Indiana Code 27-1-25-11.1. Resident third party administrator license; application; refusal to issue license; notice of material change; bond
(1) apply to act as an administrator in Indiana upon the uniform application for third party administrator license;
Terms Used In Indiana Code 27-1-25-11.1
- Administrator: means a person who directly or indirectly and on behalf of an insurer underwrites, collects charges or premiums from, or adjusts or settles claims on residents of Indiana in connection with life, annuity, or health coverage offered or provided by an insurer. See Indiana Code 27-1-25-1
- articles of incorporation: includes both the original articles of incorporation and any and all amendments thereto, except where the original articles of incorporation only are expressly referred to, and includes articles of merger, consolidation and reinsurance, and in case of corporations, heretofore organized, articles of reorganization filed in the office of the secretary of state, and all amendments thereto. See Indiana Code 27-1-2-3
- certificate of authority: means an instrument in writing issued by the department to an insurer, which sets out the authority of such insurer to engage in the business of insurance or activities connected therewith. See Indiana Code 27-1-2-3
- Church plan: has the meaning set forth in IC 27-8-10-1. See Indiana Code 27-1-25-1
- Commissioner: refers to the insurance commissioner appointed under IC 27-1-1-2. See Indiana Code 27-1-25-1
- Control: means the direct or indirect possession of the power to direct or cause the direction of the management and policies of a person, whether:
Indiana Code 27-1-25-1
- Department: means "the department of insurance" of this state. See Indiana Code 27-1-2-3
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- GAAP: refers to consistently applied United States generally accepted accounting principles. See Indiana Code 27-1-25-1
- Governmental plan: has the meaning set forth in IC 27-8-10-1. See Indiana Code 27-1-25-1
- Home state: means the District of Columbia or any state or territory of the United States in which an administrator is incorporated or maintains the administrator's principal place of business. See Indiana Code 27-1-25-1
- Insurance: means a contract of insurance or an agreement by which one (1) party, for a consideration, promises to pay money or its equivalent or to do an act valuable to the insured upon the destruction, loss or injury of something in which the other party has a pecuniary interest, or in consideration of a price paid, adequate to the risk, becomes security to the other against loss by certain specified risks; to grant indemnity or security against loss for a consideration. See Indiana Code 27-1-2-3
- Insurance producer: has the meaning set forth in Indiana Code 27-1-25-1
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Month: means a calendar month, unless otherwise expressed. See Indiana Code 1-1-4-5
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- Person: has the meaning set forth in Indiana Code 27-1-25-1
- shareholder: means one who is a holder of record of shares of stock in a corporation, unless the context otherwise requires. See Indiana Code 27-1-2-3
- United States: includes the District of Columbia and the commonwealths, possessions, states in free association with the United States, and the territories. See Indiana Code 1-1-4-5
- Year: means a calendar year, unless otherwise expressed. See Indiana Code 1-1-4-5
(3) receive a license from the commissioner;
before performing the function of an administrator in Indiana. The commissioner shall deposit a fee paid under subdivision (2) into the department of insurance fund established by IC 27-1-3-28.
(b) For the purposes of this section:
(1) if:
(A) an administrator is incorporated in Indiana; or
(B) Indiana is the administrator’s principal place of business within the United States;
the administrator shall apply to Indiana for a resident administrator license; and
(2) if:
(A) neither the state in which an administrator is incorporated nor the state that is the administrator’s principal place of business have adopted this chapter or a substantially similar law governing administrators; and
(B) the administrator has not designated any other state that has adopted this chapter or a substantially similar law governing administrators as its home state;
the administrator shall apply to Indiana for licensure as its designated home state.
(c) The uniform application for third party administrator license must include or be accompanied by the following:
(1) Basic organizational documents of the applicant, including:
(A) articles of incorporation;
(B) articles of association;
(C) partnership agreement;
(D) trade name certificate;
(E) trust agreement;
(F) shareholder agreement;
(G) other applicable documents; and
(H) amendments to the documents specified in clauses (A) through (G).
(2) Bylaws, rules, regulations, or other documents that regulate the internal affairs of the applicant.
(3) The NAIC biographical affidavits for individuals who are responsible for the conduct of affairs of the applicant, including:
(A) members of the applicant’s:
(i) board of directors;
(ii) board of trustees;
(iii) executive committee; or
(iv) other governing board or committee;
(B) principal officers, if the applicant is a corporation;
(C) partners or members, if the applicant is:
(i) a partnership;
(ii) an association; or
(iii) a limited liability company;
(D) shareholders or members that hold, directly or indirectly, at least ten percent (10%) of the:
(i) voting stock;
(ii) voting securities; or
(iii) voting interest;
of the applicant; and
(E) any other person who exercises control or influence over the affairs of the applicant.
(4) Financial information reflecting a positive net worth, including:
(A) audited annual financial statements prepared by an independent certified public accountant for the two (2) most recent fiscal years; or
(B) if the applicant has been in business for less than two (2) fiscal years, financial statements or reports that are:
(i) prepared in accordance with GAAP; and
(ii) certified by an officer of the applicant;
for any completed fiscal years and for any month during the current fiscal year for which financial statements or reports have been completed.
If an audited financial statement or report required under clause (A) or (B) is prepared on a consolidated basis, the statement or report must include a columnar consolidating or combining worksheet that includes the amounts shown on the consolidated audited financial statement or report, separately reported on the worksheet for each entity included on the statement or report, and an explanation of consolidating and eliminating entries.
(5) Information determined by the commissioner to be necessary for a review of the current financial condition of the applicant.
(6) A description of the business plan of the applicant, including:
(A) information on staffing levels and activities proposed in Indiana and nationwide; and
(B) details concerning the applicant’s ability to provide a sufficient number of experienced and qualified personnel for:
(i) claims processing;
(ii) record keeping; and
(iii) underwriting.
(7) Any other information required by the commissioner.
(d) An administrator that applies for licensure under this section shall make copies of written agreements with insurers available for inspection by the commissioner.
(e) An administrator that applies for licensure under this section shall:
(1) produce the administrator’s accounts, records, and files for examination; and
(2) make the administrator’s officers available to provide information concerning the affairs of the administrator;
whenever reasonably required by the commissioner.
(f) The commissioner may refuse to issue a license under this section if the commissioner determines that:
(1) the administrator or an individual who is responsible for the conduct of the affairs of the administrator:
(A) is not:
(i) competent;
(ii) trustworthy;
(iii) financially responsible; or
(iv) of good personal and business reputation; or
(B) has had an:
(i) insurance certificate of authority or insurance license; or
(ii) administrator certificate of authority or administrator license;
denied or revoked for cause by any jurisdiction;
(2) the financial information provided under subsection (c)(4) does not reflect that the applicant has a positive net worth; or
(3) any of the grounds set forth in section 12.4 of this chapter exists with respect to the administrator.
(g) An administrator that applies for a license under this section shall immediately notify the commissioner of a material change in:
(1) the ownership or control of the administrator; or
(2) another fact or circumstance that affects the administrator’s qualification for a license.
The commissioner, upon receiving notice under this subsection, shall report the change to the centralized insurance producer license registry described in IC 27-1-15.6-7.
(h) An administrator that applies for a license under this section and will administer a governmental plan or a church plan shall obtain a bond as required under section 4(g) of this chapter.
(i) A license that is issued under this section is valid:
(1) for one (1) year after the date of issuance, unless subdivision (2) applies; or
(2) until:
(A) the license is:
(i) surrendered; or
(ii) suspended or revoked by the commissioner; or
(B) the administrator:
(i) ceases to do business in Indiana; or
(ii) is not in compliance with this chapter.
As added by P.L.160-2003, SEC.15. Amended by P.L.11-2011, SEC.19; P.L.124-2018, SEC.48; P.L.158-2024, SEC.9.