Life and Health Third Party Administrators Forms
Introduction To Life and Health Third Party Administrators (TPA)

Arizona law requires Life and Health Administrators operating in this state to be registered with the Arizona Department of Insurance, unless they are exempt by statute (A.R.S. §20-485.12 et seq.).  Life and Health Administrators are more commonly referred to as third party administrators (TPA).

There is not a separate application procedure for resident versus non-resident TPA applicants in Arizona.  One application process applies to both:

Application Process Requirements (Word 97 format)

In Arizona, the TPA designation does not apply to those persons acting as administrators for property and casualty or workers’ compensation claims handling; they must be licensed as “adjusters” (A.R.S. §20-321). 

The registration process for a TPA requires that an application and filing fee be submitted with other documents and information.  The applications forms are now available on-line or you may request them by mail at this address:

Arizona Department of Insurance

Life and Health Division

2910 N. 44th Street, Ste. 210

Phoenix, AZ 85018

(602) 364-2393

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TPA Application Documents and Instructions
All TPAs registered with the Arizona Department of Insurance must file an Annual Financial Statement following the close of each calendar year.  The form must be filed no later than March 1st of each year:
AppCover Letter
TPA Application Instructions
TPA Application form 100
TPA Application Addendum A
TPA Bond of Administrator form L157
TPA Financial Statement form 111
Biographical Affidavit form E110

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