- (a) A TPA shall not act on behalf of a self-insurer without a written agreement with that self-insurer.
- (b) A TPA shall complete and submit “Notice of Contract Between Third Party Administrator and Self-Insurer” form WC-TPA-CBP (3/2019). The form may be obtained at https://www.nh.gov/labor/documents/tpa-contract.pdf.
(c) In addition to the “Notice of Contract Between Third Party Administrator and Self-Insurer” form, a TPA shall submit the following documents to the department:
- (1) A copy of the contract between the administrators and insurers; and
- (2) A copy of the notification which will be sent to policyholders informing them of this arrangement.
Source. #7142, eff 11-24-99, EXPIRED: 11-24-07 New. #9878-A eff 2-25-11, EXPIRED: 2-25-19 New. #12815, eff 6-26-19