Standards for license issuance and approval of registration

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  • The Commissioner may issue a license to an applicant or approve an application for registration as a TPA if the Commissioner finds that the applicant meets the standards established by this chapter including, but not limited to, the following:
    • (1) All of the materials required by this chapter or by the Commissioner have been filed;

    • (2) The persons responsible for conducting the applicant’s affairs are competent, trustworthy and possess good reputations, and have appropriate experience, training and education;

    • (3) The applicant has demonstrated the ability to assure that its services will be performed in a manner which will ensure the efficient operation of its business, including appropriate financial controls;

    • (4) The standard contract forms to be used by the applicant are acceptable;

    • (5) The applicant has adequate financial arrangements with the benefits payors for which it will perform its services and adequate arrangements for complying with the provisions of this chapter;

    • (6) The compensation arrangements made between the applicant and benefits payors do not result in the assumption of financial risk by the applicant;

    • (7) The bond requirement in section 1534 is met; and

    • (8) In the case of an applicant for registration, the provisions of § 1533 subsections (d), (e) and (f) apply only to services provided by the applicant to benefits payors other than an insurer.


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