Third Party Administrators

Third Party Administrators (TPA)

Effective 4/17/2023 – New process to apply for a TPA license and to file the annual report

Texas is excited to announce an online application process for Third Party Administrator licenses. No more forms to email or paper checks to mail. You can submit the application and fee electronically via Sircon.com. New process does not apply to Insurers acting as TPA.
Submit Annual Reports online through the electronic renewal process for Third Party Administrators. Again, no more forms to email or paper checks to mail. Submit the Annual Report with attachments, and pay the fee electronically via Sircon.com.
Tutorials – detailed instructions and tutorials are now available. If you currently hold a Texas agent or firm license, you should find many similarities in the process.
New License Number - All TPAs (except Insurers or HMOs) were issued a new license number. A copy of the license with a new license number will be sent by email. Check your spam or junk folder if you didn't receive it.

Please note, the registrationteam@tdi.texas.gov email address is no longer being used.

Application

Resident and nonresident entities seeking to do business in Texas may be required to register with the Texas Secretary of State. Contact the Texas Secretary of State to confirm.

Apply online at www.Sircon.com. Review the Resident TPA or Non-Resident TPA tutorial and make sure you have all attachments ready prior to starting the process.

Application for a Certificate of Authority - FIN489
Officers and Directors Page - FIN306
Use UCAA form 11 or TPA Biographical Affidavit - FIN484
Fingerprinting requirements
TPA Service of Process - FIN485 (foreign and alien applicants)

To submit deficiencies to your application review Tutorial for attaching a deficiency to TPA application.

Insurers or HMOs that are currently licensed in Texas that wish to register as a TPA should complete Notification that an Insurer or HMO will be acting as an Administrator and send to CLRFilings@tdi.texas.gov

Exemption under TIC Section 4151.002

As a state regulatory agency, TDI cannot provide legal advice, acknowledge, or make a determination as to whether or not an entity is exempt from TPA licensing requirements.

License Duration

TPA licenses do not expire. The June 30 "renewal" date is used to trigger the Sircon system to accept the annual report. This also allows us to determine which TPA's are not in compliance. The electronic receipt you receive is your proof or evidence of filing. Nothing else will be sent to you.

If your TPA license is no longer needed, submit a Surrender of Third Party Administrator Certificate of Authority - FIN497 to CLRFilings@tdi.texas.gov

Annual Reports

March 1 - Report to Texas Comptroller

Administrators must file a Texas Annual Insurance Maintenance, Assessment and Retaliatory Report with the Texas Comptroller on or before March 1. Summary of Maintenance Tax and Assessment Rates

June 30 - Annual Report to TDI - NEW PROCESS (INSURERS AND HMO'S SEE BELOW)

TPAs must file an annual report on or before June 30. Use the renewal function at www.Sircon.com to submit the TPA annual report and pay the $200.00 filing fee. Be sure to use the new license number and have all attachments ready prior to starting the process. Review the Tutorial for submitting TPA annual report.

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 license type.
Audited financial statement;or
For TPA license holders who receive less than $10 million annually as compensation for performing administrative services submit:
- (1) unaudited financial statement and
- (2) a completed Certification of Financial Statement for Administrators - FIN490
Certification on company letterhead, signed by an Officer, Partner, or Sole Proprietor, stating that the information provided in the annual report filing is true and correct.

If you need to add an additional document or deficiency refer to Tutorial for attaching a deficiency to TPA renewal

FOR INSURERS AND HMOs ACTING AS TPAs

Complete the TPA Annual Report Workbook, but do not complete tab FIN486.
Transfer the totals from the exhibits to Section 4 of tab FIN487.
Date and sign the form electronically.
Upload the report as one .pdf file to the Financial Filing Submission Portal
Separately mail the $200.00 filing fee with FIN321 to the address on the form.

Common TPA Transaction Forms

TPA Change of Address and/or Contact - FIN498

TPA Name Change - FIN499

TPA Change of Control - FIN502 - In addition, submit a detailed letter explaining the proposed transaction, as well as proposed pre-acquisition and post-acquisition organizational charts.

Other TPA Forms

Copy of TPA License

Need a copy of the current certificate of authority (license)? Send an email to CLRRequests@tdi.texas.gov. If you need a certified copy of the certificate of authority send your check for $11.00 along with TDI Form 321 to the address on the form.

Printing your license from Sircon.com is currently not available. The template Sircon uses for the license is very generic to accommodate all states. Texas prefers to use state specific templates that we can customize across our different license types.

License Lookup

Look up TPA license information using the "Search for a Business" tab:

Sircon Business/Individual Search (texas.gov)

Pharmacy Benefit Managers licensed as TPAs

Pharmacy Benefit Managers must file an annual report in accordance with Texas Insurance Code Section 1369.502 concerning rebates, fees, and other payments by a PBM in the preceding calendar year.

Pharmaceutical Benefits Reporting