58-56-11. Payment to TPA. If an insurer uses the services of a TPA, the payment to the TPA of any premiums or charges for insurance by or on behalf of the insured party is considered payment to the insurer. The payment of return premiums or claim payments forwarded by the insurer to the TPA is […]
58-56-16. Records to be kept. (a) Every TPA shall maintain and make available to the insurer complete books and records of all transactions performed on behalf of the insurer. The books and records shall be maintained in accordance with prudent standards of insurance record keeping and must be maintained for a period of at least […]
58-56-2. Definitions. The following definitions apply in this Article: (1) Affiliate. Any person who, directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with a specified entity or person. (2) Control. Defined in G.S. 58-19-5(2). (3) Insurance. Any coverage offered or provided by an insurer. (4) Insurer. […]
58-56-21. Approval of advertising. A TPA may use only the advertising pertaining to the business underwritten by an insurer that has been approved in writing by the insurer in advance of its use. (1991, c. 627, s. 1.)
58-56-26. Responsibilities of the insurer. (a) If an insurer uses the services of a TPA, the insurer is responsible for determining the benefits, premium rates, underwriting criteria, and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters must be provided, in writing, by the insurer […]
58-56-31. Premium collection and payment of claims. (a) All insurance charges or premiums collected by a TPA on behalf of or for an insurer, and the return of premiums received from that insurer, shall be held by the TPA in a fiduciary capacity. These funds shall be immediately remitted to the person entitled to them […]
58-56-36. Compensation to the TPA. A TPA shall not enter into any agreement or understanding with an insurer that makes the amount of the TPA’s commissions, fees, or charges contingent upon savings effected in the adjustment, settlement, and payment of losses covered by the insurer’s obligations. This section does not prohibit a TPA from receiving […]
58-56-41. Notice to covered individuals; disclosure of charges and fees. (a) When the services of a TPA are used, the TPA shall provide a written notice approved by the insurer to covered individuals advising them of the identity of, and relationship among, the TPA, the policyholder, and the insurer. (b) When a TPA collects funds, […]
58-56-46. Delivery of materials to covered individuals. Any policies, certificates, booklets, termination notices, and other written communications delivered by the insurer to the TPA for delivery to insured parties or covered individuals shall be delivered by the TPA promptly after receipt of instructions from the insurer to deliver them. (1991, c. 627, s. 1.)
58-56-51. License required. (a) No person shall act as, offer to act as, or hold himself or herself out as a TPA in this State without a valid TPA license issued by the Commissioner. Licenses shall be renewed annually. Failure to submit a complete renewal application shall result in the expiration of the license of […]
58-56-52. Prohibitions. (a) No insurance company shall act as a third party administrator with respect to residents of this State, or residents of another state from offices in this State, in connection with life or health insurance or annuities unless that insurance company is authorized to do the business of insurance in this State and […]
58-56-56. Waiver of application for license. Upon request from a TPA, the Commissioner may waive the application requirements of G.S. 58-56-51(b) if the TPA has a valid license as a TPA issued in a state that has standards for TPAs that are at least as stringent as those contained in this Article. (1991, c. 627, […]
58-56-6. Written agreement necessary. (a) No TPA may act as a TPA without a written agreement between the TPA and the insurer. The written agreement shall be retained as part of the official records of both the insurer and the TPA for the duration of the agreement and for five years thereafter. The agreement shall […]
58-56-65. Committee on Third Party Administrators. The Commissioner is authorized to appoint a Committee on Third Party Administrators in conformance with the provisions of G.S. 58-2-30. (1987, c. 676.)
58-56-66. Grounds for suspension or revocation of license. (a) The Commissioner shall, after notice and opportunity for hearing, suspend or revoke the license of a TPA if the Commissioner finds that either of the following apply to the TPA: (1) The TPA is using methods or practices in the conduct of its business that render […]
