Third Party Administrators and Exempt TPAs

Third Party Administrators are defined in O.C.G.A. 33-23-100(a)(1)

  • (1) “Administrator” means any business entity that, directly or indirectly, collects charges, fees, or premiums; adjusts or settles claims, including investigating or examining claims or receiving, disbursing, handling, or otherwise being responsible for claim funds; or provides underwriting or precertification and preauthorization of hospitalizations or medical treatments for residents of this state for or on behalf of any insurer, including business entities that act on behalf of a single or multiple employer self-insurance health plan or a self-insured municipality or other political subdivision. Licensure is also required for administrators who act on behalf of self-insured plans providing workers’ compensation benefits pursuant to Chapter 9 of Title 34. For purposes of this article, each activity undertaken by the administrator on behalf of an insurer or the client of the administrator is considered a transaction and is subject to the provisions of this title.

Exempt Third Party Administrators

  • Exemptions to the licensing requirement for Third Party Administrators are listed in O.C.G.A. 33-23-100(b)

    • If conducting business in Georgia as an Administrator and one of the exemption reasons qualify for an exemption to licensing, an application is required to be submitted with subsequent annual renewals. The form with an officer signature is to be uploaded to the applications and renewals. Applications and renewals are to be filed through Sircon.com. The filing fee is $50 plus a $5 processing fee and is required to be paid with the submission. 
  • Exempt Reasons

    O.C.G.A. 33-23-100(b) Notwithstanding the provisions of subsection (a) of this Code section, the following are exempt from licensure so long as such entities are acting directly through their officers and employees:

    • (1) An employer on behalf of its employees or the employees of one or more subsidiary or affiliated corporations of such employer;
    • (2) A union on behalf of its members;
    • (3) An insurance company licensed in this state or its affiliate unless the affiliate administrator is placing business with a nonaffiliate insurer not licensed in this state;
    • (4) An insurer which is not authorized to transact insurance in this state if such insurer is administering a policy lawfully issued by it in and pursuant to the laws of a state in which it is authorized to transact insurance;
    • (5) A life or accident and sickness insurance agent or broker licensed in this state whose activities are limited exclusively to the sale of insurance;
    • (6) A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors;
    • (7) A trust established in conformity with 29 U.S.C. Section 186 and its trustees, agents, and employees acting thereunder;
    • (8) A trust exempt from taxation under Section 501(a) of the Internal Revenue Code and its trustees and employees acting thereunder or a custodian and its agents and employees acting pursuant to a custodian account which meets the requirements of Section 401(f) of the Internal Revenue Code;
    • (9) A bank, credit union, or other financial institution which is subject to supervision or examination by federal or state banking authorities;
    • (10) A credit card issuing company which advances for and collects premiums or charges from its credit card holders who have authorized it to do so, provided that such company does not adjust or settle claims;
    • (11) A person who adjusts or settles claims in the normal course of his or her practice or employment as an attorney and who does not collect charges or premiums in connection with life or accident and sickness insurance coverage or annuities;
    • (12) An insurance company licensed in this state or its affiliate if such insurance company or its affiliate is solely administering limited benefit insurance. For the purpose of this paragraph, the term “limited benefit insurance” means accident or sickness insurance designed, advertised, and marketed to supplement major medical insurance and specifically shall include accident only, CHAMPUS supplement, disability income, fixed indemnity, long-term care, or specified disease insurance; or
    • (13) An association that administers workers’ compensation claims solely on behalf of its members
  • Applying for Exemption

    TPA Exemption Registration -

    • Complete the Download this pdf file. exemption form which is required to be signed by an officer of the entity
    • Access www.Sircon.com/Georgia and select Apply for a License Agency
      • Select New Insurance License
      • Select If Resident or Non-resident (is your business office location in Georgia (Resident) or out of state (Non-Resident)
      • Select Firm as type of applicant
      • Enter Firm Name and EIN and select which type of preparer
      • Select Georgia
      • Complete Payment Method
      • Answer all questions and enter all fields for agency
      • Upload documents required
      • Pay registration fee of $50 plus the $5 processing fee

     

  • TPA Exempt Renewals

    TPA Exemption Renewals are to be completed by 12/31 of every licensed year. The renewals are available on Sircon.com 90 days prior to the renewal date. The renewal fee is $50 plus the $5 processing fee to be paid with submission. 

    • Complete Download this pdf file. exemption form to upload with renewal application
    • Apply for the renewal online
      • Access www.sircon.com/georgia
      • Click on Renew or Reinstate a License
      • At Renew Other Insurance & Non-Insurance Licenses, select Firm and click on continue
      • At the next screen, enter Georgia as the renewal state
      • enter the EIN and Georgia license number
      • Click on Continue
      • Your licenses available for renewal will appear. If more than one, select the one to renew for Third Party Admin -  Exempt and click on Continue
      • Select answer for Question 1 by copying the entire reason and pasting in the box provided
      • Read and respond to Attestation for Georgia
      • The License Fee Summary information will appear
      • Click the renewal fees statement and Process to complete renewal
      • Complete payment
      • Upload the completed and notarized Exemption form 
  • What to Expect After Filing Initial Application or Renewal
    • After submission, an email will be sent confirming submittal.
    • The application will be reviewed within ten (10) business days of submittal
    • Any deficiencies will be sent via an email to the applicant email address
    • All deficiencies must be resolved within 60 days of the email notice
      • If not completed, the application will be closed incomplete
      • Another application submittal including payment of all fees will be required. No refunds for closed incomplete applications.
    • If the application is approved, the license will be sent via email as an attachment. Please save the license. Any future copies will require a fee for printing.

     

Third Party Administrators Licensing Process

The licensing and renewals of Third Party Administrators is available at Sircon.com as of November 15, 2024. Any questions can be sent to [email protected].

  • If conducting business in Georgia as an Administrator, an application is required to be submitted and annual renewals are due by March 1 of each year. The initial filing fee is $500 plus a $5 processing fee. Annual renewals filing fee is $400 plus a $5 processing fee. 
  • Complete all Necessary Documents and Forms

    Complete all forms and gather all corporate documents and information prior to submitting through www.Sircon.com. It is requested that all documents be uploaded as one pdf to streamline the review of the submitted documents. Viewing individual documents is time-consuming and takes more time than scrolling through one pdf.

    OCI forms are listed below and other requirements are corporate documents and bonds.

    • Articles of Incorporation which contain stamp or certification of Secretary of State
    • Georgia Secretary of State Certificate of Good Standing
    • Any trust, shareholder agreements and all amendments
    • By-laws containing corporate seal or certification page from officers of entity
    • Complete for each individual with more than 10% ownership a Biographical Statement and Affidavit Form GID-052-NT and an Authorization for Release of Information Form GID-053-NT
    • Investigative Background Reports for each of the above individuals to be submitted by the approved NAIC vendor
    • Funds Handling Checklist (GID-051-NT)
    • List of All accounts administered and NAIC company numbers with amounts of funds managed or handled for Georgia annually. List separate amount for premiums and claim paid, if applicable
    • Submit a copy of a surety bond (Administrator Fidelity Bond Form GID-057-NT below can used)
      • Bond amount equal to or at least 10% of annualized funds handled or managed
      • If applicant collects premiums and pays claims, the 10% should be calculated on the greater amount
      • 30 day's notice of cancellation to OCI and named to OCI
      • Must be for at least $100,000
    • Errors and Omissions Policy
      • Must provide 60 day's cancellation notice clause
      • Automatic renewals at the expiration date of the policy 
      • Named to the Commissioner of Insurance - State of Georgia
    • For all TPAs currently in business, copy of the Audited Financials for the past two calendar years (Financial Statement GID-056-NT form below can be used)
      • If not currently in business as a TPA, a statement of amounts and sources of funds for establishment of the business and can include a financial statement showing initial investments
    • List of ownership interest or affiliation of any kind with any insurance company responsible directly or through reinsurance for providing benefits to any plan administrative services are provided
    • Forms for Third Party Administrators Applications:
  • Access application in Sircon.com
    • Select New Insurance License
    • Select If Resident or Non-resident (if the business office location is in Georgia (Resident) or out of state (Non-Resident)
    • Select Firm as type of applicant
    • Enter Firm Name and EIN and select which type of preparer
    • Select Georgia
    • Complete Payment Method
    • Answer all questions and enter all fields for agency
    • Upload required documents and forms. In one pdf if possible instead of individual documents.
    • Submit
  • What to Expect after Filing
    • After submission, an email will be sent confirming submittal.
    • The application will be reviewed within ten (10) business days of submittal
    • Any deficiencies will be sent via an email to the applicant email address
    • All deficiencies must be resolved within 60 days of the email notice
      • If not completed, the application will be closed incomplete
      • Another application submittal including payment of all fees will be required. No refunds for closed incomplete applications.
    • If the application is approved, the license will be sent via email as an attachment. Please save the license. Any future copies will require a fee for printing.
  • Annual Renewal Process for Third Party Administrators
    • Renewals are to be filed by March 1 of each year. Each entity will receive a renewal notice approximately 90 days prior to the renewal due date. Renewal reminder notices will be emailed out the first week of December. 

    • Renewals are submitted in Sircon.com with renewal fees to be paid at time of submittal. Prepare all documents and required forms to upload with the renewal:

      NOTE: It is preferred by the processing staff for the documents to be uploaded as one pdf, if possible. It is a quicker process to view one document and scroll through the pages rather than accessing each document individually.

      • List of All accounts administered and NAIC company numbers with amounts of funds managed or handled for Georgia annually. List separate amount for premiums and claims paid, if applicable.
      • Copy of the Audited Financials for the past two calendar years (GID-056-NT can be used). For any extension request to be considered, all renewal and processing fees and all other document requirements must be provided.
      • If any changes to the entity, provide copies of the changes to the Articles of Incorporation which contain stamps or certifications from the Secretary of State 
      • If any changes, provide By-laws containing corporate seal or certification page from officers of entity
      • If any changes in ownership, provide for each individual with more than 10% ownership the Biographical Statement and Affidavit Form (GID-052-NT) and Investigative Background Reports for each of the above individuals
      • If any changes in ownership, provide the citizenship affidavit and copy of acceptable id. If no changes, no affidavit and id are required.
      • Submit a copy of a surety bond (GID-057-NT can be used) or continuation notice with bond number provided
        • Bond amount equal to or at least 10% of annualized funds handled or managed
        • If applicant collects premiums and pays claims, the 10% should be calculated on the greater amount
        • 30 day's notice of cancellation to OCI and named to OCI
        • Must be for at least $100,000

      • Errors and Omissions Policy or continuation notice with bond number provided

        • Must provide 60 day's cancellation notice clause
        • Automatic renewals at the expiration date of the policy
        • Named to the Commissioner of Insurance - State of Georgia

         

  • Forms (not all are required for renewals)

 

Contact

Sircon Website to Apply, Renew and Update Licenses

Sircon.com/Georgia