§ 1728. Preferred Provider Organization
(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 no more than a reasonable co- payment by the patient […]
§ 1731. Definiitons
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 relationship between environment and behavior, to produce socially significant improvement in human behavior. (b) “Autism services provider” means any person, […]
§ 1732. Coverage for autism spectrum disorders
(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 are medically necessary and evidence-based. (b) Coverage required in health care […]
§ 1733. Prohibitions
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-pocket expense for such coverage which places a […]
§ 1734. Limitations; review of treatment plan; diagnosis period
(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 $25,000 for […]
§ 1735. Obligation to pay
(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 disability.
§ 1721. Purpose
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 of having to wait for a reimbursement of those costs. […]
§ 1722. Definitions
(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, osteopath, hospital, dentist, registered or licensed practical nurse, optometrist, podiatrist, physical therapist, psychologist, chiropractor, par-medical […]
§ 1723. Filing and approval
(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 any semi-autonomous agency or instrumentality of the Government […]