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  State of Idaho
Department of Insurance
Third Party Administrator 2013 Annual Report

§41-914 (2) List of Insurers

The annual report shall include the complete names and addresses of all insurers with which the administrator had agreements during the preceding fiscal year.

Complete this form and submit online or send it along with other requirements.

Note: "Insure/Self-funded plan" means a person undertaking to provide life, annuity or health coverage or self-funded coverage. You may include only entities that provide coverage or benefits to Idaho residents.



How to enter List of Insurers:

  1. Enter TPA information and click “Submit TPA Information.”
  2. Enter one of the insurers/entities and its address. Enter 99999 if it does not have the NAIC #. Then click “Submit Insurer Information.”
  3. Continue #2 for the next insurer/entity. When you complete, click “Done Submitting Insurers.”

TPA Information
Name of TPA
FEIN Idaho TPA
License #

Contact:

Jean Chang, Technical Records Specialist

Examinations Section
Idaho Department of Insurance
(208)334-4311