Renewal: Proving Financial Viability and Completing Jurat Page

Per Section 500.936 of the Third Party Administrator Act, being MCL 550.936, a TPA must prove financial viability each year.

In January, an invoice is mailed to each TPA in the amount of $25.00 for review of the financial statement.  The following items must be returned with the invoice and payment:

  • An FIS 0850 Financial Statement for Third Party Administrators, Pages 1 – 3. In lieu of Pages 2 and 3 of the FIS 0850 form, the TPA may submit independent audited financial statements along with an opinion prepared by a CPA.
  • The FIS 0865 Third Party Administrator Jurat Page for Annual Renewal reporting pertinent demographic information and the company’s current officers, directors and stockholders.
  • The complete financial statement, Jurat page, invoice stub, and payment must be received at the DIFS office by the March 1 deadline. This deadline is mandated by law. An extension may be granted if requested in writing, but the extension can be granted only until April 1.

Note: Failure to file, late filing, or incorrect payment will result in a penalty, including termination of your certificate of authority as a TPA.  If concerns result from review of the financial statement, DIFS staff will contact the TPA regarding those concerns and how they can be eliminated. The Certificate of Authority is perpetual as long as the TPA is compliant with the TPA Act.