What is a Tpa?

We hear this all the time - what exactly is a TPA? A Third Party Administrator (TPA) is an organization that processes claims and performs other administrative services in accordance with a service contract. A TPA is not an insurance company.

 

The State of Ohio defines "Third party administrator" as: "any person that adjusts or settles claims in connection with life, dental, vision, health or disability insurance plans, self-insurance programs or other benefit plans for a sponsor of a plan if either the sponsor or the plan is domiciled in this state or has its principal headquarters or principal administrative offices in this state."

 

"Third party administrator" does not include any of the following:

• An insurance agent or solicitor licensed in this state whose activities are limited exclusively to the sale or insurance and who does not provide any administrative services;
• Any person who administers or operates exclusively the workers' compensation program of an employer who has been granted self-insurance status pursuant to section 4123.35 of the Revised Code;
• Any person who administers pension plans for the benefit of its own members or employees or administers pension plans for the benefit of the members or employees of any other person;
• Any person that administers an insured plan, a self-insurance program, or other benefit plans in connection with life, vision, dental, health, or disability benefits exclusively for the person's own members or employees; and
• Any health insuring corporation organized under Chapter 1751 of the Revised Code, or an insurance company that is authorized to write life or sickness and accident insurance in this state.