Third Party Administrator
Frequently Asked Questions
Is a surety bond required?
A surety bond is required if the applicant administers or will administer self-funded health plans subject to regulation under Chapter 40 or 41, Title 41, Idaho Code
Our firm adjusts P & C claims. Are we required to be licensed as a Third Party Administrator?
No. Idaho Code defines “third party administrator” as any person who directly or indirectly underwrites, collects charges or premiums from or adjusts or settles claims on residents of this state in connection with life, annuity or health insurance coverage.
Please contact Licensing regarding an MGA license.
The plan we administer is in another state, with only five covered lives in the State of Idaho. Are we required to license as a TPA in Idaho?
If you are licensed in your home state, most likely the answer is no. A nonresident administrator is not required to hold a nonresident administrator license in this state if the administrator is licensed in its home state and the administrator's duties in this state are limited to:
- the administration of a group policy or plan of insurance and no more than a total of 20% of covered persons, for all plans the administrator services, reside in this state; and
- the total number of covered persons residing in this state is less than one hundred (100).
When will my TPA license expire?
A TPA's original license will expire on December 31 of the year following its issuance. Subsequent renewals are made for two (2) year periods. For example, if a TPA was initially licensed effective March 1, 2011, that license would expire on December 31, 2012. A license renewal form (and fee) would then be required to filed with DOI on or before the expiration date of December 31, 2012. The renewal form filed on December 31, 2012 would cover a two (2) year period, which would expire on December 31, 2014 (see , Idaho Code).