2019 US Virgin Islands Code
Title 22 - Insurance
Chapter 60 - Third Party Administrators
§ 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 receiving performance-based compensation for providing hospital or other auditing services, from providing managed care or related services, or from being compensated for subrogation expenses.
(b) It is unlawful for a payor to enter into an agreement with a TPA in violation of this section.
(c) This section does not prevent the compensation of a TPA from being based on premiums or charges collected or the number of claims paid or processed.
(d) It is unlawful for a TPA to receive from a payor, covered individual or beneficiary under a plan any compensation or other payments, except as expressly set forth in the agreement between the administrator and the payor.
