All TPA's must renew their license each year
Effective March 12, 2020, all TPA license applications, notice of change of ownership, and/or change of officer or directors must be submitted electronically to LHinbox@ncdoi.gov or Citrix Sharefile, or other secure electronic filing method, NO ZIP FILES. Payment of filing fees must be done separately via USPS or overnight at addresses shown 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 for the immediate future.
The following forms are required to be submitted with every annual TPA license renewal submission:
- TPA Transmittal Form TPA License Transmittal (TPRTRN)
- TPA Application Form TPA License Application (TPAAPP)
- TPA Questionnaire TPA License Questionnaire (TPAQSN)
The following items must be included with every annual TPA license renewal submission:
- A list of the TPA officers and directors
- A list of insurance companies with which the TPA has administrative agreements & certification that company will provide signed copy if requested.
- Financial statements for the last two fiscal years, prepared by an independent CPA
- Current evidence that the TPA employs a licensed agent, ONLY if the TPA solicits new or renewal insured business
- $300 filing fee
- Current evidence of E&O or liability insurance
- Copy of current domestic license - ONLY if TPA is a non-domestic company
For an initial TPA license submission, or if information on these documents has changed since your last renewal, the following items are required with your TPA license submission:
- Biographical affidavits of TPA officers and directors - TPA Biographical Affidavit (TPABIO) or the NAIC Biographical Affidavit Form
- By-laws of TPA
- Organizational documents of TPA, such as articles of incorporation, partnership agreement, etc., including all amendments.
- Narrative discussing internal controls of TPA operations TPA License Internal Control (TPAICT)
- General description of business operations
- Executed copy of the administrator's power of attorney, ONLY for non-domestic TPA
See TPA transmittal form for details of the above listed requirements.
Submission of License TPA Application
Send Initial or Renewal application forms and documentation electronically, using Citrix ShareFile Instructions or electronically to LHinbox@ncdoi.gov. If the TPA uses its own secure filing method, we will accept that. We cannot download Zip Files. Filing Fee of $300 must be sent by mail.
NCDOI/Life & Health Division
1201 Mail Service Center
Raleigh, NC 27699-1201
Overnight Mail (ONLY)
NCDOI/ Life & Health Division
325 N. Salisbury Street
Raleigh, NC 27603
Notices for renewal of a TPA License are sent by the Department approximately 45 days prior to the expiration of the current license. The TPA must maintain a current active email account to which the Renewal Notice will be sent. If an individual’s email is used, we must be notified within 10 business days of a change to that email, pursuant to NCGS 58-56-51(g), it is for this reason we recommend a general email account for TPA.
All TPA information in our files are confidential, pursuant to NCGS 58-56-51, therefore; a third party filer should not be used for the renewal contract.