TPA Licensing

Initial and Renewal TPA License Application Submission Requirements 

Note: All TPA licenses must be renewed annually

Effective March 12, 2020: all TPA license application documentation, notice of change of ownership, and/or change of officer or directors must be submitted electronically using Citrix ShareFile Instructions and Citrix ShareFile Instructions for TPA license applications or via email to LHinbox@ncdoi.gov, or other secure electronic filing method, NO ZIP FILES. Payment of filing fees must be done separately via USPS or overnight at addresses provided in the Filing Instructions below. Please include a copy of the cover letter in order that payment may be attributed accurately. Paper filings or notifications will not be accepted. See below for information regarding TPA License Renewal Notices.

Renewal TPA License Application Submission Requirements

For Domestic and Non-Domestic TPA License Applications:

• TPA Transmittal Form TPA License Transmittal (TPATRN)
• TPA Application Form TPA License Application (TPAAPP)
• TPA Questionnaire TPA License Questionnaire (TPAQSN)
• List of TPA officers and directors and
  • Biographical affidavits required for new TPA officers or directors only - or if previously submitted affidavits need to be updated - TPA Biographical Affidavit (TPSBIO) or the NAIC Biographical Affidavit Form must be submitted for each individual
• By-laws of TPA only if updates are needed
• A list of insurance companies with which the TPA has administrative agreements including:
  • Insurer contact information only if updates are needed
  • Certification from an officer of the company stating that there is an administrative agreement for each insurer
  • Acknowledgment that if the Commissioner of Insurance requests a copy of an administrative agreement, it will be provided within 10 business days
• Organizational documents of TPA, such as articles of incorporation, partnership agreement, etc. including all amendments only if updates are needed
• Financial statements for the last two fiscal years, prepared by an independent CPA
• Narrative discussing internal controls of TPA operations TPA License Internal Control (TPAICT) only if updates are needed
• General description of business operations only if updates are needed
• Evidence that the TPA employs a licensed agent, ONLY if the TPA solicits new or renewal insured business in North Carolina
• $300 license fee
• Evidence of current E&O or liability insurance
• Current authorization to act on behalf of TPA, if TPA license renewal is being made by a third party.

In addition, for Non-Domestic TPA License Applications Only:

• Copy of current domestic license

Initial TPA License Application Submission Requirements

For Domestic and Non-Domestic TPA License Applications:

• TPA Transmittal Form TPA License Transmittal (TPATRN)
• TPA Application Form TPA License Application (TPAAPP)
• TPA Questionnaire TPA License Questionnaire (TPAQSN)
• List of TPA officers and directors and
  • Biographical affidavits required for all TPA officers or directors - TPA Biographical Affidavit (TPABIO) or the NAIC Biographical Affidavit Form must be submitted for each individual
• By-laws of TPA 
• A list of insurance companies with which the TPA has administrative agreements including:
  • Insurer contact information 
  • Certification from an officer of the company stating that there is an administrative agreement for each insurer
  • Acknowledgment that if the Commissioner of Insurance requests a copy of an administrative agreement, it will be provided within 10 business days
• Organizational documents of TPA, such as articles of incorporation, partnership agreement, etc. including all amendments
• Financial statements for the last two fiscal years, prepared by an independent CPA
• Narrative discussing internal controls of TPA operations TPA License Internal Control (TPAICT)
• General description of business operations
• Evidence that the TPA employs a licensed agent, ONLY if the TPA solicits new or renewal insured business in North Carolina
• $300 license fee
• Evidence of current E&O or liability insurance
• Current authorization to act on behalf of TPA, if TPA license renewal is being made by a third party.

In addition, for Non-Domestic TPA License Applications Only:

• Copy of current domestic license
• Executed copy of the administrator's power of attorney 
  • TPA Power of Attorney for Company (TPAPOA)
  • TPA Power of Attorney for Limited Liability Company (TPALLC)  
  • TPA Power of Attorney for Partnership (TPAPPA)

See TPA License Transmittal form (TPATRN) for details regarding the above listed requirements.

TPA License Transmittal Form