(a) No person shall actas, offer to act as, or hold himself or herself out as a TPA in this Statewithout a valid TPA license issued by the Commissioner. Licenses shall berenewed annually. Failure to submit a complete renewal application shall resultin the expiration of the license of the TPA as a matter of law; provided,however, the Commissioner may grant the TPA an extension of time for goodcause.
(b) Each applicationfor the issuance or renewal of a license shall be made upon a form prescribedby the Commissioner and shall be accompanied by a nonrefundable filing fee ofthree hundred dollars ($300.00) and evidence of maintenance of a fidelity bond,errors and omissions liability insurance, or other security, of a type and inan amount to be determined by rules of the Commissioner. Applications forissuance of licenses shall include or be accompanied by the followinginformation and documents:
(1) All organizationaldocuments of the TPA, including any articles of incorporation, articles ofassociation, partnership agreement, trade name certificate, or trust agreement,any other applicable documents, and all amendments to these documents.
(2) The bylaws, rules,regulations, or similar documents regulating the internal affairs of the TPA.
(3) The names,addresses, official positions, and professional qualifications of theindividuals who are responsible for the conduct of affairs of the TPA,including all (i) members of the board of directors, board of trustees,executive committee, or other governing board or committee, (ii) the principalofficers in the case of a corporation or the partners or members in the case ofa partnership or association, (iii) all shareholders holding directly orindirectly ten percent (10%) or more of the voting securities of the TPA, and(iv) any other person who exercises control or influence over the affairs ofthe TPA.
(4) Annual financialstatements or reports for the two most recent years that prove that theapplicant is solvent and any other information the Commissioner may require inorder to review the current financial condition of the applicant.
(5) A generaldescription of the business operations, including information on staffinglevels and activities proposed in this State and nationwide. The descriptionmust provide details setting forth the TPA's capability for providing asufficient number of experienced and qualified personnel in the areas of claimsprocessing, record keeping, and underwriting.
(6) If the applicantwill be managing the solicitation of new or renewal business, evidence that itemploys or has contracted with an agent licensed by this State for solicitingand taking applications. Any applicant that intends to directly solicitinsurance contracts or to otherwise act as an insurance agent must provideproof of having a license as an insurance agent in this State.
(7) Any other pertinentinformation required by rules of the Commissioner.
The information required bysubdivisions (1) through (7) of this subsection, including any trade secrets,shall be kept confidential; provided that the Commissioner may use thatinformation in any judicial or administrative proceeding instituted against theTPA. Applications for renewals of licenses shall include or be accompanied byany changes in the information required by subdivisions (1) through (7) of thissubsection.
(c) Each applicantshall make available for inspection by the Commissioner copies of all contractswith insurers or other persons using the services of the TPA.
(d) The Commissionermay refuse to issue a license if the Commissioner determines that the TPA, orany individual responsible for the conduct of affairs of the TPA as defined insubdivision (b)(3) of this section, is not competent, trustworthy, financiallyresponsible in accordance with subsection (b) of this section, or of goodpersonal and business reputation, or has had an insurance or a TPA licensedenied, suspended, or revoked for cause by any state.
(e) A TPA is notrequired to be licensed as a TPA in this state if all of the followingconditions are met:
(1) The TPA's principalplace of business is in another state.
(2) The TPA is notsoliciting business as a TPA in this State.
(3) In the case of anygroup policy or plan of insurance serviced by the TPA, no more than either fivepercent (5%) or 100 certificate holders, whichever is fewer, reside in thisState.
(f) A person is notrequired to be licensed as a TPA in this State if the person provides servicesexclusively to one or more bona fide employee benefit plans each of which isestablished by an employer, an employee organization, or both, and for whichthe insurance laws of this State are preempted pursuant to the EmployeeRetirement Income Security Act of 1974. Persons who are not required to belicensed shall register with the Commissioner annually, verifying their statusas described in this subsection. Failure to submit an annual verification shallresult in the expiration of the registration of the TPA as a matter of law;provided, however, the Commissioner may grant the TPA an extension of time forgood cause.
(g) A TPA shall notifythe Commissioner of any material change in its ownership, control, or otherfact or circumstance affecting its qualification for a license in this State,within 10 business days after the change.
(h) No bonding shall berequired by the Commissioner of any TPA whose business is restricted solely tobenefit plans that are either fully insured by an authorized insurer or thatare bona fide employee benefit plans established by an employer, any employeeorganization, or both, for which the insurance laws of this State are preemptedpursuant to the Employee Retirement Income Security Act of 1974. (1991, c. 627, s. 1; 2007‑298,ss. 7.4, 7.5; 2007‑484, s. 43.5; 2009‑451, s. 21.16(a).)
(a) No person shall actas, offer to act as, or hold himself or herself out as a TPA in this Statewithout a valid TPA license issued by the Commissioner. Licenses shall berenewed annually. Failure to submit a complete renewal application shall resultin the expiration of the license of the TPA as a matter of law; provided,however, the Commissioner may grant the TPA an extension of time for goodcause.
(b) Each applicationfor the issuance or renewal of a license shall be made upon a form prescribedby the Commissioner and shall be accompanied by a nonrefundable filing fee ofthree hundred dollars ($300.00) and evidence of maintenance of a fidelity bond,errors and omissions liability insurance, or other security, of a type and inan amount to be determined by rules of the Commissioner. Applications forissuance of licenses shall include or be accompanied by the followinginformation and documents:
(1) All organizationaldocuments of the TPA, including any articles of incorporation, articles ofassociation, partnership agreement, trade name certificate, or trust agreement,any other applicable documents, and all amendments to these documents.
(2) The bylaws, rules,regulations, or similar documents regulating the internal affairs of the TPA.
(3) The names,addresses, official positions, and professional qualifications of theindividuals who are responsible for the conduct of affairs of the TPA,including all (i) members of the board of directors, board of trustees,executive committee, or other governing board or committee, (ii) the principalofficers in the case of a corporation or the partners or members in the case ofa partnership or association, (iii) all shareholders holding directly orindirectly ten percent (10%) or more of the voting securities of the TPA, and(iv) any other person who exercises control or influence over the affairs ofthe TPA.
(4) Annual financialstatements or reports for the two most recent years that prove that theapplicant is solvent and any other information the Commissioner may require inorder to review the current financial condition of the applicant.
(5) A generaldescription of the business operations, including information on staffinglevels and activities proposed in this State and nationwide. The descriptionmust provide details setting forth the TPA's capability for providing asufficient number of experienced and qualified personnel in the areas of claimsprocessing, record keeping, and underwriting.
(6) If the applicantwill be managing the solicitation of new or renewal business, evidence that itemploys or has contracted with an agent licensed by this State for solicitingand taking applications. Any applicant that intends to directly solicitinsurance contracts or to otherwise act as an insurance agent must provideproof of having a license as an insurance agent in this State.
(7) Any other pertinentinformation required by rules of the Commissioner.
The information required bysubdivisions (1) through (7) of this subsection, including any trade secrets,shall be kept confidential; provided that the Commissioner may use thatinformation in any judicial or administrative proceeding instituted against theTPA. Applications for renewals of licenses shall include or be accompanied byany changes in the information required by subdivisions (1) through (7) of thissubsection.
(c) Each applicantshall make available for inspection by the Commissioner copies of all contractswith insurers or other persons using the services of the TPA.
(d) The Commissionermay refuse to issue a license if the Commissioner determines that the TPA, orany individual responsible for the conduct of affairs of the TPA as defined insubdivision (b)(3) of this section, is not competent, trustworthy, financiallyresponsible in accordance with subsection (b) of this section, or of goodpersonal and business reputation, or has had an insurance or a TPA licensedenied, suspended, or revoked for cause by any state.
(e) A TPA is notrequired to be licensed as a TPA in this state if all of the followingconditions are met:
(1) The TPA's principalplace of business is in another state.
(2) The TPA is notsoliciting business as a TPA in this State.
(3) In the case of anygroup policy or plan of insurance serviced by the TPA, no more than either fivepercent (5%) or 100 certificate holders, whichever is fewer, reside in thisState.
(f) A person is notrequired to be licensed as a TPA in this State if the person provides servicesexclusively to one or more bona fide employee benefit plans each of which isestablished by an employer, an employee organization, or both, and for whichthe insurance laws of this State are preempted pursuant to the EmployeeRetirement Income Security Act of 1974. Persons who are not required to belicensed shall register with the Commissioner annually, verifying their statusas described in this subsection. Failure to submit an annual verification shallresult in the expiration of the registration of the TPA as a matter of law;provided, however, the Commissioner may grant the TPA an extension of time forgood cause.
(g) A TPA shall notifythe Commissioner of any material change in its ownership, control, or otherfact or circumstance affecting its qualification for a license in this State,within 10 business days after the change.
(h) No bonding shall berequired by the Commissioner of any TPA whose business is restricted solely tobenefit plans that are either fully insured by an authorized insurer or thatare bona fide employee benefit plans established by an employer, any employeeorganization, or both, for which the insurance laws of this State are preemptedpursuant to the Employee Retirement Income Security Act of 1974. (1991, c. 627, s. 1; 2007‑298,ss. 7.4, 7.5; 2007‑484, s. 43.5; 2009‑451, s. 21.16(a).)
(a) No person shall actas, offer to act as, or hold himself or herself out as a TPA in this Statewithout a valid TPA license issued by the Commissioner. Licenses shall berenewed annually. Failure to submit a complete renewal application shall resultin the expiration of the license of the TPA as a matter of law; provided,however, the Commissioner may grant the TPA an extension of time for goodcause.
(b) Each applicationfor the issuance or renewal of a license shall be made upon a form prescribedby the Commissioner and shall be accompanied by a nonrefundable filing fee ofthree hundred dollars ($300.00) and evidence of maintenance of a fidelity bond,errors and omissions liability insurance, or other security, of a type and inan amount to be determined by rules of the Commissioner. Applications forissuance of licenses shall include or be accompanied by the followinginformation and documents:
(1) All organizationaldocuments of the TPA, including any articles of incorporation, articles ofassociation, partnership agreement, trade name certificate, or trust agreement,any other applicable documents, and all amendments to these documents.
(2) The bylaws, rules,regulations, or similar documents regulating the internal affairs of the TPA.
(3) The names,addresses, official positions, and professional qualifications of theindividuals who are responsible for the conduct of affairs of the TPA,including all (i) members of the board of directors, board of trustees,executive committee, or other governing board or committee, (ii) the principalofficers in the case of a corporation or the partners or members in the case ofa partnership or association, (iii) all shareholders holding directly orindirectly ten percent (10%) or more of the voting securities of the TPA, and(iv) any other person who exercises control or influence over the affairs ofthe TPA.
(4) Annual financialstatements or reports for the two most recent years that prove that theapplicant is solvent and any other information the Commissioner may require inorder to review the current financial condition of the applicant.
(5) A generaldescription of the business operations, including information on staffinglevels and activities proposed in this State and nationwide. The descriptionmust provide details setting forth the TPA's capability for providing asufficient number of experienced and qualified personnel in the areas of claimsprocessing, record keeping, and underwriting.
(6) If the applicantwill be managing the solicitation of new or renewal business, evidence that itemploys or has contracted with an agent licensed by this State for solicitingand taking applications. Any applicant that intends to directly solicitinsurance contracts or to otherwise act as an insurance agent must provideproof of having a license as an insurance agent in this State.
(7) Any other pertinentinformation required by rules of the Commissioner.
The information required bysubdivisions (1) through (7) of this subsection, including any trade secrets,shall be kept confidential; provided that the Commissioner may use thatinformation in any judicial or administrative proceeding instituted against theTPA. Applications for renewals of licenses shall include or be accompanied byany changes in the information required by subdivisions (1) through (7) of thissubsection.
(c) Each applicantshall make available for inspection by the Commissioner copies of all contractswith insurers or other persons using the services of the TPA.
(d) The Commissionermay refuse to issue a license if the Commissioner determines that the TPA, orany individual responsible for the conduct of affairs of the TPA as defined insubdivision (b)(3) of this section, is not competent, trustworthy, financiallyresponsible in accordance with subsection (b) of this section, or of goodpersonal and business reputation, or has had an insurance or a TPA licensedenied, suspended, or revoked for cause by any state.
(e) A TPA is notrequired to be licensed as a TPA in this state if all of the followingconditions are met:
(1) The TPA's principalplace of business is in another state.
(2) The TPA is notsoliciting business as a TPA in this State.
(3) In the case of anygroup policy or plan of insurance serviced by the TPA, no more than either fivepercent (5%) or 100 certificate holders, whichever is fewer, reside in thisState.
(f) A person is notrequired to be licensed as a TPA in this State if the person provides servicesexclusively to one or more bona fide employee benefit plans each of which isestablished by an employer, an employee organization, or both, and for whichthe insurance laws of this State are preempted pursuant to the EmployeeRetirement Income Security Act of 1974. Persons who are not required to belicensed shall register with the Commissioner annually, verifying their statusas described in this subsection. Failure to submit an annual verification shallresult in the expiration of the registration of the TPA as a matter of law;provided, however, the Commissioner may grant the TPA an extension of time forgood cause.
(g) A TPA shall notifythe Commissioner of any material change in its ownership, control, or otherfact or circumstance affecting its qualification for a license in this State,within 10 business days after the change.
(h) No bonding shall berequired by the Commissioner of any TPA whose business is restricted solely tobenefit plans that are either fully insured by an authorized insurer or thatare bona fide employee benefit plans established by an employer, any employeeorganization, or both, for which the insurance laws of this State are preemptedpursuant to the Employee Retirement Income Security Act of 1974. (1991, c. 627, s. 1; 2007‑298,ss. 7.4, 7.5; 2007‑484, s. 43.5; 2009‑451, s. 21.16(a).)
