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Indiana Code for Insurance Administrators is located at: IC 27-1-25
The following items must be submitted in order to renew a Resident insurance administrator license no later than July 31st. Please tab materials to correspond with its number the requirements below. Paying the renewal fee alone does not renew the license.
1. A completed Resident TPA renewal application. Each question must be completed entirely or the application will not be accepted.
2. Renewal fee of $50. (checks made payable to IDOI)
3. A list of the current officers, directors, or partners of the Administrator.
4. Biographical Affidavits for each newly elected officer, director or partner of the Administrator originally signed, notarized and dated within twelve (12) months of the application. (this item only required if there have been changes since the last renewal)
5. Audited Financial Statement prepared by an independent certified public accountant for the two most recent fiscal years (if the applicant has been in business less than two years submit financial reports that have been prepared in accordance with GAAP and certified by an officer of the applicant).
6. Insurance Administrators Compliance Checklist to be completed in conjunction with the submission of any amended or new administrative agreements. (this item only required if there have been changes since the last renewal)
7. A report including the complete names and addresses of insurers with which the administrators had an agreement with during the preceeding year.
8. Surety Bond if the Insurance Administrator is administering a Governmental Plan and/or Church Plan, if not, a statement that Administrator is not administering a Governmental and/or Church Plan.
8 (a) A report detailing the total funds administered for a Governmental Plan and/or Church Plan for Indiana and all other jurisdictions combined, if applicable.
The completed application and information requested above should be sent to the following:
*Note - All materials should be sent postal mail, faxed or emailed items will not be accepted*
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
After a complete filing has been received and approved, the Department will issue a license and send it to the applicant to the mailing address provided
NOTE: Licenses will not be mailed until after June 1st.