Title 22 — Insurance
49 chapters · 1,014 sections in this title.
22 V.I.C. § 1520 Short title
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This chapter maybe cited as “The Virgin Islands Third Party Administrators Act”.
22 V.I.C. § 1521 Definitions
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(a) For purposes of this chapter:(a) “Affiliate” or “affiliated” means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, another specified person.(b) “Business entity” means a corporation, associ…
22 V.I.C. § 1522 Licensing necessary
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It is unlawful for a person to act as a TPA in the Virgin Islands unless that person is licensed as a TPA under this chapter. This prohibition does not apply to a person while employed by, or when operating under contract with the TPA licensed under this chapter. Any entity doing…
22 V.I.C. § 1523 Payment to a TPA
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If an insurer uses the services of a TPA, any premiums or charges for insurance paid to the TPA by or on behalf of the insured party, or any collateral furnished to the TPA by or on behalf of the insured party, is considered to have been received by the insurer, and the return of…
22 V.I.C. § 1524 Maintenance of information
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(a) A TPA shall maintain in its principal office and make available to the payor complete books and records of all transactions performed on behalf of the payor. The books and records must be maintained as part of the TPA’s official records in accordance with prudent standards of…
22 V.I.C. § 1525 Approval of advertising
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A TPA who advertises on behalf of its client may use only advertising that has been approved in writing by the client in advance of its use and which conforms to the requirements of chapter 49 of this title. A TPA who mentions any current or former client in its advertising must …
22 V.I.C. § 1526 Responsibilities of the payor and TPA
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(a) No TPA may act as a TPA without a written agreement between the TPA and the payor. A copy of the agreement must be retained by the TPA for the duration of the agreement and for five years thereafter. The agreement must contain all provisions required by this section, except i…
22 V.I.C. § 1527 Collection of premium, fiduciary duties of TPA
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(a) All insurance charges, premiums, collateral, and loss reimbursements collected by a TPA on behalf of or for a payor, the return of premiums or collateral received from a payor, and any funds held by the TPA for the payment of claims, must be held by the TPA in a fiduciary cap…
22 V.I.C. § 1528 Payment of claims, fiduciary duties of TPA
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(1) The TPA is the trustee for all money that is received to pay claims and claim adjustment expenses. All claim moneys must be deposited in a special fiduciary account in a financial institution that is located in the Virgin Islands. The special fiduciary account must be designa…
22 V.I.C. § 1529 TPA’s fiduciary duties regarding the TPATFA and the CASA
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(a) For each plan that requires a TPATFA, the balance at all times must be the amount deposited plus accrued interest less authorized disbursements. If the TPATFA balance is less than the amount deposited plus accrued interest less authorized disbursements, it is presumed that th…
22 V.I.C. § 1530 Compensation to the TPA
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(a) It is unlawful for a TPA to enter into an agreement or understanding with a payor in which the effect is to make the amount of the TPA’s commissions, fees, or charges contingent upon savings effected in the payment of losses covered by the payor’s obligations. This subsection…
22 V.I.C. § 1531 Disclosure of charges and fees
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(a) When a TPA collects funds, the reason for collection of each item must be identified to the insured party, and each item must be shown separately from any premium. Additional charges may not be made for services to the extent the services have been already paid for by the pay…
22 V.I.C. § 1532 Delivery of materials to covered individuals
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Any policies, certificates, booklets, termination notices, or other written communications delivered by the payor to the TPA for delivery to insured parties or covered individuals must be delivered by the TPA promptly after receipt of instructions from the payor to deliver them. …
22 V.I.C. § 1533 TPA’s application for licensure
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(a) A TPA applying in the Virgin Islands for licensure shall do so on a form provided by the Commissioner accompanied by the certification of an authorized representative of the TPA. (b) The application must include or be accompanied by the following information and documents:(1)…
22 V.I.C. § 1534 Bond requirement for TPAs
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(a) Every applicant for a TPA license shall file with the application and maintain while so licensed, a fidelity bond in favor of the Government of the Virgin Islands executed by a surety company and payable to any party injured under the terms of the bond. The bond must be conti…
22 V.I.C. § 1535 Registration requirement
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A person who is not required to be licensed as a TPA under this chapter and who directly or indirectly underwrites, collects charges or premiums from, or adjusts or settles claims on residents of the Virgin Islands, only in connection with life, annuity or health coverage provide…
22 V.I.C. § 1536 Standards for license issuance and approval of registration
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(1) The Commissioner may issue a license to an applicant or approve an application for registration as a TPA if the Commissioner finds that the applicant meets the standards established by this chapter including, but not limited to, the following:(1) All of the materials required…
22 V.I.C. § 1537 Annual report and filing fee
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(a) Each TPA licensed under section 1533 shall file an annual report in duplicate originals for the preceding calendar year with the Commissioner on or before March 31 of each year, or within such extension of time as the Commissioner for good cause may grant. The report must be …
22 V.I.C. § 1538 Examinations
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(a) The Commissioner or the Commissioner’s designee may examine the records of any applicant or holder of a TPA license. (b) Any TPA or applicant being examined shall provide to the Commissioner or the Commissioner’s designee convenient and free access during business hours to al…
22 V.I.C. § 1539 Grounds for denial, suspension or revocation of licensure
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(a) The Commissioner shall, deny, suspend or revoke the license of a TPA, or shall issue a cease and desist order if the TPA does not have a license if, after notice and opportunity for hearing, the Commissioner finds that the TPA:(1) is in an unsound financial condition;(2) is u…
22 V.I.C. § 1540 Administrative fine
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(a) If the Commissioner finds that one or more grounds exist for the revocation or suspension of a license issued under this chapter, the Commissioner may, in lieu of, or in addition to such suspension or revocation, impose a fine upon the TPA. (b) The Commissioner may impose a f…
22 V.I.C. § 1541 Judicial review
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Any person aggrieved by an order of the Commissioner may appeal to the appropriate court in accordance with the appeals procedures set forth in chapter 7 of this title.
22 V.I.C. § 1542 Unauthorized activities
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Nothing in this chapter may be construed to permit any person or entity to receive or collect charges, contributions or premiums for, or adjust or settle claims in connection with any type of life or health benefit, unless that person or entity may through the insurance laws of a…
22 V.I.C. § 1543 Felony convictions
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(1) Any TPA or any individual listed on the application as required by section 1533 who is convicted of a felony, must, not later than 30 days after the entry date of the judgment:(1) report the conviction to the Commissioner, and(2) provide the Commissioner with a copy of the ju…
22 V.I.C. § 1544 Regulations
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Pursuant to the authority vested in the Commissioner in chapter 3, of this title the Commissioner may issue regulations for the proper administration and functioning of the provisions of this chapter.