Life & Health

Initial License

• General Information
• 2009 TPA License Fee Notice

Statutes and Regulations:

• NC General Statutes - Article 56 of Chapter 58 of NCGS
• NC Administrative Code - T11 NCAC Chapter 21 Section .0100

Forms Required in an Initial Licensure Submission:

• TPA License Transmittal (TPRTRN)
• TPA License Application (TPAAPP)
• TPA License Questionnaire (TPAQSN)
• TPA License Internal Control (TPAICT)
• TPA Power of Attorney for Company (TPAPOA)
• TPA Power of Attorney for Partnership (TPAPPA)
• TPA Biographical Affidavit (TPABIO)

License Renewal

• General Information

Statutes and Regulations:

• NC General Statutes - Article 56 of Chapter 58 of NCGS
• NC Administrative Code - T11 NCAC Chapter 21 Section .0100

Forms Required for Renewal Licensure Submission:

• TPA License Transmittal (TPRTRN)
• TPA License Application (TPAAPP)
• TPA License Questionnaire (TPAQSN)

Additional Forms For Renewal Licensure – Submit When Changes Have Been Made:

• TPA License Internal Control (TPAICT)
• TPA Power of Attorney for Company (TPAPOA)
• TPA Power of Attorney for Partnership (TPAPPA)
• TPA Biographical Affidavit (TPABIO)

Initial Registration

• General Information

Statutes and Regulations:

• NC General Statutes - Article 56 of Chapter 58 of NCGS
• NC Administrative Code - T11 NCAC Chapter 21 Section .0100

Forms Required in an Initial Registration Submission:

• TPA Registration Application (TPAREGAPP)
• TPA Registration Transmittal (TRANSMTREG)
• TPA Registration Internal Control (TPAREGICT)

Registration Renewal

• General Information

Statutes and Regulations:

• NC General Statutes - Article 56 of Chapter 58 of NCGS
• NC Administrative Code - T11 NCAC Chapter 21 Section .0100

Instructions:

• TPA Registration Renewal Information

Filing Instructions

• Third Party Administrator (TPA) License and Registration Application Submission Instructions

List of Licensed TPAs

We are unable to provide a list of licensed or registered TPAs at this time. Should  you need to know if a specific TPA is licensed or registered in North Carolina, please email the Life & Health Division at   L&Hinbox@ncdoi.gov and we will respond promptly.