§ 1535. Registration requirement
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 provided by a self-funded plan other than a governmental […]
§ 1529. TPA’s fiduciary duties regarding the TPATFA and the CASA
(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 the TPA misappropriated fiduciary funds and has acted in a financially […]
§ 1530. Compensation to the TPA
(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 does not prohibit a TPA from […]
§ 1531. Disclosure of charges and fees
(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 payor. (b) The TPA shall […]
§ 1532. Delivery of materials to covered individuals
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. All policies, certificates, booklets, termination notices or other written communications must conform to […]
§ 1533. TPA’s application for licensure
(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) the names, titles and contact information for all authorized […]
§ 1524. Maintenance of information
(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 insurance record keeping and must be maintained […]
§ 1525. Approval of advertising
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 obtain the client’s […]
§ 1526. Responsibilities of the payor and TPA
(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 insofar as the TPA […]
§ 1527. Collection of premium, fiduciary duties of TPA
(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 capacity. The funds may […]