Third Party Administrator (TPA) Agent's
Registered by Agent and Adjuster Licensing. Email: license@tdi.texas.gov
Company Licensing TPA Forms
Application
The third party administrator company must first be formed at the Texas Secretary of State's Office.
Submit evidence along with:
Insurers and HMOs, use Notification that an Insurer or HMO will be acting as an Administrator - FIN482
All others,use Application for a Certificate of Authority - FIN489
Company Licensing Fee Transmittal Form - FIN321
Other Forms
TPA Biographical Affidavit - FIN484
TPA Service of Process - FIN485
TPA Change of Address and/or Contact - FIN498
TPA Change of Control - FIN502 - In addition, submit a detailed letter explaining the transaction, as well as, before and after organizational charts.
License Duration
TPA licenses do not expire. There is no annual renewal, but there are annual reporting requirements.
To surrender your license, submit Surrender of Third Party Administrator Certificate of Authority - FIN497 to CLRFilings@tdi.texas.gov.
Annual Reporting
March 1 - Report to Texas Comptroller
TPA license holders must file a Texas Annual Insurance Maintenance, Assessment and Retaliatory Report with the Texas Comptroller on or before March 1.
June 30 - Annual Report to TDI
TPA license holders must file on or before June 30. Upon submission, you will receive an automated receipt email. There will be no other communication regarding your annual report.
Instructions for Filing the Third Party Administrators Annual Report - FIN500
Company Licensing Fee Transmittal Form - FIN321
TPA Annual Report Workbook (Microsoft Excel file)
- Insurers and HMOs that are authorized to act as a TPA, complete tab FIN487. All other TPA license holders, complete tab FIN486. All other exhibits must be completed regardless of what other types of TDI certificates of authority held.
- Submitting the Excel workbook is recommended; however, you may submit the following instead:
- TPA license holders who receive less than $10 million annually as compensation for performing administrative services may instead email (1) unaudited financial statements and (2) a completed Certification of Financial Statement for Administrators - FIN490
Pharmacy Benefit Managers licensed as TPAs
Pharmacy Benefit Managers must file an annual report in accordance with Insurance Code Section 1369.502 concerning rebates, fees, and other payments by a PBM in the preceding calendar year.
Pharmaceutical Benefits Reporting