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https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9130/ | 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 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9130 - Transitory prov... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9130 - Transitory provisions for issuers offering health plans to PYME... | (a) Issuers interested in offering and marketing, or who wish to continue offering and marketing the health plans authorized under this chapter, or any other designed for PYMES employers in Puerto Rico, shall comply with the following:
(1) As a transition measure, and while the provisions of this chapter are implemente... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9131/ | 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10377)›Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9131 - Repealed. Act J... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9131 - Repealed. Act July 10, 2013, No. 55, § 18, eff. 30 days after J... | History Aug. 29, 2011, No. 194, —Aug. 29, 2011, No. 194, § 8.110, eff. 180 days after Aug. 29, 2011; Act Aug. 9, 2013, No. 55, § 20, effective July 10, 2013. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9132/ | 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 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9132 - Basic health pl... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9132 - Basic health plan | (a) The Commissioner shall authorize the manner and level in which the PYMES employer issuer shall provide coverage according to this chapter and the provisions of § 9005 of this title.
(b) The Commissioner shall provide the benefit levels, cost-sharing, exclusions, and limitations of the basic health plan in its diffe... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9133/ | 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 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9133 - Periodic market... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9133 - Periodic market evaluation | The Commissioner shall conduct a study at least every three (3) years on the effectiveness of the provisions of this chapter. The report shall analyze the effectiveness of the provisions of this chapter in promoting rate stability, product availability, and coverage affordability of health plans for PYMES employers. Th... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9134/ | 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 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9134 - Waiver of certa... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9134 - Waiver of certain Commonwealth laws | No Commonwealth law or regulation approved after the effective date of this chapter requiring the coverage of a healthcare service or benefit, or requiring the reimbursement, utilization or inclusion of a specific category of healthcare provider or person, shall apply to the health plans delivered by PYMES employer iss... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9135/ | 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 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9135 - Administrative ... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9135 - Administrative procedures | The Commissioner shall issue policy letters or regulations as necessary for the implementation of the provisions of this chapter following the procedure established therefor in §§ 201-232 of this title.
History —Aug. 29, 2011, No. 194, § 8.150, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 23, eff. 30 day... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9136/ | 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 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9136 - Standards to as... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9136 - Standards to assure fair marketing | (a) Each issuer shall actively market all health plans sold by the issuer to all PYMES employers in Puerto Rico.
(b) No PYMES employer issuer or producer shall, directly or indirectly, engage in the following activities:
(1) Encouraging or directing PYMES employers to refrain from filing an application for coverage wit... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-106/9137/ | 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 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137)›§ 9137 - Required disclo... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 106 - Small and Medium-sized Businesses Employer Health Insurance Availability (§§ 9121 — 9137) › § 9137 - Required disclosure | (a) In connection with the offering for sale of any health plan to a PYMES employer, the issuer shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:
(1) The provisions of the health plan that, in accordance with this chapter, grant the issuer the right to change ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9161/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9161 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9161 - Title | This chapter shall be known and cited as the Chapter on Individual Health Plan and Guaranteed Availability.
History —Aug. 29, 2011, No. 194, added as § 10.010 on July 22, 2013, No. 69, § 1, eff. 60 days after July 22, 2013. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9162/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9162 - Public policy | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9162 - Public policy | The purpose of this chapter is to enhance the availability of health insurance coverage to persons who are not insured under an employer or labor union group health plan, regardless of their health status or claim experience; to prevent abusive rating practices; to require disclosure of rating practices in the individu... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9163/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9163 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9163 - Definitions | As used in this chapter, the term:
(a) Affiliate or affiliated to.— Means “affiliate” as defined in §§ 9121-9137 of this title.
(b) Geographic service area.— Means a geographic area as defined in §§ 9121-9137 of this title.
(c) Issuer or Individual health plan issuer.— Means a health insurance organization or issuer as... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9164/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9164 - Applicability and scope | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9164 - Applicability and scope | (a) The provisions of this chapter concerning individual health plans and the issuers that offer them shall apply to:
(1) Individual health plan offered to and that covers enrollees and their dependents who are residents of Puerto Rico or dependents who study and reside outside of Puerto Rico at the time of issue, rega... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9165/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9165 - Restrictions related to rates and fo... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9165 - Restrictions related to rates and forms | (a) Rates for individual health plans shall be subject to the provisions of the Affordable Care Act and the interpretive regulations adopted thereunder. Moreover, individual health plan issuers shall establish their rates based on the rating characteristics defined in this chapter and those established for such purpose... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9166/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9166 - Renewability of coverage | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9166 - Renewability of coverage | (a) An individual health plan issuer shall be renewable or shall continue in force the coverage for the enrollee and his/her dependent, at the option of the enrollee, and in accordance with the applicable federal regulations and legislation, except in the following cases:
(1) The enrollee has failed to pay premiums or ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9167/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9167 - Availability of coverage under a con... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9167 - Availability of coverage under a conversion privilege clause from a group health pla... | (a)
(1) As a condition of transacting insurance in Puerto Rico, individual health plan issuers shall offer approved basic health plans in its different metal levels of coverage to recently insured individuals who apply for an individual health plan and agree to make premium payments and satisfy the other reasonable req... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9168/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9168 - Availability of coverage in the indi... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9168 - Availability of coverage in the individual market—Federally defined eligible individ... | (a) Notwithstanding the provisions of § 9167 of this title and subject to subsection (b) of this section and the applicable federal regulations, if an eligible individual who is a federally defined eligible individual applies for coverage under an individual health plan within sixty-three (63) days of termination of th... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9169/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9169 - Health plan standards | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9169 - Health plan standards | The Commissioner shall provide through policy letter the form and level of coverage of the basic health plan in its different metal plans options for the individual market, so as to comply with the federal provisions and provide, at least, the Essential Health Benefit Package in accordance with § 9005 of this title, wh... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9170/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9170 - Certification of creditable coverage | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9170 - Certification of creditable coverage | (a) Individual health plan issuers offering individual health plans shall provide written certification of creditable coverage to all individuals in accordance with subsection (b).
(b) The certification of creditable coverage shall be provided:
(1) At the time an individual ceases to be covered under the health plan or... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9171/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9171 - Standards to assure fair marketing | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9171 - Standards to assure fair marketing | (a)
(1) If an issuer denies individual health plan coverage to an eligible person on the basis of his/her health status or claims experience or that of his/her dependents, the issuer shall offer such person the opportunity to purchase an approved basic health plan in any of its different metal levels of coverage.
(2) E... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9172/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9172 - Health Plan Issuer Association | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9172 - Health Plan Issuer Association | (a)
(1) A nonprofit corporation is hereby established to be known as the “Health Plan Issuer Association”. All issuers that underwrite individual health plans and basic health plans for PYMES employers in any of its different metal levels of coverage in Puerto Rico shall be members of this Association.
(2) The Associat... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9173/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9173 - Participation in employer-sponsored ... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9173 - Participation in employer-sponsored health plans | A health plan sponsored and paid by an employer qualified under the Employee Retirement Income Security Act of 1974 (ERISA), as amended, specifically basic health plans for PYMES employers in any of its different metal levels of coverage may participate in the Health Plan Issuer Association established in § 9172 of thi... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9174/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9174 - Special rules related to converted p... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9174 - Special rules related to converted policies | (a) Upon the approval of the basic health plans in the different metal levels of coverage in accordance with § 9169 of this title, all issuers required to offer a converted policy to an individual, pursuant to the provisions of this Code, may offer as a converted policy a choice of the individual basic health plans onl... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-108/9175/ | 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 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175)›§ 9175 - Guaranteed availability of individua... | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 108 - Individual Health Plans and Guaranteed Availability (§§ 9161 — 9175) › § 9175 - Guaranteed availability of individual health plans | (a) Subject to the applicable federal legislation and regulations, all issuers shall allow individuals to enroll in at least the individual basic health plans they have available in the individual market from October 1, 2013 to March 31, 2014, without risk assessment. For subsequent years, the enrollment period shall b... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-110/9201/ | 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 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204)›§ 9201 - Title | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204) › § 9201 - Title | This chapter shall be known and may be cited as the chapter on the Prohibition on the Use of Discretionary Clauses.
History —Aug. 29, 2011, No. 194, § 12.010, eff. 180 days after Aug. 29, 2011. |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-110/9202/ | 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 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204)›§ 9202 - Purpose | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204) › § 9202 - Purpose | The purpose of this chapter is to assure that health insurance benefits and disability income protection coverage are contractually guaranteed so as to prevent the conflict of interest that occurs when health insurance organizations or issuers have discretionary authority to decide what benefits are due. Nothing in thi... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-110/9203/ | 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 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204)›§ 9203 - Definitions | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204) › § 9203 - Definitions | (a) Disability income protection coverage.— Is a policy, contract, certificate or agreement that provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from either sickness or injury or a combination of them.
(b) Healthcare services.— Means services for ... |
https://law.justia.com/codes/puerto-rico/title-twenty-six/subtitle-3/chapter-110/9204/ | 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 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204)›§ 9204 - Discretionary clauses prohibited | 2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 3 - Puerto Rico Health Insurance Code (§§ 9001 — 10377) › Chapter 110 - Prohibition on the Use of Discretionary Clauses (§§ 9201 — 9204) › § 9204 - Discretionary clauses prohibited | (a) No policy, contract, certificate or agreement offered or issued in Puerto Rico by a health insurance organization or issuer to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services may contain a provision purporting to reserve discretion to health insurance organizations or iss... |
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... |
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