Application
Resident and nonresident entities seeking to do business in Texas may be required to register with the Texas Secretary of State. Contact the Texas Secretary of State to confirm.
Apply online at www.Sircon.com. Review the Resident TPA or Non-Resident TPA tutorial and make sure you have all attachments ready prior to starting the process.
- Application for a Certificate of Authority - FIN489
- Officers and Directors Page - FIN306
- Use UCAA form 11 or TPA Biographical Affidavit - FIN484
- Fingerprint and Biographical Affidavit Requirements
- TPA Service of Process - FIN485 (foreign and alien applicants)
To submit deficiencies to your application review Tutorial for attaching a deficiency to TPA application.
Insurers or HMOs that are currently licensed in Texas that wish to register as a TPA should complete Notification that an Insurer or HMO will be acting as an Administrator - FIN482 and send to CLRFilings@tdi.texas.gov
Exemption under TIC Section 4151.002
As a state regulatory agency, TDI cannot provide legal advice, acknowledge, or make a determination as to whether or not an entity is exempt from TPA licensing requirements.
License Duration
TPA licenses do not expire. The June 30th "renewal" date is used to trigger the Sircon system to accept the annual report. This also allows us to determine which TPA's are not in compliance. The electronic receipt you receive is your proof or evidence of filing. Nothing else will be sent to you. The expiration date will update once TDI has processed the annual report filing.
If your TPA license is no longer needed, submit a Surrender of Third Party Administrator Certificate of Authority - FIN497 to CLRFilings@tdi.texas.gov
Annual Reports
March 1 - Report to Texas Comptroller
Administrators must file a Texas Annual Insurance Maintenance, Assessment and Retaliatory Report with the Texas Comptroller on or before March 1. Summary of Maintenance Tax and Assessment Rates
June 30 - Annual Report to TDI - (HMOS SEE BELOW)
The renewal function will not be available until April 1st
TPAs must file an annual report on or before June 30. Use the renewal function at www.Sircon.com to submit the TPA annual report and pay the $200.00 filing fee. Be sure to use the new license number and have all attachments ready prior to starting the process.
Review the Tutorial for submitting TPA annual report.
- TPA Annual Report - TDI Form FIN486;
- TPA Annual Report Exhibits A-E - TDI Form FIN488;
- Audited financial statement;or
- For TPA license holders who receive less than $10 million annually as compensation for performing administrative services submit:
- (1) unaudited financial statement and
- (2) a completed Certification of Financial Statement for Administrators - FIN490
- Certification on company letterhead, signed by an Officer, Partner, or Sole Proprietor, stating that the information provided in the annual report filing is true and correct.
If you need to add an additional document or deficiency refer to Tutorial for attaching a deficiency to TPA renewal
FOR INSURERS AND HMOs ACTING AS TPAs
- Complete and sign the Annual Report form for Insurers or HMOs - TDI Form FIN487.
- TPA Annual Report Exhibits A-E - TDI Form FIN488
- Upload the report as one .pdf file to the Financial Filing Submission Portal
- Mail the $200.00 filing fee along with TDI Form FIN321 to the address on the form.
Common TPA Transaction Forms
TPA Change of Address and/or Contact - FIN498
TPA Change of Control - FIN502 - along with a detailed letter explaining the proposed transaction, and proposed pre-acquisition and post-acquisition organizational charts.
Copy of TPA License
Need a copy of the current certificate of authority (license)? Send an email to CLRRequests@tdi.texas.gov. If you need a certified copy of the certificate of authority send your check for $11.00 along with TDI Form FIN321 to the address on the form.
Printing your license from Sircon.com is currently not available. The template Sircon uses for the license is very generic to accommodate all states. Texas prefers to use state specific templates that we can customize across our different license types.
License Lookup
Look up TPA license information using the "Search for a Business" tab:
Sircon Business/Individual Search (texas.gov)
Pharmacy Benefit Managers licensed as TPAs
Pharmacy Benefit Managers must file an annual report in accordance with Texas Insurance Code Section 1369.502 concerning rebates, fees, and other payments by a PBM in the preceding calendar year.
Pharmaceutical Benefits Reporting