Overview

Title 38, Chapter 51 of the South Carolina Code of Laws, defines the regulations for administrators for insurance benefits plans and, as mandated by law, administrators are to be licensed and regulated by the Director of Insurance. 

Licensing

1. TPA Application, Form 1030 
   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.
    
2. Licensing fee of $100. 
   The check should be made payable to the South Carolina Department of Insurance.
    
3. Original or certified copies of partnership agreements; articles of incorporation, certified by the Secretary of State, Certificate of Good Standing/Certificate of Authority from the South Carolina Secretary of State; trade name certificate; trust agreement; shareholder agreement; and other applicable documents and amendments to those documents.
    
4. A list of the names, addresses, and official titles of positions held by individuals who are responsible for the conduct of the Administrator.
    
5. Biographical Affidavit, Form 1000c 
   An affidavit should be completed on each official officer/director listed above.
    
6. A certified copy of the business certificate from the Clerk of Court in the county where domiciled if the Administrator plans to use a "d.b.a" name.
    
7. Administrator Bond, Form 1029
   A $75,000 surety bond must be issued by a South Carolina licensed insurer and must include a 30-day notice of cancellation to the SCDOI.  In lieu of a bond, letters of credit or certificates of deposit in which deposits are guaranteed by the Federal Savings and Loan Insurance Corporation to meet the financial obligation.  Under no circumstances will this requirement be waived. 
     
8. A copy of your financial statement (two most recent calendar years) which must include a balance sheet and income statement.  An officer of the company must sign the financial statement.
    
9. A copy of the written service agreement between the administrator and insurer or client.  If the applicant is currently not acting as an administrator, a statement indicating that no written agreement has not been executed should be submitted.
    

Renewals

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

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

1. 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.
    
2. Biographical Affidavit, Form 1000c
     
3. $100 Renewal Fee
     
4. Year-End Financial Statement
   

Exemptions

Section 38-51-10 provides a detailed list of those who are exempt from the licensing requirements.  

Those who collect charges or premiums from or adjust or settle claims on residents of this State in connection with life or health insurance or annuities and are acting directly through their officer(s) and employees are exempt from holding a Third Party Administrator (TPA) license.  However, a Notice of Exemption, Form 1200 must be completed and submitted to the Special Licensing Office at our department.

TPAs administering only single employer self-funded (ERISA) plans or Section 125 Cafeteria Plans are not required for licensure.  The United States Internal Revenue Department regulates Section 125 Cafeteria Plans.

Frequently Asked Questions 

Frequently Asked Third Party Administrator Questions
 

SCDOI Contact

Willie Seawright
Phone: 803-737-6134
Email: wseawright@doi.sc.gov