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Polsinelli - Insurance Polsinelli - Insurance
         

  

May 2016

  

TPA Agreement Filing and Compliance Requirements

  

 
 

  

     

  

 
 

Third Party Administrators Professionals:

  

Steven L. Imber

913.234.7469

Email | Bio

  

Justin T. Liby

913.234.7427

Email | Bio

  

Jennifer Osborn Nix

913.234.7472

Email | Bio

  

  

To learn more about our Third Party Administrators practice, to contact one of our Third Party Administrators attorneys, or for more Third Party Administrators Intelligence, click here.

  

  


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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. To assist our TPA and insurer clients comply globally with all the TPA laws under the state insurance codes, we have created a national regulatory addendum, which contains the mandated statutory provisions.

The national regulatory addendum is available on a flat-fee basis. For more information regarding our national regulatory addendum, please contact the authors.

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.

For More Information

For questions regarding this information, please contact one of the authors, a member of Polsinelli’s Third Party Administrators practice, or your Polsinelli attorney.

 
 

  

     

  

 

 

  

     

  

 
 

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