P.R. Laws tit. 26, § 3001
For the purposes of this chapter, the following terms and phrases shall have the meaning indicated hereinbelow:
(a) Insurer.— Means an entity engaged in the business of granting health contracts, as defined in this Code.
(b) Actionable claim for payment.— Means a claim for services rendered, submitted manually or electronically by a provider to an insurer or health services organization that contains the information and documents needed for the disposition thereof in compliance with the Health Insurance Portability and Accountability Act of 1996 (P. L. 104-191 of August 21, 1996) and Article 30.050 of this act, and whose data do not require a specific finding that prevents the payment thereof within the established terms.
(c) Health care plan.— Means the one defined as a “health are plan” in § 1902 of this title; any insurance for disability or expenses for illness or any health plan operating in Puerto Rico, even though it operates as an association that includes medical benefits, regardless of the law of the Commonwealth of Puerto Rico under which it is organized or authorized to do business.
(d) Commissioner.— Means the Commissioner of Insurance of Puerto Rico.
(e) Participating provider.— Means any physician, hospital, primary services center, diagnostic and treatment center, dentist, laboratory, pharmacy, emergency or prehospitalization medical services or any other person authorized to provide health care services in Puerto Rico, that under contract with an insurer or health services organization renders health services to subscribers or beneficiaries of a health care or health insurance plan.
(f) Subscriber.— Means any person who receives the benefits of a health care or health insurance plan.
(g) Health services organization.— Means any person who renders or makes a commitment to provide a health care plan to one or more subscribers, pursuant to this Code.
(h) Health insurance.— Insurance for expenses incurred for bodily injury, disability or illness, or according to the definition of “disability insurance” provided in § 403 of this title.
History —Ins. Code, added as § 30.020 on July 7, 2002, No. 104, § 1, eff. 180 days after July 7, 2002.