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Third Party Administrator Agreement Filing and Compliance Requirements

The NAIC Model Third Party Administrator Act and almost every state that has enacted laws regulating TPAs require such agreements to comply with the following:

  • The TPA shall not act without a written agreement between a TPA and the insurer.

  • The written agreement must contain all the provisions required by state TPA laws.

  • The written agreement must be retained as part of the official records of both the insurer and the TPA for the duration of the agreement and for a prescribed number of years thereafter.

While almost every state that has enacted TPA laws imposes the above requirements pertaining to administrative service agreements, there are a number of states that also have affirmative requirements to file the agreements with state insurance regulators or report the existence of such agreements to the regulators within prescribed time periods. 

The national regulatory addendum is available on a flat-fee basis. 

Additionally, below are some examples of the affirmative requirements to file the written agreements with state insurance regulators or report the existence of such agreements to the regulators:

Nevada

Pursuant to Nev. Admin. Code § 683A.1215, TPAs must provide the Nevada Division of Insurance a copy of each agreement the TPA enters into with an insurer within 90 days after the effective date of the agreement. The Nevada Division of Insurance has recently been following up with TPAs to confirm that the Division has received copies of each agreement the TPA has listed in its Annual Report.

Tennessee

Pursuant to Tenn. Code § 56-6-402, TPAs must file each administrative service agreement with the Tennessee Insurance Department for its review and approval prior to the agreement being utilized in Tennessee.

Florida

Pursuant to a signed affidavit submitted with a TPA's application to the Florida Office of Insurance Regulation, a TPA agrees that they will submit all administrative agreements within 30 days of execution for the first year after licensure as a TPA in Florida.

Louisiana

Pursuant to La. Stat. § 22:1651, entering into a TPA service agreement is a material change requiring a TPA to submit notice to the Louisiana Insurance Department within 60 days.

Minnesota

Minn. R. 2767.0700 requires TPAs to notify the Minnesota Insurance Department within 30 days of signing a new TPA service agreement.

© Polsinelli PC, Polsinelli LLP in California

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About this Author

Steven L. Imber, Polsinelli PC, Insurance Regulatory Attorney, Enforcement Actions Lawyer,
Shareholder

Steve Imber chairs Polsinelli's Insurance Business and Regulatory group.  As a former General Counsel at a state insurance department, Steve Imber has the knowledge and experience to provide quality counsel to insurers, third party administrators, insurance agencies, medical discount plans and other insurance regulated entities. His practice includes representing and assisting clients on multi-state and national licensing projects, research projects, enforcement actions, market conduct examinations, audits and compliance programs and various other regulatory and...

913.234.7469
Shareholder

Justin Liby has a talent for organizing and managing large national and multi-state licensure and research projects. This knack provides him with a solid foundation for crafting and implementing sound, efficient strategies that achieve success for his clients. Justin concentrates his efforts on helping the insurance industry navigate the formidable federal and state regulatory maze to achieve the industry’s business needs. He stays current in the insurance industry's evolution, as well as the legislation and regulatory activity impacting the industry.

Justin is a former regulator for the Kansas Insurance Department and in-house counsel for a national third-party administrator.

913-234-7427
Counsel

Jennifer Osborn Nix works diligently for insurance companies, third-party administrators, and other regulated entities to further their goals and help them remain compliant within the 50-state regulatory scheme. She focuses on insurance regulatory and compliance issues, with a primary emphasis on life and health insurance matters.

Jennifer works with many regulated entities, including many in the health care sector, who rely on her for research, advice, strategic counsel, and licensing.

913.234.7472