1. Begin by providing general information such as the name of the Third-Party Administrator (TPA), address, contact information, and FEIN (Federal Employer Identification Number).

2. Next, provide detailed information about the TPA including the structure of the organization, ownership details, and any related parties or affiliates.

3. Indicate the lines of insurance business for which the TPA will provide services and list any current or previous licenses held in other states.

4. Include information on the financial condition of the TPA, such as a financial statement and proof of a surety bond or other means of financial responsibility.

5. Provide details of any disciplinary actions, lawsuits, or criminal convictions involving the TPA or any of its principals.

6. Submit proof of compliance with the Arkansas Insurance Department's continuing education requirements for TPAs.

7. Include any additional documentation or information requested by the Arkansas Insurance Department to support the TPA application.

It is typically not possible to fill out the Arkansas Third-Party Administrator Application or Registration form online. However, users can find up-to-date and state-specific form templates on US Legal Forms. These forms can be completed online or downloaded in Word, PDF, and RTF formats for easy completion.

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Arkansas Third-Party Administrator Application / Registration

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