Title 22 — Insurance
49 chapters · 1,014 sections in this title.
22 V.I.C. § 1721 Purpose
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The Legislature of the Virgin Islands believes that many residents of the Virgin Islands who are covered by a recognized health insurance plan are nevertheless prevented from enjoying the benefits of such a plan by the high up-front cost of obtaining healthcare, and the prospect …
22 V.I.C. § 1722 Definitions
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(a) “Commissioner” means the Commissioner of Insurance. (b) “Health care provider” means a person, corporation, facility or institution who must be licensed by this territory to provide health care or professional medical services including but not limited to any physician, osteo…
22 V.I.C. § 1723 Filing and approval
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(a) No health insurance plan, upon passage of this act, shall be issued, delivered or used unless it has been filed with and approved by the Commissioner. The health insurance for employees of the Government of the Virgin Islands and any group health insurance plan contracted by …
22 V.I.C. § 1724 Initial billing
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(a) If a patient, at the time of requesting health care services, presents to the health care provider evidence of coverage by a recognized health insurer, then the health care provider shall apply the following procedure when requiring payment for any services rendered:(1) The h…
22 V.I.C. § 1725 Prompt payment by insurer
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(a) Any insurer providing health insurance coverage shall be required to process and pay any uncontested claim, within thirty (30) calendar days from the date of receiving the claim. (b) If there is a contested claim, the insurer shall, within the same thirty (30) day calendar pe…
22 V.I.C. § 1726 Information and dispute resolution requirements
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(a) Each insurer providing coverage under a health insurance plan shall establish and maintain an accessible information service which health care providers may contact telephonically and electronically to ascertain immediately whether a patient, service or procedure is covered u…
22 V.I.C. § 1727 Failure to comply; penalties
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(a) Any health care provider or recognized health insurer who willfully violate the provisions of this chapter shall be subject to the following penalties:(1) A health care provider or recognized health insurer who intentionally or negligently fails to comply with the provisions …
22 V.I.C. § 1728 Preferred Provider Organization
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(a) Notwithstanding the provisions of this chapter, any physician who is a member of a Preferred Provider Organization (“PPO”) which meets, the requirements set forth below, shall not be subject to the requirements of section 1724 of this title:(1) The PPO physician shall require…
22 V.I.C. § 1731 Definitions
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(a) As used in this subchapter:(a) “Applied behavior analysis” means the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, including the use of direct observation, measurement and functional analysis of the relationsh…
22 V.I.C. § 1732 Coverage for autism spectrum disorders
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(a) After the effective date of this subchapter, a health care insurer that offers, issues for delivery, delivers, executes, adjusts, uses, or renews a health care insurance plan shall provide coverage for the costs of the diagnosis and treatment of autism spectrum disorders that…
22 V.I.C. § 1733 Prohibitions
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(1) A healthcare insurance plan must not impose:(1) any limits on the number of visits an insured may make to an autism services provider pursuant to a treatment plan on any basis other than a lack of medical necessity, or(2) a coinsurance, copayment, deductible or other out-of-p…
22 V.I.C. § 1734 Limitations; review of treatment plan; diagnosis period
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(a) The insurer may limit the coverage in the insurance health care plan for behavioral therapy to a yearly benefit of $50,000 for a child who is younger than nine years of age, $35,000 for a child who is at least nine years of age but younger than thirteen years of age and $25,0…
22 V.I.C. § 1735 Obligation to pay
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(a) This subchapter does not limit benefits that are otherwise available to an individual under a health benefit plan. (b) Nothing in this subchapter relieves an insurer from an otherwise valid obligation to provide or to pay for services provided to an individual with a disabili…
22 V.I.C. § 1801 Definitions
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(1) For the purposes of this subchapter the term,(1) “Children” means persons under the under eighteen years of age, or under twenty-one years of age if still attending high school.(2) “Hearing aid” means durable medical equipment that is of a design and circuitry to compensate f…
22 V.I.C. § 1802 Coverage for hearing aid
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(a) An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the Virgin Islands must provide coverage for a hearing aid and any related services for the full cost of one hearing aid pe…
22 V.I.C. § 1803 Additional coverage; benefits included
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(a) An insurer that delivers, issues for delivery or renews in the Virgin Islands an individual or group health insurance policy, health care plan or certificate of health insurance may make available to the policyholder the option of purchasing additional hearing aid coverage th…
22 V.I.C. § 1804 Deductibles and coinsurance
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Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
22 V.I.C. § 1805 Exclusions
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This subchapter does not apply to short-term travel, accident-only or limited or specified disease policies.
22 V.I.C. § 1901 Definitions
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(a) As used in this subchapter the term—(a) “Telemedicine” means the use of medical information exchanged from one distant site to another via electronic communications to improve, maintain, or assist patients’ health status. Videoconferencing, transmission of still images, and e…
22 V.I.C. § 1902 Mandatory plan coverage
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A health care insurer that offers, issues for delivery, delivers, executes, adjusts, uses, or renews a health care insurance plan shall provide coverage for the costs of telemedicine services and treatment that arc medically necessary.