§ 1520. Short title

This chapter maybe cited as “The Virgin Islands Third Party Administrators Act”.

§ 1522. Licensing necessary

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 business as a […]

§ 1523. Payment to a TPA

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 […]

§ 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 […]

§ 1528. Payment of claims, fiduciary duties of TPA

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 designated as a CASA. All claims paid by the […]

§ 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 […]

§ 1534. Bond requirement for TPAs

(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 continuous and in one of […]

§ 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 […]

§ 1536. Standards for license issuance and approval of registration

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 by this chapter or by the Commissioner have been filed; […]

§ 1537. Annual report and filing fee

(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 in the form prescribed by the […]

§ 1538. Examinations

(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 all books, records, documents and other papers relating to the TPA’s […]

§ 1539. Grounds for denial, suspension or revocation of licensure

(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 using such methods or […]

§ 1540. Administrative fine

(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 fine upon a TPA not to […]