Renewals

Every third-party administrator is required to renew its license by March 1 of each year. The following information must be submitted to the department before March 1. Renewals received after March 1 are subject to administrative disciplinary action. If you wish to surrender your license, please contact the department for instructions.

Please note: All signatures and documents must be original. Documents with reproduced or stamped signatures will not be accepted. Faxed documents will also not be accepted.

Required Documentation
  • Application for TPA Renewal
    • The application must be signed by the president if the administrator is a corporation; a partner if the administrator is a partnership; and the individual proprietor in the case of a sole proprietorship. The information furnished on the application must be given under oath. The application must disclose a contact person. Incomplete or improperly competed applications will not be accepted.
  • Biographical Affidavit, Form 1000c
  • Renewal Fee of $100
  • Year-End Financial Statement