Amendments to the TPA

DIFS staff should be notified in writing within 30 days of any of the following changes to the TPA:

  • Change in articles of incorporation or bylaws:  Report by submitting a true copy of the amended articles of incorporation or bylaws.
  • Change of the corporate entity or Federal Employer Identification Number (FEIN). Change of the corporate entity, such as a merger or re-incorporation, is deemed to be significant. If new officers, directors, or stockholders of 10% or more result from a merger, each new individual or entity must complete an FIS 0862 Third Party Administrator Affiliation Statement.  A change of FEIN requires a new application and fees for the new entity.
  • Change in officers, directors, or shareholders holding 10% or more of the TPA's stock. An FIS 0862 Third Party Administrator Affiliation Statement will be required if one has not already been filed for the individual(s) or entities. For changes in officer titles, or resignations of officers, directors, or stockholders, inform DIFS Insurance Licensing staff in writing.  For changes in ownership, provide verification of the ownership change with stock certificates, ownership agreements, etc.
  • Change in status of the business. For example, if you are going to cease acting as a TPA, inform DIFS Insurance Licensing staff in writing.