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Division of Insurance
Third Party Administrator (TPA)
Third party administrators (TPA), defined in SDCL 58-29D-1, directly or indirectly solicit or effect coverage of, underwrite, collect charges or premiums from, or adjust or settle claims in connection with workers' compensation, life or health coverage or annuities. Some exceptions apply.
TPAs, including Pharmacy Benefits Managers (PBM), are required to submit a license or registration application through the National Insurance Producers Registry (NIPR) with supporting documentation to be submitted via the NIPR Attachment Warehouse.
A TPA only qualifies for registration if one of two requirements are met:
- If the administrator exclusively provides services to one or more bona fide employee benefit plans, each of which is established by an employer or an employee organization, or both, and for which the insurance laws of this state are preempted pursuant to the Employee Retirement Income Security Act of 1974. Pursuant to SDCL 58-29D-27.
- If the administrator has a valid license as an administrator issued in a state which has standards for administrators that are at least as stringent as those contained in this chapter. Pursuant to SDCL 58-29D-29.
- Valid states: Alaska, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Rhode Island, Texas, West Virginia
For additional information:
TPA License Application Checklist
TPA Registration Application Checklist
Each licensed or registered TPA must file an annual renewal on or before July first of each year. Failure to file a renewal will result in lapsing of the license or registration.
Third Party Administrator Listing
Licensure or registration of a specific entity can be verified through SBS License Look Up Search.