The Rhode Island Third Party Health Insurance Administrator license
Third Party Health Insurance Administrator
A certificate of authority rather than a license, held by the organization that collects premiums or settles claims on somebody else’s health coverage. It is qualified on solvency and a staffing plan, and it is the only thing the Department issues annually.
Course
None
This license has no pre-licensing course route.
Ways in
2
None of them requires a state exam, because this license has none.
Exam
n/a
Not required on any of the routes below.
Every way to qualify
More than one route leads to this license, and which one you take changes what you study and whether you sit the exam. There is no pre-licensing course among them: this license is qualified for by experience or a license held in another state.
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Route 1 Apply for a certificate of authority
No state exam for this license
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Organizational and internal governing documents, the names and professional qualifications of everybody responsible for the conduct of the administrator’s affairs including ten percent shareholders, two years of financial statements proving solvency, and a business plan detailing the staffing levels and the capability to provide enough experienced personnel in claims processing, recordkeeping and underwriting
27-20.7-12(a) forbids acting as, offering to act as, or holding out as an administrator without a valid certificate of authority, and 27-20.7-12(b) lists seven things the application carries. Two of them are the substance of the qualification. Annual financial statements for the two most recent years have to prove the applicant is solvent, and the business plan has to set out staffing levels and detail the capability to provide a sufficient number of experienced and qualified personnel in claims processing, recordkeeping and underwriting. Where the applicant will manage the solicitation of new or renewal business it also proves it employs or has contracted with a licensed agent, and where it intends to solicit directly it proves it holds a producer license of its own. No examination and no course appear in the chapter. 27-20.7-12(d) is the refusal power and it reaches the individuals as well as the organization. 27-20.7-12(e) makes the certificate valid until surrendered, suspended or revoked, and the annual report under 27-20.7-14 is what keeps it: the Department holds a NIPR renewal in pending status until the report arrives and is approved. The fee is $250 a year for the certificate of authority and $250 for the waiver certificate; the ERISA exempt registration costs nothing.
Read at webserver.rilegislature.gov on 2026-08-18
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Route 2 Hold a certificate in a state at least as stringent as the NAIC model
No state exam for this license
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a valid certificate of authority as an administrator issued in a state whose standards for administrators are at least as stringent as those in the NAIC model statute for third-party administrators
27-20.7-13, and it is a narrower thing than the usual reciprocity clause: the commissioner may waive the application requirements of 27-20.7-12(b) on request, not the certificate itself. The test is not that the other state is on a list, it is that the other state’s standards for administrators are at least as stringent as the National Association of Insurance Commissioners model statute, which makes it the only route on this site measured against a model law rather than against another state’s license. The Department prices the result as its own line, the Third Party Health Insurance Administrators waiver certificate, at the same $250 a year as the full certificate of authority.
Read at webserver.rilegislature.gov on 2026-08-18
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No national seller sells a course for this certificate. Nothing could: it goes to an organization on its solvency and its staffing plan, and there is no examination and no individual qualification behind it.