P.R. Laws tit. 3, § 729e
The Administration may approve the following health benefit plans:
(a) Service benefit plan.— Any plan offering one or more levels of benefit or alternatives to all eligible employees, and under which payments are made by a carrier under contracts with physicians, hospitals, or other health service providers, for benefits of the types described in § 729f of this title, rendered to employees or family members, as defined in subsection (g) of this title, or, under certain conditions, payments are made by a carrier to the employee or family members, as defined in subsection (g) of this title.
(b) Indemnity benefit plan.— Any plan offering one or more levels of benefit or alternatives, to all eligible employees, and under which a carrier agrees to pay a certain sum of money, not in excess of the actual expenses incurred, for benefits of the types described in § 729f(2) of this title.
(c) Employee organization plans.— Employee organization plans that offer benefits of the types referred to in § 729f of this title, which are sponsored or underwritten, and are administered, in whole or in a substantial part, by employee organizations, and which are available only to persons (and family members, as defined in subsection (g) of this title, who, at the time of enrollment, are members of the organization.
Health plans contracted under subsections (a) and (b) of this section shall be offered by entities that have been authorized by the Insurance Commissioner to do business in Puerto Rico, and whose financial solvency shall be accredited each year, and which have been active for at least three (3) years prior to the date of contracting with the Secretary of the Treasury. It shall be the continuous obligation of these entities to report to the Office of the Insurance Commissioner any change that affects their financial solvency.
History —June 29, 1963, No. 95, p. 280, § 5; Mar. 25, 1976, No. 18, p. 40, § 4; Jan. 23, 2006, No. 22, § 1; June 26, 2013, No. 36, § 3.