Third-Party Administrator requirements
Who needs a license?
Businesses acting as a third-party administrator (TPA) must receive an Oregon
license. TPA activities include:
- Directly or indirectly soliciting or effecting life or health insurance
- Collecting charges or premiums from policyholders
- Adjusting claims
- Settling claims
The Insurance Division issues third-party administrator licenses for life and
health. Workers' compensation TPAs need to register with the Workers'
Compensation Division and hold a general lines adjuster
license issued by the Insurance Division. No adjuster license is needed
if the person works for an authorized insurer.
Assumed business names must be registered with the Secretary of State Corporation
Renewals of TPA licenses are required every other year.
The current license fee is $45.
If there has been a material change in ownership or control or in any other
matter affecting the qualification of the third-party administrator, you must
immediately notify the Insurance Division. Biographical affidavits are required
when there is any change of owner, partner, director, or officer.
To apply as a Third-Party Administrator
- Apply online at NIPR.com
- You will receive an email from the Insurance Division requesting documentation.
You can find the list of required documents here.
Click to view list.
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Each TPA shall file an annual report to the Insurance Division by March 1 of
each year, covering the previous calendar year. If your annual report is for
a time period other than a calendar year (e.g., fiscal year), you may submit
the most current financial statements as of March 1.
Please note the annual report is different from the renewal, which is required
every two years.
The annual report must:
- Be verified by at least two officers if the TPA is a corporation and by
two partners if the TPA is a partnership.
- Include a contact email
- Include the complete names and addresses of all insurers with which the
TPA had an agreement during the preceding fiscal year.
- Include a balance sheet and income statement for the immediately preceding
calendar year. Two officers or two partners must verify the balance sheet
and income statement.
Note: If consolidated reports are submitted, they must also include stand-alone
Quarterly health enrollment report
Licensed TPAs, and others, are required to submit information regarding covered
lives on a quarterly basis, or to file an exemption once per calendar year.
Information regarding the report may be found here.