Third Party Administrators (TPA)

Pursuant to 38a-720a any entity acting as a Third-Party Administrator (TPA) in Connecticut must be either licensed or registered with the Department.

“Third-party administrator” means any person or entity who directly or indirectly underwrites, collects premiums, or charges from, or adjusts or settles claims on, residents of this state in connection with life, annuity or health coverage offered or provided by an insurer.

TPA License or TPA Registration?

  • TPAs must either be licensed or registered with the Department to conduct business in Connecticut.
  • An entity cannot hold both a registration and a license at the same time, it must be one or the other.
  • Those entities exempted by statute from TPA licensure, but who perform some elements of TPA service must Register with the Department. A list of exemptions from licensure are found in C.G.S. 38a-720(11) and include:
    • An employer administering its employee benefits plan or the benefit plan of an affiliated employer under common management and control.
    • A union administering a benefit plan on behalf of its members.
    • An insurer that is licensed in this state or is acting as an authorized insurer with respect to insurance lawfully issued to cover a Connecticut resident and sales representative thereof.
    • An insurance producer who is licensed to sell life, annuity or health coverage in this state, whose activities are limited exclusively to the sale of insurance.
    • A creditor acting on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors.
    • A trust and its trustees, agents and employees acting pursuant to such trust established in conformity with 29 USC Section 186, as amended from time to time.
    • A trust exempt from taxation under Section 501(a) of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time, and its trustees and employees acting pursuant to such trust, or a custodian and the custodian's agents and employees acting pursuant to a custodian account that meets the requirements of Section 401(f) of the Internal Revenue Code of 1986, or any subsequent corresponding internal revenue code of the United States, as amended from time to time;
    • A credit union or a financial institution that is subject to supervision or examination by federal or state banking authorities, or a mortgage lender, to the extent such credit union, financial institution or mortgage lender collects or remits premiums to licensed insurance producers or limited lines producers or to authorized insurers, in connection with loan payments.
    • A credit card issuing company that advances or collects premiums or charges from its credit cardholders who have authorized collection.
    • An attorney‐at‐law who adjusts or settles claims in the normal course of such attorney's practice or employment and who does not collect premiums or charges in connection with life, annuity, or health coverage.
    • An adjuster who is licensed in this state or is not subject to the licensure requirements of chapter 702 of the general statutes and whose activities are limited to adjusting claims.
    • An insurance producer who is licensed in this state and acting as a managing general agent, as defined in section 38a‐90a of the general statutes, whose activities are limited exclusively to those specified in said section.
    • An insurance producer who is licensed in this state and acting as a managing general agent, as defined in section 38a‐90a of the general statutes, whose activities are limited exclusively to those specified in said section.
    • A consortium of federally qualified health centers funded by the state, providing services only to the recipients of programs administered by the Department of Social Services.
    • A pharmacy benefits manager registered under section 38a‐479bbb of the general statutes.
    • An entity providing administrative services to the Health Reinsurance Association established under section 38a‐ 556 of the general statutes; or
    • A nonprofit association or one of its direct subsidiaries that provides access to insurance as part of the benefits or services such association or subsidiary makes available to its members.

Applying for a TPA License:

  • Apply by going to the National Insurance Producer Registry (NIPR). Under Licensing Center, select “Apply for a New License.”
  • Submit all required licensing supportive documentation through the NIPR warehouse or send via fax to 860-297-3872 or send via email to CID.TPA@CT.GOV. Please do not send any documents or correspondence via regular mail—it will be returned.

Applying for a TPA Registration:

  • Apply by going to the National Insurance Producer Registry (NIPR). Under Licensing Center, select “Apply for a New License.”
  • Submit the additional TPA registration form after completing the registration application through NIPR. The registration form must be submitted through the NIPR warehouse or send via fax to 860-297-3872 or send via email to CID.TPA@CT.GOV. Please do not send any documents or correspondence via regular mail—it will be returned.

No home state license:

  • If you are applying for a license or registration and your home state does not have an equivalent license or registration, you may use the “Designated Home State” (DHS) choice in NIPR when the application is submitted.

Making Changes (ex: Address)- TPA License & TPA Registration:

TPA License and TPA Registration renewal date:

  • Per C.G.S. 38a-720j(f), Any license issued to a third-party administrator shall be in force until September thirtieth of each year.
  • Both TPA licenses and registrations will expire annually on September 30th. There is no ability to late renew. Any license or registration received after that date must be submitted as “new” and there will be a break in the license or registration sequence.
  • Renewal notices will be emailed to the email address on file. Failure to update the email address or contact information in the system will not eliminate the requirement to renew timely.
  • The NIPR online application will be available 90 days before the date of expiration. You will be unable to submit renewal applications before that time.

Fees:

  • TPA License- $500 (new), $450 (renewal), plus $5.60 NIPR transaction fee.
  • TPA Registration- $0 (new/renewal), $5.60 NIPR transaction fee

Print or Verify a license or registration: Search and print a license

Other Resources:

Contacts or questions: For more information, contact cid.tpa@ct.gov