Third Party Administrator (Life/Health)

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WHAT IS A LIFE AND HEALTH ADMINISTRATOR (OR TPA)?

A life and health administrator, also know as a third-party administrator ("TPA") collects money or processes claims for residents of Arizona in connection with life or health insurance coverage.  Arizona Revised Statutes ("ARS") § 20-485 provides a full definition, including the types of entities that are not considered TPAs.

WHO MUST BE LICENSED?

Before applying to register a TPA, review the exemptions from the registration requirements, review the entities listed in ARS § 20-485(A)(1), which are listed on the first page of Form E-100: Application for Life and Health Administrator Registration, to determine whether you are excluded from TPA registration requirements. 

  • If you are adjusting property and casualty claims, you need to be licensed as an adjuster (click here for requirements).
  • If you are administering workers compensation claims, contact the Industrial Commission of Arizona.
  • If you are a motor vehicle service contract administrator, Arizona does not have a licensing/registration requirement; however, you or the insurer must file motor vehicle service contracts with the Department and you or the insurer must post a surety bond with the Department's Financial Affairs Division. ARS § 20-1095.06
  • Arizona does not have jurisdiction (and no license is required) if you are only administering ERISA plans (a self-insured program operated by a single employer for the benefit of its employees or the employees of a wholly-owned subsidiary).

Arizona law does not distinguish between TPAs that are organized within Arizona from TPAs organized in other states.  The entity must be formed or registered with the Arizona Corporation Commission (http://www.azcc.gov/Default.htm) and registered with the Arizona Department of Insurance unless exempt from registration requirements. 

Form E-100: Application for Life and Health Administrator Registration

Before applying, carefully read the instruction sheet provided on the first page to determine whether you are required to register as a third party administrator.

NAIC Form 11: BIographical Affidavit

Must be completed by each partner, officer, and director, and each other individual owning 10% or more of a TPA  applicant.  ARS § 20-485.12(B)(5)

Form L157: Bond of Life and Health Administrator

Face amount must equal the greater of either (A) 10% of total funds handled for life and health coverage of Arizona residents, or (B) $5,000. Funds handled includes premiums collected for and/or claims paid on behalf of an insurer.  Submit with power of attorney. ARS § 20-485.10

Form E-100-A: Life and Health Administrator Registration Addendum

If the applicant uses any name or has any office other than those reported in Section A or B of Form E-100, use this form to report the applicant's complete name and address for all offices in each jurisdiction.  ARS § 20-485.12(B)(6).

TPA Registration Application Checklist

To ensure your application is complete, correct, and meets all registration requirements so the Department can promptly issue a Certificate of Registration, use this document to check your application before you submit it.  The Department uses this document when reviewing applications.

TPA Renewal Application Checklist

Due Date:  March 1. 

You may submit your renewal application after January 1, but the renewal application must be received by the Department of Insurance by March 1. 

Form 111: TPA Financial Statement

Must be certified by two officers of the applicant.  Must be current within 90 days of application filing date.  ARS § 20-485.12(B)(1)(a) and (b)

ARS § 41-1030(G) requires most Arizona government agencies to prominently print the provisions of ARS § 41-1030(B), (D), (E) and (F) on all license applications.  The following is the language in ARS § 41-1030(B), (D), (E) and (F):

B.        An agency shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically authorized by statute, rule or state tribal gaming compact. A general grant of authority in statute does not constitute a basis for imposing a licensing requirement or condition unless a rule is made pursuant to that general grant of authority that specifically authorizes the requirement or condition.

D.        This section may be enforced in a private civil action and relief may be awarded against the state.  The court may award reasonable attorney fees, damages and all fees associated with the license application to a party that prevails in an action against the state for a violation of this section.

E.        A state employee may not intentionally or knowingly violate this section.  A violation of this section is cause for disciplinary action or dismissal pursuant to the agency’s adopted personnel policy.

F.         This section does not abrogate the immunity provided by section 12-820.01 or 12-820.02.