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Title: Third Party Administrator License
Alternate Title:
Description: Minnesota Department of Commerce
Subject: Insurance
Insurance Professionals
Creation Date: 9/11/2008 2:18:01 PM
Modification Date: 8/15/2024 6:22:35 PM

Agency Name: Commerce, Minnesota Department of
Agency URL: https://mn.gov/commerce/
Agency Description: The Minnesota Department of Commerce is the chief regulator for the banking, energy, insurance, real estate, securities, telecommunications industries and also operates Minnesota's Unclaimed Property.
Agency Phone: 651-539-1500
Agency Fax: Agency URL: https://mn.gov/commerce/

Agency Address:
85 7th Place East, Suite 500

St. Paul
MN
55101

Unit Name:
Unit URL:
Unit Description:
Unit Phone: Unit Fax: Contact person(s): tuan.tran@state.mn.us
Unit URL:

Audience: Hold Application URL: https://www.sircon.com/
Renewal URL: https://www.sircon.com/
Versa URL:
Requirements:

Review:

Insurance Licensing

Third Party Administrator

The annual activity report should be filed on the Excel spreadsheet form. The spreadsheet should be emailed to tuan.tran@state.mn.us

Contact
Tuan Tran, Self-Insurance Analyst
Minnesota Department of Commerce
Email: tuan.tran@state.mn.us
Phone: 651-539-1748
Fax: 651-539-1550

Rules: 2767

Statutes: 60A.23

Forms:

Licensing Forms

Application/Renewal form (.pdf)
- Must be completed to be considered for TPA licensing or the renewal of a TPA license
Online application is also available for new and renewal applications (Note that the online renewal form is available on the SIRCON website beginning 90 days prior to the license expiration date.)
Guarantee form (.pdf)
- Must be completed when applying for a TPA license when an applicant uses the financial statements of a parent or other related entity to meet the financial requirements. The guarantee must be accompanied by a resolution by the guarantor's board of directors authorizing the guarantee.
Third Party Administrator Bond form (.pdf)
Minn. Stat. § 270C.72 (Tax Clearance; Issuance of Licenses) (.pdf)
Annual Activity Report (.xlsx)
Annual Activity Report (.xls)

Forms are available at Insurance Licensing - Third Party Administrator

Fees:

$1,500 every three years.

Period of Issuance:

Normally three years.

Length of Determination:
Other Info:
Activity: Insurance
License Detail URL:

Third Party Administrator

Insurance Licensing

Insurance

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