TPA Licensing

All TPA's must renew their license each year.

The following forms are required to be submitted with every annual TPA license renewal submission:

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:

See TPA transmittal form for details of the above listed requirements.

Filing Instructions - Information

Filing Instructions - Information

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.

Mailing Address:

Regular 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

Include a self-addressed envelope for return of license. If you have any questions, contact LHinbox@ncdoi.gov or at 919-807-6057

Renewal Information

Renewal Information

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.