The following items need to be submitted to the address below to be considered for a Third Party Administrator License:

Please review RSA 402-H and Ins 2300.

• Application Form
• Surety Bond Form
• NAIC Biographical Affidavit Form
• $1,000.00 application fee. **Fee is non-refundable.
• A detailed written business plan describing the planned or expected business activity in New Hampshire must also be included.
• State the name(s) of the owner(s) of the administrator.

The completed application package and filing fee should be directed to the New Hampshire Insurance Department, Financial Regulation Division.

Please note that effective October 1, 1995, the New Hampshire Department of Labor assumed sole responsibility, regulatory authority and licensing for Third Party Administrators for Self-Insured Workers’ Compensation, pursuant to 1995 Chapter 161. The Insurance Department will continue to regulate all other Third Party Administrators. It is possible that your company may be required to be licensed by both the Department of Insurance and the Department of Labor. To contact the New Hampshire Department of Labor, call (603) 271-3176.

If you have any questions, please contact Linda M. Zalinskie.

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