044-4 Wyo. Code R. §§ 4-12 - Initial TPA License

(a) A TPA applying to this state shall apply for licensure using forms prescribed by the commissioner and designate an individual as the TPA's contact person for department communications.

(b) The application forms shall include or be accompanied by the following information and documents:

(i) Verification of registration with the Wyoming Secretary of State or documentation from the Wyoming Secretary of State verifying that registration is not necessary;

(ii) Audited annual financial statements or reports for the two (2) most recent fiscal years that prove that the applicant has a positive net worth. If the applicant has been in existence for less than two (2) fiscal years, the application shall include financial statements or reports, certified by an officer of the applicant and prepared in accordance with GAAP, for any completed fiscal years, and for any month during the current fiscal year for which such financial statements or reports have been completed. An audited financial report prepared on a consolidated basis shall include a columnar consolidating or combining worksheet that shall be filed with the application for licensure and include the following:

(A) Amounts shown on the consolidated audited financial report shall be shown on the worksheet;

(B) Amounts for each entity shall be stated separately; and

(C) Explanations of consolidating and eliminating entries shall be included. The applicant shall also include such other information as the commissioner may require to review the current financial condition of the applicant;

(iii) Completed Designation of Third Party Administrator Form for each active contract. A TPA license shall not be issued without at least one (1) active designation;

(iv) Completed Entity/Third Party Administrator Contract Checklist for each active contract. A TPA license shall not be issued without at least one (1) active written agreement; and

(v) Such other pertinent information as may be required by the commissioner.

(c) A TPA licensed or applying for licensure under this section shall make available for inspection by the commissioner copies of all contracts with payors or other persons utilizing the services of the TPA.

(d) A TPA licensed or applying for licensure under this section shall produce its accounts, records and files for examination, and make its officers available to give information with respect to its affairs, as often as reasonably required by the commissioner.

(e) The commissioner may refuse to issue a license if the commissioner determines that the TPA or any individual responsible for the conduct of affairs of the TPA is not competent, trustworthy, financially sound or of good personal and business reputation, or has had an insurance or a TPA certificate of authority or license denied or revoked for cause by any jurisdiction, or if the commissioner determines that any of the grounds set forth in section 14 of this chapter exists with respect to the TPA.

(f) A license issued under this section shall continue in force until renewed, expired, surrendered, suspended, revoked or otherwise terminated.

(g) Any license referred to in subsection (f) of this section is considered expired if the commissioner does not receive the renewal application as required in section 13 of this chapter by June 30 of the renewal year.

(h) An individual may not qualify for licensure under this section.

(i) A TPA licensed or applying for licensure under this section shall notify the commissioner within thirty days of any material change in its contact person for the TPA or other fact or circumstance affecting its qualification for a license in this state.

(j) A TPA licensed or applying for a license under this section shall maintain a surety bond with the State of Wyoming as obligee for its use and benefit to cover persons in this state who have remitted premiums, plan contributions, or insurance charges or other monies to the TPA in the course of the TPA's business. The bond shall be the greater of the following amounts:

(i) One hundred thousand dollars ($100,000); or

(ii) Ten percent (10%) of the aggregate total amount of funds handled in this state, not to exceed one million dollars ($1,000,000) unless a larger amount is deemed by the commissioner to be necessary for the protection of the protection of the payor's policyholders or members in this state.

(k) For the purposes of fixing the amount of the bond described in paragraph (j) of this section, the amount of funds handled shall be determined by the total funds handled by the TPA within the borders of and on behalf of the citizens of Wyoming during the preceding year. If no funds were handled during the preceding year the amount of funds reasonably estimated to be handled during the current licensing year by the TPA. Such bond or deposit shall provide protection to the payor's policyholders or members in this state against loss by reason of acts of fraud or dishonesty and negligence by the TPA.

Notes

044-4 Wyo. Code R. §§ 4-12

Amended, Eff. 11/2/2022.