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 coverage
- Collecting charges or premiums from policyholders
- Adjusting claims
- Settling claims
The Division of Financial Regulation 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 Division of Financial Regulation. 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 Division.
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.
Apply as a third-party administrator
- Apply online at NIPR.com
- You will receive an email from the Division of Financial Regulation requesting documentation. The list of required documents is below.
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 of the following:
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
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 nonresident applicants.
Each TPA must file an annual report to the Division of Financial Regulation 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.
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. Two officers or two partners must verify the balance sheet and income statement.
- 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.
Note: If consolidated reports are submitted, they must also include stand-alone financials.
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.