Definitions | For purposes of this chapter:
(a) Evidence of coverage.— Means a certificate, policy, agreement, or contract setting forth the coverage to which a subscriber is entitled.
(b) Limited health service organization.— Means any corporation, partnership or other entity that undertakes to provide or arrange for the provision ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9273/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9273 - Certificate of authority required | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9273 - Certificate of authority required | No person, corporation, partnership, or entity may operate a limited health service organization in Puerto Rico without obtaining a certificate of authority therefor from the Commissioner.
History —Aug. 29, 2011, No. 194, added as § 16.030 on Aug. 23, 2012, No. 203, § 2, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9274/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9274 - Application for certificate of authority | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9274 - Application for certificate of authority | An application for a certificate of authority to operate as a limited health service organization shall be filed with the Commissioner on a form prescribed by him/her. The application shall be sworn by an officer or authorized representative of the applicant and shall set forth or enclose the following documents:
(a) A... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9275/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9275 - Issuance or denial of certificate of authority | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9275 - Issuance or denial of certificate of authority | (a) The Commissioner shall issue or deny a certificate of authority to any applicant that files an application pursuant to § 9274 of this title. The Commissioner shall issue a certificate of authority provided that the following conditions are met:
(1) The requirements of § 9274 of this title have been fulfilled.
(2) T... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9276/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9276 - Effect on organizations operating on effective date ... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9276 - Effect on organizations operating on effective date of this chapter | Within ninety (90) days after the effective date of this chapter, every limited health service organization operating in Puerto Rico without a certificate of authority shall submit an application for a certificate of authority to the Commissioner pursuant to the provisions of § 9274 of this title. Such organization may... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9277/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9277 - Filing requirements for authorized entities | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9277 - Filing requirements for authorized entities | (a) A health service organization, a disability insurance company, a nonprofit health, hospital or medical service organization, or a fraternal benefit society may file for approval with the Commissioner a request to offer limited health services by submitting the information described in subsections (d), (e), (g), (h)... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9278/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9278 - Changes and material modifications; addition of limi... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9278 - Changes and material modifications; addition of limited health services | (a) A limited health service organization shall file with the Commissioner prior to use, a notice of any intended change in rates, charges, or benefits and of any material modification of operations or information furnished pursuant to § 9274 of this title. Such filing shall be made within sixty (60) days before the ch... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9279/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9279 - Evidence of coverage | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9279 - Evidence of coverage | (a) Every limited health service organization shall issue an evidence of coverage to each one of its subscribers, which shall contain a clear and complete statement of:
(1) The limited health services to which each subscriber is entitled;
(2) any limitation of the services, kinds of services or benefits to be provided,... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9280/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9280 - Rates and charges | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9280 - Rates and charges | (a) The rates for a limited health service plan to be used by a limited health service organization shall be filed with the Commissioner, before applying them in Puerto Rico. No filing shall be effective until sixty (60) days after the receipt thereof in the Office of the Commissioner, unless it is expressly approved b... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9281/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9281 - Construction with other laws | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9281 - Construction with other laws | (a)
(1) A limited health service organization organized under the laws of Puerto Rico shall be deemed to be a domestic insurer for purposes of insurance holding companies regulations, unless specifically exempted in writing from one (1) or more of the provisions of such regulations by the Commissioner.
(2) A limited he... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9282/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9282 - Nonduplication of coverage | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9282 - Nonduplication of coverage | A limited health service organization, health service organization, disability insurance company, nonprofit health, hospital or medical service organizations may exclude, in any contract or policy, any coverage that would duplicate the coverage for limited health services.
History —Aug. 29, 2011, No. 194, added as § 16... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9283/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9283 - Grievance system | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9283 - Grievance system | Every limited health service organization shall establish and maintain a grievance system as provided in §§ 9391 et seq. and 9501 of this title, which shall be approved by the Commissioner and provide reasonable procedures for resolving written grievances initiated by subscribers and providers related to the provisions... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9284/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9284 - Examination | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9284 - Examination | (a) The Commissioner may examine the affairs of any limited health service organization and providers with which such organization maintains contracts, agreements or other arrangements, at least every three (3) years.
(b) Every limited health service organization and provider shall make its relevant books and records a... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9285/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9285 - Investments | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9285 - Investments | The funds of a limited health service organization shall be invested only in securities and other investments allowed by the laws of Puerto Rico for the investment of assets that constitute the legal reserve of life issuers or other securities or investments that the Commissioner may allow.
History —Aug. 29, 2011, No. ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9286/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9286 - Authorized representatives | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9286 - Authorized representatives | (a) No limited health service organization shall engage in procurement and underwriting activities, if not by an authorized representative of such organization.
(b) The provisions related to licensing, commissions, requirements, examination, controlled businesses, bonds, summons, books, documents, and reports of §§ 949... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9287/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9287 - Contracts with providers | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9287 - Contracts with providers | All contracts with providers for the provision of limited health services to subscribers shall contain the following terms and conditions:
(a) In the event the limited health service organization fails to pay a provider for rendering services to a subscriber, including insolvency or breach of contract or any other reas... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9288/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9288 - Protection against insolvency; deposit | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9288 - Protection against insolvency; deposit | (a) Except as approved in accordance with subsection (d) of this section, each limited health service organization shall at all times have and maintain tangible net equity equal to the greater of fifty thousand dollars ($50,000); or two percent (2%) of the organization's annual gross premium income.
(b) For purposes of... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9289/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9289 - Officers and employees fidelity bond | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9289 - Officers and employees fidelity bond | (a) A limited health service organization shall maintain in force a fidelity bond in its own name on its officers and employees in an amount not less than fifty thousand dollars ($50,000) or in any other amount prescribed by the Commissioner.
(b) In lieu of the bond requirement, a limited health service organization ma... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9290/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9290 - Annual reports | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9290 - Annual reports | (a) Every limited health service organization shall file with the Commissioner, on or before March 31 of each year, an exact report covering the preceding calendar year, certified by a certified public accountant and signed under oath by two (2) principal officers.
(b) The report shall be on forms prescribed by the Com... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9291/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9291 - Suspension or revocation of certificate of authority | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9291 - Suspension or revocation of certificate of authority | (a) The Commissioner may suspend or revoke the certificate of authority issued to a limited health service organization pursuant to this chapter upon determining that any of the following conditions exist:
(1) The limited health service organization is operating significantly in contravention of its basic organizationa... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9292/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9292 - Additional sanctions for violations | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9292 - Additional sanctions for violations | In addition to the suspension or revocation of the certificate of authority or in lieu of such penalty, a limited health service organization which has violated any provision of this Code, the Insurance Code of Puerto Rico, rule, regulation, or lawful order of the Commissioner, may be imposed the sanctions or penalties... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9293/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9293 - Rehabilitation or liquidation | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9293 - Rehabilitation or liquidation | (a) Any rehabilitation or liquidation of a limited health service organization shall be deemed to be the rehabilitation or liquidation of an issuer and shall be conducted under the supervision of the Commissioner by virtue of the Insurance Code of Puerto Rico on rehabilitation or liquidation. The Commissioner may reque... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9294/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9294 - Filing fees | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9294 - Filing fees | Every limited health service organization shall pay to the Commissioner the established fees for the following:
(a) For filing an application for a certificate of authority or amendment thereto;
(b) for filing a material modification of or an addition to a limited health service;
(c) for filing each annual report, and
... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9295/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9295 - Confidentiality | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9295 - Confidentiality | (a) Any information obtained by a limited health service organization from the subscriber or a provider pertaining to the diagnosis, treatment or health of the subscriber shall be deemed confidential and shall not be disclosed to any person except:
(1) To the extent that it may be necessary to carry out the purposes of... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-114/9296/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296)›§ 9296 - Taxes | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 114 - Limited Health Service Organization (§§ 9271 — 9296) › § 9296 - Taxes | The same taxes provided for health service organizations shall be imposed upon each limited health service organization. Such organizations shall be entitled to the same tax deductions, reductions, and credits that health service organizations are entitled to receive.
History —Aug. 29, 2011, No. 194, added as § 16.260 ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9321/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9321 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9321 - Title | This chapter shall be known and may be cited as the chapter on Healthcare Professionals or Entities Credentialing Verification.
History —Aug. 29, 2011, No. 194, added as § 18.010 on Aug. 23, 2012, No. 203, § 3, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9322/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9322 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9322 - Purpose | The purpose of this chapter is to require health insurance organizations or issuers to establish a comprehensive healthcare professional or entity credentialing verification program to ensure that participating healthcare professionals meet specific minimum standards of professional or licensing qualifications. The sta... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9323/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9323 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9323 - Definitions | For purposes of this chapter:
(a) Credentialing verification.— Is the process of obtaining and verifying information about a healthcare professional or entity, and evaluating that healthcare professional or entity, when such healthcare professional or entity applies to become a participating provider in a managed care ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9324/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9324 - Applicability and scope | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9324 - Applicability and scope | This chapter shall apply to health insurance organizations or issuers that offer managed care plans.
History —Aug. 29, 2011, No. 194, added as § 18.040 on Aug. 23, 2012, No. 203, § 3, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9325/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9325 - General responsibilities... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9325 - General responsibilities of health insurance organizations or issuers | (a) A health insurance organization or issuer shall:
(1) Establish written policies and procedures for credentialing verification of all healthcare professionals or entities with which the health insurance organization or issuer contracts and apply these standards consistently;
(2) verify the credentials of a healthcar... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9326/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9326 - Verification responsibil... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9326 - Verification responsibilities of health insurance organizations or issue... | A health insurance organization or issuer shall:
(a) Obtain primary verification of at least the following information about the applicant:
(1) Current license, certificate of authority or registration to practice his/her profession in Puerto Rico;
(2) meets financial responsibility requirements;
(3) status of hospital... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9327/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9327 - Healthcare professional'... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9327 - Healthcare professional's right to review credentialing verification inf... | A health insurance organization or issuer shall provide a healthcare professional or entity the opportunity to review and correct information submitted in support of his/her credentialing verification application as set forth below.
(a) Each healthcare professional or entity that is subject to the credentialing verific... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-116/9328/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328)›§ 9328 - Contracting | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 116 - Healthcare Professionals or Entities Credentialing Verification (§§ 9321 — 9328) › § 9328 - Contracting | Whenever a health insurance organization or issuer contracts to have another entity perform the credentialing functions required by this chapter, the Commissioner shall hold the health insurance organization or issuer responsible for monitoring the activities of the entity with which it contracts.
History —Aug. 29, 201... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9351/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9351 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9351 - Title | This chapter shall be known and may be cited as the Health Insurance Organization or Issuer Quality Assessment and Improvement.
History —Aug. 29, 2011, No. 194, added as § 20.010 on Aug. 23, 2012, No. 203, § 4, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9352/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9352 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9352 - Purpose | This chapter establishes criteria for the quality assessment and quality improvement activities of all health insurance organizations or issuers that offer managed care plans. The purpose of establishing such criteria is to enable health insurance organizations or issuers to evaluate, maintain and improve the quality o... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9353/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9353 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9353 - Definitions | (a) Consumer.— Means someone in the general public who may or may not be a covered person or enrollee or enrollee or a purchaser of healthcare services, including employers.
(b) Quality assessment.— Means the measurement and evaluation of the quality and outcomes of medical care provided to individuals, groups or popul... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9354/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9354 - Applicability... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9354 - Applicability and scope | Except as otherwise specified, this chapter shall apply to all health insurance organizations or issuers that offer managed care plans.
History —Aug. 29, 2011, No. 194, added as § 20.040 on Aug. 23, 2012, No. 203, § 4, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9355/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9355 - Quality asses... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9355 - Quality assessment standards | Any health insurance organization or issuer that provides managed care plans shall develop and maintain the infrastructure and disclosure systems necessary to measure the quality of healthcare services provided to covered person or enrollees or enrollees on a regular basis and appropriate to the types of plans offered ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9356/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9356 - Quality impro... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9356 - Quality improvement standards for closed plans | In addition to meeting the requirements of § 9355 of this title, a health insurance organization or issuer that issues a closed plan, or a combination plan having a closed component, shall develop and maintain the internal structures and activities necessary to improve the quality of its services as required by this se... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9357/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9357 - Corporate ove... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9357 - Corporate oversight | The chief medical officer or clinical director of the health insurance organization or issuer shall have primary responsibility for the quality assessment and quality improvement activities carried out by, or on behalf of, the health insurance organization or issuer. Furthermore, such chief medical officer or clinical ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9358/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9358 - Reporting and... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9358 - Reporting and disclosure requirements | (a) As specified below, every health insurance organization or issuer shall document and communicate information about its quality assessment program and quality improvement program, if it has one, and shall:
(1) Include a summary of its quality assessment and quality improvement programs in marketing materials;
(2) in... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9359/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9359 - Confidentiali... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9359 - Confidentiality | (a) Data or information pertaining to the diagnosis, treatment or health of a covered person or enrollee is confidential and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this chapter and as allowed by the laws of Puerto Rico and the United States of Ame... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-118/9360/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360)›§ 9360 - Contracting | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 118 - Health Insurance Organization or Issuer Quality Assessment and Improvement (§§ 9351 — 9360) › § 9360 - Contracting | Whenever a health insurance organization or issuer contracts to have another entity perform the quality assessment or quality improvement functions, the Commissioner shall hold the health insurance organization or issuer responsible for monitoring the activities of the entity with which it contracts.
History —Aug. 29, ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9391/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9391 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9391 - Title | This chapter shall be known and may be cited as the Health Insurance Organizations or Issuers Grievance Procedure. In the case of plans for private employers governed by the Employee Retirement Income Security Act of 1974, known as ERISA, any provision in this chapter found to be inconsistent with any federal law or re... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9392/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9392 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9392 - Purpose | The purpose of this chapter is to provide standards for the establishment and maintenance of procedures by health insurance organizations and issuers to ensure that covered persons or enrollees have the opportunity for the appropriate resolution of grievances, as defined in this chapter.
History —Aug. 29, 2011, No. 194... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9393/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9393 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9393 - Definitions | For purposes of this chapter:
(a) Covered benefits or benefits.— Means those healthcare services to which a covered person or enrollee is entitled under the terms of a health plan.
(b) Certification.— Means a document that contains a determination by a health insurance organization or issuer, or a utilization review or... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9394/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9394 - Applicability and scope | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9394 - Applicability and scope | Except as otherwise specified, this chapter shall apply to all health insurance organizations or issuers.
None of the provisions of this chapter shall limit or in any way impair the legal powers of the Office of the Patient’s Advocate, the Medical Discipline and Licensure Board, or the Puerto Rico Health Insurance Admi... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9395/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9395 - Requirements to report griev... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9395 - Requirements to report grievances to the Commissioner | (a) Health insurance organizations or issuers shall maintain written records to document all grievances received during a calendar year (the register).
(b) A request for a first level review of a grievance involving an adverse determination shall be processed in compliance with § 9397 of this title. A request for a sta... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9396/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9396 - Grievance review procedures | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9396 - Grievance review procedures | (a) Except as specified in § 9400 of this title, health insurance organizations or issuers shall receive and resolve grievances from covered persons or enrollees as provided in §§ 9397–9399 of this title.
(b) Health insurance organizations or issuers shall file a copy with the Commissioner of the procedures required un... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9397/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9397 - First level reviews of griev... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9397 - First level reviews of grievances involving an adverse determination | (a) Within one hundred eighty (180) days after the receipt of a notice of an adverse determination, a covered person or enrollee, or his/her authorized representative, may file a grievance with the health insurance organization or issuer requesting a first level review of the adverse determination.
(b) The health insur... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9398/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9398 - Standard reviews of grievanc... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9398 - Standard reviews of grievances not involving an adverse determination | (a) Health insurance organizations or issuers shall establish written procedures for standard reviews of grievances that do not involve an adverse determination.
(b)
(1) The procedures shall permit a covered person or enrollee, or his/her authorized representative, to file a grievance that does not involve an adverse d... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9399/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9399 - Voluntary level of reviews o... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9399 - Voluntary level of reviews of grievances | (a)
(1) A health insurance organization or issuer that offers managed care plans shall establish a voluntary review process for its managed care plans to give those covered persons or enrollees who are dissatisfied with the first level review decision made pursuant to § 9397 of this title, or who are dissatisfied with ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-120/9400/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400)›§ 9400 - Expedited reviews of grievan... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 120 - Health Insurance Organization or Issuer Grievance Procedure (§§ 9391 — 9400) › § 9400 - Expedited reviews of grievances involving an adverse determination | (a) Health insurance organizations or issuers shall establish written procedures for the expedited review of urgent care requests involving an adverse determination.
(b) The procedures shall allow a covered person or enrollee, or his/her authorized representative, to request an expedited review under this section to th... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9421/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9421 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9421 - Title | This chapter shall be known and may be cited as the chapter on Utilization Review and Benefit Determination.
History —Aug. 29, 2011, No. 194, added as § 24.010 on Aug. 23, 2012, No. 203, § 5, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9422/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9422 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9422 - Purpose | This chapter establishes standards and criteria for the structure and operation of utilization review and benefit determination processes carried out by health insurance organizations or issuers. Its purpose is to facilitate ongoing assessment and management of healthcare services provided to covered persons or enrolle... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9423/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9423 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9423 - Definitions | For purposes of this chapter:
(a) Certification.— Means a document containing a determination by a health insurance organization or issuer or utilization review organization that a request for a benefit under the health insurance organization or issuer's health plan has been reviewed and, based on the information provi... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9424/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9424 - Applicability and scope | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9424 - Applicability and scope | This chapter shall apply to health insurance organizations or issuers offering a health plan that provides or performs utilization review services. The requirements of this chapter also shall apply to any designee of the health insurance organization or issuer or utilization review organization that performs utilizatio... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9425/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9425 - Corporate oversight of utilization review p... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9425 - Corporate oversight of utilization review program | A health insurance organization or issuer shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the health insurance organization or issuer and for ensuring that all requirements of this chapter and the corresponding regulations are met. The health insurance organization... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9426/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9426 - Contracting | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9426 - Contracting | Whenever a health insurance organization or issuer contracts to have a utilization review organization or other entity perform the utilization review functions required by this chapter, the Commissioner shall hold the health insurance organization or issuer liable for monitoring the activities of the utilization review... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9427/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9427 - Scope and content of utilization review pro... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9427 - Scope and content of utilization review program | (a)
(1) A health insurance organization or issuer that requires a request for benefits under the covered person or enrollee’s health plan to be subjected to utilization review shall implement a written utilization review program that describes all review activities and procedures, both delegated and non-delegated for:
... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9428/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9428 - Operational requirements | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9428 - Operational requirements | (a) A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health insurance organization or issuer may develop its own clinical review criteria or it may obtain or use license clinical review crite... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9429/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9429 - Procedures for standard utilization review ... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9429 - Procedures for standard utilization review and benefit determinations | (a) A health insurance organization or issuer shall maintain written procedures for making standard utilization review and benefit determinations on requests for benefits submitted by covered persons or enrollees and for notifying its determinations within the specified time frames required under this section.
(b)
(1)
... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9430/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9430 - Procedures for expedited utilization review... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9430 - Procedures for expedited utilization review and benefit determinations | (a)
(1) Health insurance organizations or issuers shall establish written procedures for notifying covered persons or enrollees of expedited utilization review and benefit determinations with respect to urgent care requests.
(2)
(A) As part of the procedures required under clause (1) of this subsection, a health insura... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9431/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9431 - Emergency services | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9431 - Emergency services | (a) When conducting utilization review or making a benefit determinations for emergency services, a health insurance organization or issuer shall comply with the provisions of this section.
(b) A health insurance organization or issuer shall cover emergency services necessary to screen and stabilize a covered person or... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9432/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9432 - Confidentiality requirements | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9432 - Confidentiality requirements | Health insurance organizations or issuers shall annually certify to the Commissioner that their utilization review programs comply with all applicable Commonwealth and federal law establishing health information confidentiality requirements.
History —Aug. 29, 2011, No. 194, added as § 24.120 on Aug. 23, 2012, No. 203, ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9433/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9433 - Disclosure requirements | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9433 - Disclosure requirements | (a) A health insurance organization or issuer shall include a clear and comprehensive description of its utilization review and benefit determination procedures in the certificate of coverage or member handbook provided to covered persons or enrollees. The description shall include the procedures for obtaining review o... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-122/9434/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434)›§ 9434 - Rulemaking authority | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 122 - Utilization Review and Benefit Determination (§§ 9421 — 9434) › § 9434 - Rulemaking authority | The Commissioner may promulgate the necessary regulations to carryout the purposes of this chapter.
History —Aug. 29, 2011, No. 194, added as § 24.140 on Aug. 23, 2012, No. 203, § 5, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9461/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9461 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9461 - Title | This chapter shall be known and may be cited as the chapter on Managed Care Plan Network Adequacy.
History —Aug. 29, 2011, No. 194, added as § 26.010 on Aug. 23, 2012, No. 203, § 6, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9462/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9462 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9462 - Purpose | The purpose and intent of this chapter are to establish standards for the creation and maintenance of networks by health insurance organization or issuers and to assure the adequacy, accessibility and quality of healthcare services offered under a managed care plan. Requirements for contracts between health insurance o... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9463/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9463 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9463 - Definitions | For purposes of this chapter:
(a) Intermediary.— Means a person authorized to negotiate and execute contracts with health insurance organizations or issuers on behalf of healthcare providers or a healthcare provider network.
(b) Primary care provider.— Means a participating provider in charge of supervising, coordinati... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9464/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9464 - Applicability and scope | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9464 - Applicability and scope | This chapter shall apply to all health insurance organizations or issuers that offer managed care plans.
History —Aug. 29, 2011, No. 194, added as § 26.040 on Aug. 23, 2012, No. 203, § 6, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9465/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9465 - Network adequacy | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9465 - Network adequacy | (a) Any health insurance organization or issuer providing a managed care plan shall maintain a network that is sufficient in numbers and types of providers to assure that all services to covered persons or enrollees will be accessible without unreasonable delay.
(b) Covered persons or enrollees shall have access to eme... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9466/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9466 - Requirements for health insurance organizations or is... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9466 - Requirements for health insurance organizations or issuers and participating providers | A health insurance organization or issuer offering a managed care plan shall satisfy all the following requirements:
(a) A health insurance organization or issuer shall establish a mechanism whereby the participating provider will be notified on an ongoing basis of the specific covered health services for which the pro... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9467/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9467 - Intermediaries | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9467 - Intermediaries | A contract between a health insurance organization or issuer and an intermediary shall satisfy all the requirements contained in this section:
(a) Intermediaries and participating providers with whom they contract shall meet all the requirements of § 9466 of this title.
(b) A health insurance organization or issuer’s r... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9468/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9468 - Filing requirements and state administration | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9468 - Filing requirements and state administration | (a) Beginning on the effective date of this chapter, a health insurance organization or issuer shall file with the Commissioner sample contract forms proposed for use with its participating providers and intermediaries, so that the Commissioner may ascertain compliance with the provisions of this chapter.
(b) A health ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9469/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9469 - Contracting | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9469 - Contracting | (a) The execution of a contract shall not relieve the health insurance organization or issuer of its liability to any person with whom it has contracted for the provision or coverage of services, nor of its responsibility for compliance with the law or applicable regulations.
(b) All contracts shall be in writing and s... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9470/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9470 - Enforcement of this chapter | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9470 - Enforcement of this chapter | (a) If the Commissioner determines that a health insurance organization or issuer has not contracted with enough participating providers to assure that covered persons or enrollees have accessible healthcare services in a geographic area, or that a health insurance organization or issuer’s access plan does not assure r... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-124/9471/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471)›§ 9471 - Effective date | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 124 - Managed Care Plan Network Adequacy (§§ 9461 — 9471) › § 9471 - Effective date | (a) All contracts between a health insurance organization or issuer and provider or intermediary in effect shall comply with this chapter not later than eighteen (18) months after the effective date of this chapter. The Commissioner may grant an extension of six (6) months, if the health insurance organization or issue... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-126/9501/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 126 - External Review (§§ 9501 — 9517)›§ 9501 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 126 - External Review (§§ 9501 — 9517) › § 9501 - Title | This chapter shall be known and may be cited as the chapter on External Review.
History —Aug. 29, 2011, No. 194, added as § 28.010 on Aug. 23, 2012, No. 203, § 7, eff. 90 days after Aug. 23, 2012. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-126/9502/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 126 - External Review (§§ 9501 — 9517)›§ 9502 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 126 - External Review (§§ 9501 — 9517) › § 9502 - Purpose | The purpose of this chapter is to provide standards for the establishment and maintenance of external review procedures that shall govern in Puerto Rico, to assure that covered persons or enrollees have the opportunity for an independent review of an adverse determination or final adverse determination by health insura... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-126/9503/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 126 - External Review (§§ 9501 — 9517)›§ 9503 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 126 - External Review (§§ 9501 — 9517) › § 9503 - Definitions | For purposes of this chapter:
(a) Certification.— Means a document that contains a determination by a health insurance organization or issuer or its designee utilization review organization that the request for healthcare service or the healthcare service provided has been reviewed and, based on the information furnish... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-126/9504/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 126 - External Review (§§ 9501 — 9517)›§ 9504 - Applicability and scope | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 126 - External Review (§§ 9501 — 9517) › § 9504 - Applicability and scope | (a) Except as provided in subsection (b) of this section, this chapter shall apply to all health insurance organizations or issuers.
(b) The provisions of this chapter shall not apply to a group or individual policy or certificate that provides coverage only for a specified disease, specified accident or accident-only ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-126/9505/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 126 - External Review (§§ 9501 — 9517)›§ 9505 - Notice of right to external review | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 126 - External Review (§§ 9501 — 9517) › § 9505 - Notice of right to external review | (a)
(1) A health insurance organization or issuer shall notify the covered persons or enrollees in writing of the covered person or enrollee's right to request an external review to be conducted pursuant to this chapter. Such notification shall be made when the health insurance organization or issuer sends written noti... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-126/9506/ | PR | Justia›US Law›US Codes and Statutes›Laws of Puerto Rico›2023 Laws of Puerto Rico›TITLE TWENTY-SIX - Insurance (§§ 101 — 10377)›Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377)›Chapter 126 - External Review (§§ 9501 — 9517)›§ 9506 - Request for external review | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 126 - External Review (§§ 9501 — 9517) › § 9506 - Request for external review | (a) All requests for external review shall be made to the Commissioner or in accordance with the review process adopted by the health insurance organization or issuer in compliance with the applicable federal law. The Commissioner may provide the form and content of external review requests.
(b) A covered person or enr... |
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Unemployment Word Count by State
Calculates the total word count of documents related to unemployment in each state, revealing insights into the volume of unemployment-related content by location.
CO Title 8 Word Count
Calculates the total number of words in the content of entries related to 'Title 8' in Colorado, providing insight into the volume of text data available for that specific category and state.