P.R. Laws tit. 26, § 1902
For the purposes of this chapter the following terms shall have the meaning stated below:
(1) Health care basic services.— Means the health care services that may be required by the subscribers in order to maintain the best state of physical and mental health, which are contracted for between the subscriber and the organization.
(2) Subscriber.— Means any person who has subscribed to a health care plan.
(3) Coverage evidence.— Means any written certificate, document or contract issued to a subscriber which establishes the subscribers’ rights and obligations under a health care plan, as well as the rights and obligations of the person who offers such plan.
(4) Health care plan.— Means any agreement whereby a person is bound to provide certain health care services to a subscriber or group of subscribers either directly or through a provider, or to pay all or part of the cost of such services in consideration of an amount preestablished in said agreement, deemed to be earned regardless of whether the subscriber uses the health care services provided by the plan or not. Notwithstanding the above, said plan shall primarily provide health care services, as distinguished from the mere compensation for the cost of such services.
(5) Health care services.— Means medical or dental care, hospitalization or services incidental to the providing of said care or hospitalization.
(6) Health services organization.— Means any person who offers or is bound to provide one or more health plans.
(7) Provider.— Means any physician, hospital or any other person authorized in Puerto Rico to provide health care services.
History —Ins. Code, added as § 19.020 on June 2, 1976, No. 113, p. 313, § 1; July 2, 1987, No. 88, p. 337, § 1.