OAR 836-075-0000: Third Party Administrators; License Application; Required Information

An applicant for a third party administrator license shall provide the following electronically in accordance with directions set forth on the Division of Financial Regulation website of the Department of Consumer and Business Services at dfr.oregon.gov: (1) Information relating to the organizational form of the applicant as follows: (a) The name under which the applicant will transact business as a third party administrator; (b) The principal place of business at which the applicant will transact business as a third party administrator, including the street and mailing addresses and telephone number; (c) The organizational form of the applicant (corporation, partnership, sole proprietorship); (d) All assumed business names and other names under which the applicant will transact business as a third party administrator; (e) Whether the applicant has ever had a judgment entered against the applicant for fraud, and whether any insurer, insurance producer or other person claims the applicant to be indebted to it, together with the details of any such indebtedness; (f) Whether any license of the applicant to act in any occupational or professional capacity has ever been refused, revoked or suspended in this or any other state, and whether the applicant has otherwise ever been the subject of a complaint to a professional licensing board or agency. If the applicant's answer is affirmative in any respect, the applicant must also provide the name and address of the licensing board or agency, the date of the complaint or the action taken against the license, a description of the nature of the complaint or the reason for the action taken against the license, and, with regard to a complaint, a description of the licensing board or agency's disposition of the complaint; (g) Whether the applicant has ever filed for bankruptcy or been adjudged a bankrupt; (h) All states and provinces of Canada in which the applicant currently holds a license or certificate of authority to transact business as a third party administrator, or has held such a license or certificate within ten years prior to the date of the application; (i) The names, addresses, official positions and professional qualifications of the individuals who are responsible for the conduct of affairs of the administrator, including all members of the board of directors, board of trustees, executive committee or other governing board or committee; the principal officers in the case of a corporation or the partners or members in the case of a partnership or association; shareholders holding directly or indirectly ten percent or more of the voting securities of the administrator; and any other person who exercises control or influence over the affairs of the administrator; (j) The name and telephone number of a contact person who is knowledgeable about preparation of the annual financial statements or reports required under section (4) of this rule. (2) An appointment of the director, on the application, as agent for service of process, if the third party administrator will be a nonresident licensee. (3) Biographical information for each owner, partner, director and officer of the applicant, on the Biographical Affidavit form designed by the National Association of Insurance Commissioners. (4) The following documents, which must accompany the application under section (1) of this rule: (a) All basic organizational documents of the applicant, including any articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, share-holder agreement and other applicable documents and all amendments to such documents; (b) The bylaws, rules, regulations or similar documents regulating the internal affairs of the applicant; (c) Annual financial statements or reports for the two most recent years, which prove that the applicant is solvent, and such information as the director may require in order to review the current financial condition of the applicant, except as provided in subsection (d) of this section; (d) If the applicant is a corporation that is newly formed for the purpose of transacting business as a third party administrator, the financial statements or reports of each incorporator, shareholder and officer for the two most recent years, a current balance sheet for the corporation and such information as the director may require in order to review the current financial condition of the applicant; (e) A statement describing the business plan, including information on staffing levels and activities proposed in this state and nationwide. The plan must provide details setting forth the applicant's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing, recordkeeping and underwriting; (f) Evidence that the applicant has a fiduciary account established in a federally or state-insured financial institution. An applicant that is an insurance producer licensed under ORS Chapter 744 need not comply with this subsection if the applicant is in compliance withers ORS 744.225 with respect to the premiums, charges and return premiums referred to in ORS 744.730; (g) Evidence of insurance coverage required by ORS 744.726; (h) If the applicant will be managing the solicitation of new or renewal business, proof that it employs or has contracted with an insurance producer licensed by the director for solicitation and taking of applications. Any applicant that intends directly to solicit insurance contracts or to otherwise act as an insurance producer must provide proof that it has a license as an insurance producer in this state.