Third party administrator, also referred to as administrator, is a person who collects charges or premiums from, or who, for consideration, adjusts or settles claims of residents of the state in connection with insurance coverage, annuities, or service insurance coverage, except:
- A union on behalf of its members;
- A person administering a:
- pension plan subject to the federal Employee Retirement Income Security Act of 1974;
- governmental plan as defined in Section 414(d), Internal Revenue Code; or
- non-electing church plan as described in Section 410(d), Internal Revenue Code.
- An employer on behalf of the employer’s employees or the employees of one or more of the subsidiary or affiliated corporations of the employer;
- An insurer licensed under Chapter 5, 7, 8, 9, or 14, but only for a line of insurance for which the insurer holds a license in this state; or
- A person licensed or exempt from licensing under Chapter 23a, Insurance Marketing – Licensing Producers, Consultants, and Reinsurance Intermediaries or Chapter 26, Insurance Adjusters; and whose activities are limited to those authorized under the license the person holds or for which the person is exempt.
Person includes an individual, a partnership, a corporation, an incorporated or unincorporated association, a joint stock company, a trust, a limited liability company, a reciprocal, a syndicate or another similar entity or combination of entities acting in concert.
A person may not perform, offer to perform, or advertise any service as a third party administrator without a valid license under section 31A-25-203 and express authority from all insurers it represents. A person may not utilize the services of another as a third party administrator if he knows or should know the other does not have a license or the insurer authority as required by law.
Every third party administrator shall have a written agreement with each insurer and with each group policyholder represented.