. Comment on Reducing inefficiencies by revisiting third party administrator (TPA) agreements in Non-Life Insurance?
A third part administrator (TPA) is any person who collects charges or premiums from, or who pays or settles claims on, residents of this state in connection with life, health/disability insurance coverage or variable annuity contracts, except a/an:
- Employer on behalf of employees,
- Union on behalf of members,
- Fully self-funded insurance plan meeting ERISA definition,
- Insurance company licensed in this state,
- Prepaid hospital or medical care plan (This includes prepaid dental and vision prepaid programs not associated with an insurance policy),
- Insurance producer acting in the capacity of a producer,
- Creditor on behalf of debtors,
- Financial institution when acting as such and not as an administrator,
- Credit card company, provided that company does not adjust or settle claims, or
- Person who adjusts or settles claims in the normal course of his business as an attorney or a licensed adjuster who does not collect charges or premiums in connection with insurance coverage or annuities.
Unless an entity falls into one of the exceptions listed above, there is no waiver of the registration requirement. All TPA’s not exempted above must register with the Department.
Renewal/Continuation of License (Regulations, Section 16)
- Registrations renew annually on March 31.
- Renewal notices are mailed on or before February 1.
- Wyoming Application for TPA Registration (marked as Renewal) and required attachments must be filed on or before March 31.
Fee:
- No licensing or renewal fees are required.
Forms:
- Wyoming Application for TPA Registration and required attachments (this form is used for new and renewal applicants).
- Insurer/Third Party Administrator Contract Checklist.
- Insurer Appointment of Third Party Administrator Form.
- Third Party Administrator Bond (must include power of attorney to execute bond).
Updating Ownership, Address or Other Vital Information
The administrator may provide updated information throughout the year by letter or during the renewal process via the renewal application. Forms and information to change a business entity name are located on the Address/Name Change page.
Written Agreement Necessary (Regulations, Section 4)
- A written agreement between the TPA and the insurer is required and must be retained by the insurer and administrator for the duration of the contract and 3 years thereafter.
- The agreement does not need to be filed with the Department. Only the Insurer/Third Party Administrator Contract Checklist needs to be filed.
- The agreement must contain provisions that comply with Sections 4 through 13 of the Regulation, unless the provisions do not apply to the TPA’s functions.
- The provisions may be included as an appendix to the agreement so long as those terms supersede any conflicting contract language.
- The Insurer/Third Party Administrator Contract Checklist must be filed subsequent to any contract being entered throughout the licensing period.
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Answer not as per Q asked?????
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