INSTRUCTIONS: CONNECTICUT TPA ANNUAL REPORT CHECKLIST

An annual report should be filed by Connecticut third party administrators (TPA). This article discusses the checklist and report form, which can be obtained from the website of the government of Connecticut.

Connecticut TPA Annual Report Checklist Step 1: The first page contains the checklist. Check each box when you have met the requirements. Line 1 asks whether you have included a $100 filing fee payable to "Treasurer, State of Connecticut."

Connecticut TPA Annual Report Checklist Step 2: Line 2 asks if information in the annual report has been verified by at least two TPA officers.

Connecticut TPA Annual Report Checklist Step 3: Line 3 asks if you have included evidence of the required surety bond or audited financial statements for the two most recent years.

Connecticut TPA Annual Report Checklist Step 4: Line 4 asks if you have included the complete names and addresses of all insurers or other persons with whom the TPA had written agreements during the past year.

Connecticut TPA Annual Report Checklist Step 5: Line 5 asks if you have a current certificate of good standing from your domiciliary state.

Connecticut TPA Annual Report Checklist Step 6: Line 6 asks if you have included an explanation of any sanctions or administrative proceedings taken against your company in this or any other state.

Connecticut TPA Annual Report Checklist Step 7: Line 7 asks if you have included an explanation for any officer or director who has been convicted of a crime.

Connecticut TPA Annual Report Checklist Step 8: Line 8 asks if you have renewed your TPA license online prior to September 31.

Connecticut TPA Annual Report Checklist Step 9: Enter the trade or doing business as name of the TPA on the first blank line of the second page.

Connecticut TPA Annual Report Checklist Step 10: Enter your Connecticut insurance department license number on the second blank line, your address on the next two blank lines, your telephone number on the fifth blank line and your email address on the sixth blank line.

Connecticut TPA Annual Report Checklist Step 11: Answer all remaining questions on the second page by checking "Yes" or "No" as applicable.

Connecticut TPA Annual Report Checklist Step 12: Up to two company officers and directors should sign and date the last page.