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TPA, PBM, & Other Entities

Third Party Administrators (TPA)

A “third party administrator” or “TPA” is an entity that directly or indirectly underwrites, collects charges or premiums, or adjusts or settles claims in connection with life, annuity, or health coverage in Idaho. There are three types of licensure available to TPA’s. Please review the options and apply for the one that best fits your operations. Fees, if any, are explained below:

  1. Idaho Home State TPA license:  a license allows a TPA to administer insurance or self-funded coverage. A TPA in any State may apply for an Idaho Home State TPA license under Idaho Code § 41-911.
  2. Non-Resident TPA license: a TPA licensed in a recognized State may apply for an Idaho Non-Resident TPA license. Recognized States under Idaho Code § 41-912 include the following. If not licensed in a recognized State, apply for an Idaho Home State TPA license:
    1. Delaware
    2. Indiana
    3. Kansas
    4. West Virginia
    5. Florida
    6. Missouri
    7. New Hampshire 
  3. TPA Registration: registration allows a TPA to administer coverage provided only by self-funded plans not regulated by title 41, Idaho Code. To administer insurance coverage requires a TPA license.

Important Dates: TPA’s must file the following reports by the corresponding due dates and/or deadlines:

Required For Licensed TPA’s:

  • July 1: Annual Report pursuant to Idaho Code § 41-914.

Required for All TPA’s, Licensed or Registered:

  • March 15: Immunization Assessment
  • April 1: PBM Annual Registration (if applicable, it is required to license as a TPA and PBM, see below)
  • May 1: Health Plan Survey
  • November 1 – December 31: TPA Renewal of License or Registration (every 2-years, see below)
  • January 1 – 31: TPA Reinstatement (if failed to renew. Includes fee, see below)

 

Fees Applicable to TPA’s: Application fees are due at the time of application. All other fees are due upon assessment. Fees are non-refundable. Fees are payable by check to the following address. Include the applicant’s identifying information with the check:

Idaho Department of Insurance
700 W. State St., 3rd Floor
P.O. Box 83720
Boise, Idaho 83720-0043

Fees:

Idaho Home State Application Fee

$300

Idaho Non-Resident Application Fee

$300

Idaho Registration Fee

None

TPA Renewal

$80

TPA Reinstatement

$160

Late Filing Fee – Per Day

$25/day

Disclosure: This guidance is not all-inclusive. Please review Idaho Code, Title 41, Chapter 9, or contact us. It is the responsibility of the TPA to maintain compliance. 

Third Party Administrators must be renewed every 2 years (24 months).

Renewals for TPA’s opens November 2nd and ends December 31st.

For online licensed TPA renewal click here.

Please send the following for MAIL-IN paper renewal:

  • Registered TPA (only paper renewal available)
  • Non-Refundable Renewal Fee: $60 Checks should be made payable to the Idaho Department of Insurance.

If applying by paper the completed application and attachments should be mailed to:

Idaho Department of Insurance
700 W State Street, Fl 3
PO Box 83720
Boise ID 83720-0043

Reinstatement period begins January 1st and ends January 31st. After January 31st, you must reapply with application, all applicable forms and $300, non-refundable application fee.

To reinstate a license, you will need to submit the following:

  • Completed TPA Reinstatement Form
  • Non-Refundable Reinstatement Fee: $160.00Checks should be made payable to the Idaho Department of Insurance.

The completed application and attachments should be mailed to:

Idaho Department of Insurance
700 W State Street, 3rd Floor
PO Box 83720
Boise ID 83720-0043

     After January 31st, you must reapply with application, all applicable forms and $300, non-refundable application fee.

Producers and agencies have a duty to report any criminal or administrative actions to the Idaho Department of Insurance within 30 days per §41-1021

We encourage producers to use the NIPR Reporting of Actions Warehouse at www.nipr.com as a convenient means to post your documents and explanations in order to report to us and any state in which you are licensed.

Have more questions?

Contact the TPA & PBM Licensing team:

Pharmaceutical Benefit Managers (PBM)

“Pharmacy benefit manager” or “PBM” means a person or entity doing business in this state that contracts with pharmacies on behalf of an insurer, third-party administrator, or managed care organization to administer prescription drug benefits to residents of this state. 

A PBM is require to register annually before April 1, utilizing the PBM Registration Form

There is no fee for registering a PBM.

  • Do I require a PBM registration if I maintain other licenses through the Department (e.g. Certificate of Authority, TPA license)?
    • Yes. There are no exclusions for PBM Registration. Multiple licenses may be required.
  •  When do I register my PBM each year?
    • Registration occurs between January 1 and March 31, annually.
  • Is there a fee for registering a PBM?
    • No. There is no fee for registering a PBM.

Have more questions?

Contact the TPA & PBM Licensing team:

Other Regulated Entities

More entity types:

Risk Retention Groups (RRG’s) are regulated pursuant to Idaho Code, Title 41, Chapter 48, link: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH48/

Disclosure: Idaho does not have a captive RRG law. Captives may license as insurers.

Domestic Retention Groups: Any RRG intending to charter in Idaho should contact the Department and review Company Admissions requirements. A Certificate of Authority is required prior to transacting the business of Insurance in Idaho.

Foreign Retention Groups: Registration is required of any RRG chartered outside of Idaho. There is no fee to register. 

Idaho utilizes the NAIC Uniform Risk Retention Group Registration Form.

Foreign RRG’s must file an annual statement as detailed in the Annual Checklist.

Purchasing Groups are regulated pursuant to Idaho Code, Title 41, Chapter 48, link: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH48/

Registration is required. 

Idaho utilizes the NAIC Uniform Purchasing Group Form.

There is no fee to register. An annual continuation fee of $100 is payable through the Premium Tax filing system.

Charitable Gift Annuities are subject to Idaho Code § 41-120, link:  https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH1/SECT41-120/

Requirements Include:

The charitable organization must file with the Director of Insurance:

  1. Notice to the Department in writing the date on which it enters into the organization’s first qualified charitable gift annuity agreement. This notice must:
    1. Be signed by the officer or director of the charitable organization
    2. Identify the charitable organization.
    3. Certify that:
      1. The organization is a charitable organization;
  2. When entering into an agreement for a qualified charitable gift annuity, the charitable organization shall disclose in writing to the donor, in the annuity agreement:
    “NOTICE: A charitable gift annuity is not insurance under the laws of this state and is not subject to regulation by the Department of Insurance or protected by a guaranty association affiliated with the Department. The notice provisions of this subsection must be written in a separate paragraph in the annuity agreement in a print size no smaller than that employed in the annuity agreement generally.”
  3. Failure of a charitable organization to comply with the notice requirements imposed by Section 41-120, Idaho Code, may result in a fine in an amount not to exceed $1,000 per qualified charitable gift annuity agreement issued until the charitable organization complies with the above noted reporting requirements.

Rating Organizations and Advisory Organizations require licensure pursuant to Idaho Code, Title 41, Chapter 14, link: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH14/

Please review the respective filing requirements in Idaho Code for these entities and contact us.

Have more questions?

Contact the Company Activities team:

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