Third Party Administrator (Life/Health)

IMPORTANT:

Before applying for or renewing a Life and Health Administrator (TPA) license, you must first make sure that information about the TPA on the Arizona Corporation Commission web site is up to date. If the application contains information that is different from information maintained by the Arizona Corporation Commission, the application will be rejected.
All applications must be completed on the computer. The computer will check the application to help make sure it is complete. Additionally, the form will tell you additional documents you must submit as part of your application based on entries you make in the form. Do not print your application until you have entered all required information on it.
After printing the application, obtain signature(s) and scan the application forms to your computer or network.
RENEWAL SEASON. When you enter an application into the online portal, the system will provide you a packet number that applies to the application. Do not try to use a packet number from a previous submission.
Before using the Portal to submit your application, you should make sure you save all the documents you need to upload to one location on your computer or network. Save a separate biographical affidavit document for each individual. Do not save them all together as one document. This will make it easier for you to upload all those documents through the Portal. Double check the list of documents you've saved on your computer/network against the additional documents your application form says are required in order to ensure your application is complete when you submit it.
Use the Third-party Administrator Registration Portal (https://azinsurance.online/Upload/tpa) to upload application documents, pay any required fee, and to submit your application to us instantaneously. There is no additional cost to use the Portal, and your documents will be transmitted to us in a secure, encrypted manner. For an application requiring a fee, you must simultaneously submit your application and payment using the online portal; do not submit your application without a payment, and do not enter your payment without then submitting your application.

What Is a Life and Health Administrator (or TPA)?

A life and health administrator, also know as a third-party administrator ("TPA") collects money or processes claims for residents of Arizona in connection with life or health insurance coverage. Arizona Revised Statutes ("ARS") § 20-485 provides a full definition, including the types of entities that are not considered TPAs.

Who Must Be Licensed?

Before applying to register a TPA, review the exemptions from the registration requirements, review the entities listed in ARS § 20-485(A)(1), which are listed on the first page of Form E-100: Application for Life and Health Administrator Registration, to determine whether you are excluded from TPA registration requirements.

If you are adjusting property and casualty claims, you need to be licensed as an adjuster (click here for requirements).
If you are administering workers compensation claims, contact the Industrial Commission of Arizona.
If you are a motor vehicle service contract administrator, Arizona does not have a licensing/registration requirement; however, you or the insurer must file motor vehicle service contracts with the Department and you or the insurer must post a surety bond with the Department's Financial Affairs Division. ARS § 20-1095.06
Arizona does not have jurisdiction (and no license is required) if you are only administering ERISA plans (a self-insured program operated by a single employer for the benefit of its employees or the employees of a wholly-owned subsidiary).

Arizona law does not distinguish between TPAs that are organized within Arizona from TPAs organized in other states. The entity must be formed or registered with the Arizona Corporation Commission (http://www.azcc.gov) and registered with the Arizona Department of Insurance unless exempt from registration requirements.

Form E-115: Life and Health (Third-party) Administrator Information Update
Form L-WAV: Fee Waiver Request	Only use this form (rather than paying the license fee) if you meet all the requirements on the form. If you file this form, it becomes part of your license application, and if you file incorrect, misleading, incomplete, or materially untrue information on a license application, an insurance license can be denied, suspended or revoked, you could be assessed civil penalties and you could be the subject of other administrative and legal consequences. The fee waiver only applies to the license fee. It does not apply to other fees and costs you may need to pay in order to become licensed.
Form E-503-TPA: Affidavit of Lost Certificate of Registration	Complete this form if surrendering a Certificate of Registration that has been misplaced or destroyed.
Form E-100-B: Life and Health Administrator Biographical List	Complete this form to report the name and title of each individual reflected in the count on Form E-100, Item 13, Section E.
Form E-200: TPA Registration Application Checklist	To ensure your application is complete, correct, and meets all registration requirements so the Department can promptly issue a Certificate of Registration, use this document to check your application before you submit it. The Department uses this document when reviewing applications.
Form E-100-A: Life and Health Administrator Registration Addendum	If the applicant uses any name or has any office other than those reported in Section A or B of Form E-100, use this form to report the applicant's complete name and address for all offices in each jurisdiction. ARS § 20-485.12(B)(6).
Form E-100: Application for Life and Health Administrator Registration	New version of form posted 03/18/2022 @ 11:15AM Use this form to first determine whether you need to apply for a third-party administrator registration. If the first page of the application indicates you must apply, complete the remainder of the application and include ALL required enclosures along with your fee payment. An incomplete application will delay your registration and will create additional work for you and for us. Submit your completed application, including all required enclosures and payment, using the Third Party (Life/Health) Administrator Registration Portal, accessible at https://azinsurance.online/Upload/tpa.
Form E-111: Renewal Application for Life and Health Administrator Registration	Due Date: March 1 You may submit your renewal application after January 1, but the renewal application must be received by the Department of Insurance by March 1 or you will be subject to a $25 per day late fee. The application must be certified by two officers of the applicant. Must be current within 90 days of application filing date. Use the TPA Online Registration Portal at https://azinsurance.online/Upload/tpa to file renewal documents and pay the renewal fee. ARS § 20-485.12(B)(1)(a) and (b)
Form E157: Bond of Life and Health Administrator	Face amount must equal the greater of either (A) 10% of total funds handled for life and health coverage of Arizona residents, or (B) $5,000. Funds handled includes premiums collected for and/or claims paid on behalf of an insurer. Submit with power of attorney. ARS § 20-485.10
NAIC Form 11: Biographical Affidavit	Must be completed by each partner, officer, and director, and each other entity owning 25% or more of a Service Company applicant.