Florida Insurance License

Third Party Administrator Application Package

Online

$100 application fee + fingerprint fee

• The application must be signed by the President or Secretary of the applicant company.
• Original signatures and a corporate seal are required
• If a fictitious name is being used, provide documentation of registration with the Florida secretary of state

• Fingerprints
  • Applicants are required to prepay electronically for the processing of fingerprint cards required in Section IV-5. Florida residents have the option of having their fingerprints digitaly scanned rather than providing paper fingerprint cards. Use Form OIR-C1-938 Fingerprint Payment and Submission Procedure for instructions
• Provide an original certified copy of the articles of incorporation/ organization and all amendments
• Provide an original certificate of good standing issued by Secretary of State in the domicile state. 
• Provide a copy of hte company's current bylaws. 
  • The Bylaws must be sealed, signed, and dated by the Secretary of the corporatino. No signatures other than the Secretary's will be accepted. The Secretary's statement must also be recently dated. 
• Provide an original Florida certificate of good standing
• Provide Financial Statements
  • If the applicant has been in existence for 2 or more years, provide audited financial statements from the 2 most recent fiscal years. If the audit contains consolidated financials, explanations and breakdowns will be required
  • If the applicant has been in existence less than 2 years, submit financial statements certified by an officer of the applicant and prepared in accordance with generally accepted accounting principles for any completed fiscal years and for any month during hte current fiscal year in which financial statements have been completed. 
• Submit a plan of operations, including: 
  • A brief history of hte company since its incorporation
  • A list of all states in which the applicant is license as and administrator and the dates licenses were issued
  • A description of each line of insurance to be administered in Florida. 
    • Name of the insurer
    • Services to be provided (e.g., marketing, claims adjudication, premium collection, underwriting etc.)
  • If any administrative services are currently being performed for any insurer on beahlf of Florida residents, submit a full explaination as to the dates of inception, types of coverage, names of insurers, amounts of claims paid or premiums collected, and numbers of Florida residents involved. 
  • Provide a narrative on staffing levels and activities proposed in this state and nationwide.
    • Include details about the applicant's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing, recordkeeping, and underwriting
• Obtain a fidelity (surety) bond equal to at least 10% of annualized funds handled or managed. 
  • Must include a 30-day cancellation notice provision in favor of the Office
• Provide a statement explaining the nature an extend of hte applicatin's ownership interest or affiliation with any insurance company that is responsible, directly or through re-insurance, for providing benefits to any plan for which the applicant provides administrative services
• List the complete name and address of all branches operating in Florida. Note where books and records pertaining to Florida insureds will be made available to the Office
• Submit a sample of the administrative agreement the appliant plans to use in Florida
  • Agreement must comply with all Florida statutes
• Provide a list of all officers directors and shareholders with a 10% or greater interest in the company. 
  • If a parent company exists, provide the names of all officers and directors up through the ulitmate parent corporation or holidng company. Use a separate form for each company
  • For shareholders, if a parent company exists, provide the name, ownership percentage, number of shares, and class of shares held by each shareholder who has a 10% or creater interest in the company up through the ulitmate parent company or holding company
• Provide an organization chart if the applicant is a subsidary of a parent or holidng company
• When reporting names, report the full name (first, middle, and last name) for each. If no middle name exists, use "NMN"
• Submit a biographical affidavit for all officers directors and shareholders reported 
  • Social security numbers are mandatory
  • Follow Florida's state statutes and proceses to appropriately submit Social Security Numbers safely
  • Notarization is required
• Submit a background investigative report for all officers, directors, and shareholders reported (appliant and ultimate parent company only - personnel of intermediate parent companies are not required)
• Submit fingerprint cards for each of the officers, directors, and shareholders reported. 
  • You must use Florida's fingerprint cards. The Office of Insurance will provide them upon request
  • Complete at a local law enforcement station or similar agency
• Make a copy of your check.
  • Send the copy with the application.
  • Send th actual check and invoice to the Financial Services Bureau
• The President, Secretary, or Treasurer must sign the checklist affirming that the applicaiton is true and complete.

Insurance Administrator Annual Report

Online

$250

Annually within 3 months after the end of the administrator’s fiscal year.

FL Stat. § 626.89