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.
- Names, addresses, official positions, and professional qualifications
of the individuals who are responsible for the conduct of the third-party
administrator. This includes:
- All members of the board of directors, board of trustees,
executive committee, or other governing board or committee;
- Corporation's principal officers or partnership or
association's partners or members;
- Shareholders holding directly or indirectly 10 percent
or more of the voting securities of the administrator; and
- Any other person who exercises control or influence
over the affairs of the administrator.
- Biographical information for each owner, partner, director,
and officer of the applicant, using the Biographical Affidavit from
designed by NAIC.
- All basic organizational documents of the applicant, including
articles of incorporation, articles of association, partnership
agreements, trade name certificates, trust agreements, shareholder
agreements, and all amendments to such documents.*
- The bylaws, rules, and regulations or similar documents regulating
the internal affairs of the applicant.*
- Annual stand-alone financial statements or reports for
the past two years and the most current quarterly stand-alone
financial statement. Provide the name and telephone number of a
contact person who is knowledgeable about the preparation of the
reports or financial statements being filed.
- A statement describing the business plan, including information
on staffing levels and activities proposed in Oregon and nationwide.
The plan must provide details about the applicant's ability to provide
a sufficient number of experienced and qualified personnel in the
areas of claims processing, recordkeeping, and underwriting.
- Evidence that the applicant has a fiduciary account established
in a federally or state-insured financial institution. The evidence
may be a bank statement or a letter from the bank verifying the
existence of a bank account.
- Evidence of current errors and omissions insurance in the minimum
amount of $500,000 for claims made or per occurrence. The insurance
must cover errors, omissions, and violations of fiduciary responsibility
by the TPA, its employee, or both. The evidence must include policy
language indicating that TPA activities are covered.
- Any applicant that will be managing the solicitation of new
or renewal business must submit proof that the applicant employs
or has contracted with an agent licensed by the Insurance Division
for solicitation and taking of applications. Any applicant who intends
to directly solicit insurance contracts or to otherwise act as an
insurance agent must provide proof that they are licensed as an
agent in Oregon.
* These items are not required for non-resident applicants.
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.