Third Party Administrators and Exempt TPAs

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

TPA Exemption Registration -

• Complete the 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 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 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 

• 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.

• Articles of Incorporation which contain stamp or certification of Secretary of State
• Georgia Security 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 one copy for each individuals with more than 10% ownership the Biographical Statement and Affidavit Form GID-052-NT
• Investigative Background Reports for each of the above individuals
• 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 and name 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:
  •   Authority for Release of Information GID-053-NT
  •   Biographical Statement and Affidavit GID-052-NT
  •   Administrator Fidelity Bond Form GID-057-NT
  •   Financial Statement GID-056-NT
  •   Renewal Instruction GID-363-NT
  •   Resolution Form GID-055-NT
  •   Citizenship Affidavit GID-276

• 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

• 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.

• 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. If its 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.
• If any changes to the entity, provide Articles of Incorporation which contain stamp or certification of 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 one copy for each individuals with more than 10% ownership the Biographical Statement and Affidavit Form (GID-052-NT) and Investigative Background Reports for each of the above individuals
  • 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 (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 and name to the Commissioner of Insurance - State of Georgia
  • 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.