State Requirements

Applicant must provide a vaild business and resident address, which must not be a P.O. box.

Applicant must submit a valid business email address and fax number.

All submitted phone numbers must be exactly 10 digits.

Applicant must provide Business address not in the state of Alaska.

The license expiration date is two (2) years from initial date of licensure.

Identify the key personnel who supervise or have responsibility over personnel performing TPA functions.

Third-Party Administrator (TPA) Applicant Requirements

• All Third Party Administrator applicants must submit or be aware of the following requirements. Documents can be submitted using the mailing address referenced in the State Contact Information section.
• All basic organizational documents of the Third-Party Administrator, including articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement and other applicable documents and all endorsements to the required documents.
• Bylaws, rules, regulations and similar documents regulating the internal affairs of the administrator.
• The names, mailing addresses, physical addresses, official positions and professional qualifications of persons who are responsible for the conduct of affairs of the Third-Party Administrator, including the members of the board of directors, board of trustees, executive committee or other governing board or committee, the principal officers in the case of a corporation or the partners or members in the case of a partnership or association, shareholders holding directly or indirectly ten (10) percent or more of the voting securities of the Third-Party Administrator and any other person who exercises control or influence over the affairs of the Third-Party Administrator.
• Certified (audited) financial statements for the prior two (2) years prepared by an independent certified public accountant that establish that the applicant is solvent, that the applicant's system of accounting, internal control and procedure is operating effectively to provide reasonable assurance that money is promptly accounted for and paid to the person entitled to the money. If the applicant submits a consolidated statement, a consolidating worksheet for the applicant must also be included.
• A statement describing the business plan including information on staffing levels and activities proposed in this state and in other jurisdictions and provide details establishing the Third-Party Administrator's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims handling, underwriting, and record keeping.
• Identify the key personnel who supervise or have responsibility over personnel performing TPA functions.

• Applicant is required to enter exactly one (1) Designated Responsible Licensed Producer (DRLP) on the application and have an active resident or non-resident license in Alaska. Applicant may not enter more than one DRLP.
• Designated Responsible Licensed Producer (DRLP) must cumulatively cover the lines of authority (LOAs) requested on the application. To be valid LOAs, DRLP LOAs must be active and be associated with the same license class as the applicant license class.
• Applicants are not allowed to apply for surety LOA if property and casualty LOAs are actively held on PDB. This applies across license classes.
• Applicants for the variable line of authority must supply FINRA CRD number on application.
• Applications not completed within four (4) months from the date filed will be considered withdrawn and new application forms and fees will be required pursuant to Alaska Statute 21.27.040(f).
• If applicant responds "yes" to one of the background questions please submit supporting documents electronically via NIPR's Attachments Warehouse. The documents may also be submitted to the state via mail, email, or fax.

Fingerprinting information:

• Applicants must submit an FBI FD 258 fingerprint card to the Alaska Division of Insurance for the division to conduct a state and national criminal background check. A fingerprint card is only required if the applicant does not hold an active insurance license.
• The fingerprint card is required for a state and national criminal background check to occur.
• *Please note that fingerprint cards may not be uploaded via NIPR’s Attachment Warehouse.  The original documents must be sent directly to the Alaska Division of Insurance. You may view the states contact information here.*
• The Code of Federal Regulations provides information that assists individuals with requesting changes, corrections, or updates of identification records in 28 CFR 16.34. You may direct any challenge as to the accuracy or completeness of any entry on your record to the FBI, who will then forward your challenge to the agency which submitted the data. Please refer to www.fbi.gov for additional information.