2019 US Virgin Islands Code
Title 22 - Insurance
Chapter 60 - Third Party Administrators
§ 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 company representatives who are the applicant’s contact for department communications regarding licensure and related filings, consumer complaints and the required statutory deposit;

• (2) unless a TPA who is a nonresident of Virgin Islands is notified by the Commissioner that the Commissioner is able to verify the TPA’s home state certificate of authority or license status through an electronic database maintained by the NAIC, an annual statement filed by nonresident TPA, its affiliates, or subsidiaries, from the nonresident’s home state’s licensing authority stating that its home state TPA certificate of authority or license remains in force and has not been revoked or suspended by its home state during the preceding year.

• (3) all basic organizational documents of the applicant, including any articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement and any other documents governing the operation of applicant that are applicable to the applicant’s form of business organization and all amendments to such documents;

• (4) a copy of the executed bylaws, rules, regulations or similar documents regulating the operation of the applicant’s internal affairs;

• (5) the names, addresses and official positions of the persons responsible for the conduct of the affairs of the applicant, including, but not limited to each member of the board of directors, board of trustees, executive committee, or other governing board or committee; the principal officers in the case of a corporation or the partners or members in the case of a partnership, association or limited liability company; any shareholders or member holding directly or indirectly 10 percent or more of the voting stock, voting securities or voting interest of the applicant; any person who loaned funds to the applicant for the operation of the business; and any other person who exercises control or influence over the affairs of the applicant;

• (6) a fully completed and notarized biographical affidavit for each individual who is listed in paragraph (5);

• (7) annual financial statements or reports, prepared in accordance with GAAP and audited by an independent certified public accountant, for the two most recent fiscal years that prove that the applicant has a positive net worth. If the financial affairs of the applicant’s parent company are audited by an independent certified public accountant, but those of the applicant are not, then a copy of the most recent audited financial statement of the applicant’s parent company, audited by an independent certified public accountant, must be submitted. A consolidated financial statement of the applicant and the parent company satisfies this requirement unless the Commissioner determines that additional or more recent information is required for the proper administration of this chapter. If the applicant has been in existence for less than two fiscal years, the application must include financial statements or reports, certified by an officer of the applicant and prepared in accordance with GAAP, for any completed fiscal years, and for any month during the current fiscal year for which such financial statements or reports have been completed. An audited financial or annual report prepared on a consolidated basis must include a columnar consolidating or combining worksheet that must be filed with the report and include the following:

  • (A) amounts shown on the consolidated audited financial report must be shown on the worksheet;

  • (B) amounts for each entity must be stated separately; and

  • (C) explanations of consolidating and eliminating entries must be included. The applicant shall also include such other information as the Commissioner may require to review the current financial condition of the applicant;

• (8) a copy of the applicant’s business plan that includes, but is not limited to, information on staffing levels and activities proposed in the Virgin Islands and nationwide. The plan must provide details setting forth the applicant’s source of initial funding, and a statement of the applicant’s qualifications and capability to carry out the plan and for providing a sufficient number of experienced and qualified personnel in the areas of claims processing, record keeping, and underwriting;

• (9) a list of benefit payors under contract with the applicant and a copy of the standard contract or contracts used by the applicant in the course of business;

• (10) a resolution duly executed by the applicant, appointing the Commissioner and the Commissioner’s successor in office as the true and lawful agent of the applicant in and for the Virgin Islands upon whom all lawful process in any legal action, or proceeding against the organization on a cause of action arising in the Virgin Islands may be served;

• (11) a non-refundable filing fee and a license fee to be established by the Commissioner; and

• (12) other pertinent information as may be required by the Commissioner.

(c) A TPA licensed or applying for licensure under this section shall make available for inspection to the Commissioner copies of all contracts with payors or other persons utilizing the services of the TPA.

(d) A TPA licensed or applying for licensure under this section shall produce its accounts, records and files for examination, and make its officers available to give information with respect to its affairs, as often as reasonably required by the Commissioner.

(e) The Commissioner may refuse to issue a license if the Commissioner determines that the TPA or any individual responsible for the conduct of affairs of the TPA is not competent, trustworthy, financially responsible or of good personal and business reputation, or has had an insurance or a TPA certificate of authority or license denied or revoked for cause by any jurisdiction, or if the Commissioner determines that any of the grounds set forth in section 1539 of this chapter exists with respect to the TPA.

(f) Unless surrendered, suspended or revoked by the Commissioner, a license issued under this section remains valid for so long as the TPA continues in business in the Virgin Islands, if the holder of the license maintains a valid bond as required by section 1534 and pays the annual fee to be established from time to time by the Commissioner prior to the anniversary date of the license, and remains in compliance with this chapter.,

(g) A TPA licensed or applying for licensure under this section shall notify the Commissioner within 30 days after any material change in its ownership, control, contact person for the TPA or other fact or circumstance affecting its qualification for a license in the Virgin Islands. The Commissioner shall report any such changes to the appropriate electronic database maintained by the AIC or its affiliates.

(h) A TPA who is a non-resident of the Virgin Islands is not eligible for a TPA license under this section if it does not hold a home state certificate of authority or license in a state that has adopted the NAIC Third Party Administrator Model Law or a state that applies substantially similar provisions as are contained in that Model Law to that TPA. If the TPA act, in the TPA’s home state does not extend to stop-loss insurance, but if the home state otherwise applies substantially similar provisions as are contained in the Model Law to that TPA, then that omission does not operate to disqualify the TPA from receiving a TPA license in the Virgin Islands.

(i) Each license must contain the name, business address, an assigned identification number for the applicant, the issue date, date of expiration and any other information the Commissioner considers necessary.

(j) A TPA license may not be issued to TPAs who are not domiciled in the United States, District of Columbia, Commonwealth of Puerto Rico or in some territory of the United States.