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Blank Ohio Ins3213 Template

The Ohio Ins3213 form is a comprehensive document designed for Third Party Administrators (TPAs) seeking to renew or continue their business entity license with the Ohio Department of Insurance. This form, directed by Judith L. French, requires detailed information including demographic data, the type of license requested (Resident or Non-Resident), and a series of background questions aimed at ensuring compliance with both state and federal insurance regulations. It serves as a crucial step for TPAs to legally operate within Ohio, ensuring that they meet all necessary criteria related to financial stability, professional liability, and adherence to the laws governing insurance practices.

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The Ohio Ins3213 form serves a vital role in the regulatory landscape for Third-Party Administrators (TPAs) operating within the state. Directed by Judith L. French, the form encompasses several crucial sections including the choice between applying for a resident or non-resident license, demographic information of the business entity, and specific details about the Designated/Responsible Licensed Producer responsible for ensuring the entity's compliance with the state's insurance laws. Applicants are required to disclose any past misdemeanor or felony convictions, excluding certain traffic violations and juvenile adjudications, and must also report any involvement in administrative proceedings related to professional or occupational licenses. Additionally, the form queries TPAs about their fidelity bond coverage, professional liability, and Errors and Omissions (E&O) insurance, essential requirements that ensure the financial integrity and professional competence of TPAs. It also scrutinizes the handling of plan sponsor and insurer funds, adherence to maintaining records and changes in key personnel or business address that have occurred since the last application or renewal. Furthermore, the form encompasses certifications and attestations that confirm the veracity of the provided information and the applicant's compliance with child support obligations, alongside a designated agent for service of process. Accompanied by a non-refundable application fee and necessary documentation, the Ohio Ins3213 form is comprehensive, ensuring TPAs meet all regulatory requirements and uphold the highest standards of operation within Ohio.

Example - Ohio Ins3213 Form

Judith L. French, Director

Check appropriate boxes for license requested:

(Please Print or Type)

Resident License

Non-Resident License

Identify Home State:

Identify Home State License #:

Demographic Information

1Business Entity’s Name

2FEIN

3Ohio License Number

4National Producer Number (NPN)

5 Is the business entity affiliated with a financial institution/bank?

Yes

6Business Address

7City

8State

9Zip or Foreign Country

10Phone Number (include extension)

11Fax Number

12Business E-Mail Address

13Business Web Site Address

14Mailing Address

15P.O. Box

16City

17State

18Zip or Foreign County

Designated/Responsible Licensed Producer

19Identify at least one Designated/Responsible Licensed Producer responsible for the business entity’s compliance with the insurance laws, rules, and regulations of this state:

Name	SSN	NPN
Name	SSN	NPN
Name	SSN	NPN
Name	SSN	NPN

Background Questions

20
1a. Has the business entity or any owner, partner, officer or director of the business entity, or member or manager of a limited liability company		Yes	No
been convicted of, or is currently charged with, committing a MISDEMEANOR or had a judgment withheld or deferred for a
MISDEMEANOR which has not been previously reported to this insurance department?
You may exclude the following misdemeanor convictions or pending misdemeanor charges: traffic citations, driving under the influence
(DUI), driving while intoxicated (DWI), driving without a license, reckless driving, or driving with a suspended or revoked license.
You may also exclude juvenile adjudications (offenses where you were adjudicated delinquent in a juvenile court).
1b. Has the business entity or any owner, partner, officer or director of the business entity, or member or manager of a limited liability company		Yes	No
been convicted of, or is currently charged with, committing a FELONY or had a judgment withheld or deferred for a FELONY which has
not been previously reported to this insurance department?
You may also exclude juvenile adjudications (offenses where you were adjudicated delinquent in a juvenile court).
If you have a felony conviction involving dishonesty or breach of trust, have you applied for written consent to engage in the business of	N/A	Yes	No
insurance in your home state as required by 18 USC 1033?
If so, was consent granted? (Attach copy of 1033 consent approved by home state.)	N/A	Yes	No
1c. Has the business entity or any owner, partner, officer or director of the business entity, or member or manager of a limited liability company		Yes	No
been convicted of, or is currently charged with a MILITARY OFFENSE which has not been previously reported to this insurance
department?

NOTE: For Questions 1a, 1b, and 1c, “Convicted” includes, but is not limited to, having been found guilty by verdict of a judge or jury, having entered a plea of guilty or nolo contendere or no contest, or having been given probation, a suspended sentence, or a fine.

If you answered “Yes” to any of the above questions (1a, 1b, or 1c), you must attach to this application:

a)a written statement explaining the circumstances of each incident,

b)a copy of the charging document, and

c)a copy of the official document, which demonstrates the resolution of the charges or any final judgment.

INS3213 (Rev. 02/2021)

Page 1 of 3

Ohio Department of InsuranceBUSINESS ENTITY TPA LICENSE RENEWAL/CONTINUATION

Background Questions (continued)

2. Has the business entity or any owner, partner, officer or director, or manager or member of a limited liability company, been named or

Yes

involved as a party in an administrative proceeding regarding any professional or occupational license or registration, which has not been previously reported to this state?

“Involved” means having a license censured, suspended, revoked, canceled, terminated; or, being assessed a fine, placed on probation or surrendering a license to resolve an administrative action. “Involved” also means being named as a party to an administrative or arbitration proceeding, which is related to a professional or occupational license. “Involved” also means having a license application denied or the act of withdrawing an application to avoid a denial. You may exclude terminations due solely to noncompliance with continuing education requirements or failure to pay a renewal fee.

If “Yes”, you must attach to this application:

a)a written statement identifying the type of license; identifying all parties involved (including their percentage of ownership, if any) and explaining the circumstances of each incident,

b)a copy of the Notice of Hearing or other document that states the charges and allegations, and

c)a copy of the official document which demonstrates the resolution of the charges or any final judgment.

3.	Does the TPA hold a fidelity bond or other comparable insurance policy coverage for all employees as required by R.C. 3959.11 and	Yes	No
	OAC 3901-8-05 (D) (5)?
	If “Yes”, provide a copy of bond or insurance policy coverage. Make sure documentation includes the name of the carrier, policy number
	and effective dates.
4.	Does the TPA carry any type of professional liability and/or E&O insurance for TPA activities as required by ERISA?	Yes	No
	If “Yes”, provide proof of coverage or bond. Make sure documentation includes the name of the carrier, policy number and effective dates.
5.	Do you understand that any required bond, insurance policy, professional liability and E&O insurance policy must be maintained for	Yes	No
	the duration of the licensure period?

6.Will the TPA’s records continue to be maintained in accordance with the requirements of OAC 3901-8-05 (L) and (M)? If the

	answer to any of the questions below is “No”, then attach a letter stating how those records are maintained.
	a)	Records reflect all administered transactions?		Yes	No
	b)	Detailed preparation or journalizing and posting of books and records are maintained?		Yes	No
	c)	Records are maintained throughout the term of the administration agreement?		Yes	No
	d)	All disbursement records contain the information required by R.C. 3959.15 (E)-(H)?		Yes	No
	e)	Annual reports are required to be filed with insurers and plan sponsors within 90 days of the end of each fiscal year of the plan?		Yes	No
	f)	Return premiums or contributions are paid to insurer or plan sponsors within 30 days of receipt?		Yes	No
7.	Since the last application or renewal have any Excess Insurers (Stop-Loss Carriers) or Managing General Underwriters approved the TPA to			Yes	No
	administer claims for plans using their stop-loss products?
	If “Yes”, provide the names and contact information for each one on a separate document.
8.	Since the last application or renewal has the TPA been licensed as a Managing General Agent?			Yes	No
	If “Yes”, provide a name of the States and license status on a separate document.
9.	What type(s) of claims will the TPA administer or plan to administer within the next year in this state?
	(Must check at least one option – Select all appropriate options that apply)
		Traditional self-insured employee benefit plans	Government self-insured employee benefit plans
		Preferred Provider Org. (PPO)	Fully insured employee benefit plans
		Prescription drug claims	Provider billing processing
		Life insurance claims	Medical/Managed care
		Disability insurance claims	Other, attach description on a separate document.
		Dental claims
10. How does the TPA handle plan sponsor and insurer funds?
	(Must check at least one option – Select all appropriate options that apply)
		Accounts are owned by the insurance company
		Plan sponsor owns accounts/TPA has check writing ability
		TPA has a separate fiduciary account(s) for plan sponsor & insurer funds
		OTHER: Attach a letter of explanation.
11. Does the applicant understand that the TPA and its officers shall be responsible for the supervision of the actions of any and all personnel				Yes	No
	and subcontractors who adjust or settle claims on behalf of the applicant according to OAC 3901-8-05 (E)(3)?

Applicant’s Signature:

Ohio Department of InsuranceBUSINESS ENTITY TPA LICENSE RENEWAL/CONTINUATION

Background Questions (continued)

12.	Does the applicant understand that the TPA may not commingle among its personal assets, or draw against for its own purposes, any	Yes	No
	monies or contributions of a plan sponsor or plan participant according to OAC 3901-8-05 (H)(1)?
13.	Have there been any changes of officers, directors, partners, members or trustees, or any change of shareholders or other owners or	Yes	No
	members holding 5% or more ownership in the TPA or change of business address that has not been previously reported to the Department
	as required by OAC 3901-8-05(D)(5)?
	If “Yes”, include the Department’s document for business entity changes.
14.	Is the TPA operating as a Pharmacy Benefit Manager (PBM)?	Yes	No
14.	Is the TPA operating as a Pharmacy Benefit Manager (PBM)?

Applicant’s Certification and Attestation

On behalf of the business entity or limited liability company, the undersigned owner, partner, officer or director of the business entity, or member or manager of a limited liability company, hereby certifies, under penalty of perjury, that:

1.All of the information submitted in this application and attachments is true and complete and I am aware that submitting false information or omitting pertinent or material information in connection with this application is grounds for license or registration revocation and may subject me and the business entity or limited liability company to civil or criminal penalties.

2.Unless provided otherwise by law or regulation of the jurisdiction, the business entity or limited liability company hereby designate the Commissioner, Director or Superintendent of Insurance, or other appropriate party in each jurisdiction for which this application is made to be its agent for service of process regarding all insurance matters in the respective jurisdiction and agree that service upon the Commissioner, Director or Superintendent of Insurance, or other appropriate party of that jurisdiction is of the same legal force and validity as personal service upon the business entity.

3.The business entity or limited liability company grants permission to the Commissioner, Director or Superintendent of Insurance, or other appropriate party in each jurisdiction for which this application is made to verify information with any federal, state or local government agency, current or former employer, or insurance company.

4.Every owner, partner, officer or director of the business entity, or member or manager of a limited liability company, either (a) does not have a current child-support obligation, or (b) has a child-support obligation and is currently in compliance with that obligation.

5.I authorize the jurisdictions to give any information concerning me, as permitted by law, to any federal, state or municipal agency, or any other organization and I release the jurisdictions and any person acting on their behalf from any and all liability of whatever nature by reason of furnishing such information.

6.I acknowledge that I understand and will comply with the insurance laws and regulations of the jurisdictions to which I am applying for licensure/registration.

7.For Non-Resident License Applications, I certify that I am licensed and in good standing in my home state/resident state for the lines of authority requested from the non-resident state.

8.I hereby certify that upon request, I will furnish the jurisdiction(s) to which I am applying, certified copies of any documents attached to this application or requested by the jurisdiction(s).

Must be signed by an officer, director, or partner of the business entity, or member or manager if a limited liability company who has authority to act on behalf of the business entity:

Signature

Type or Print Name

Title

Address

Date

Social Security Number

City

State

Zip

Application Attachments

22The following attachments must accompany the application; otherwise the application may be returned unprocessed or considered deficient.

1.Non-refundable fee (check or money order) made payable to the “State of Ohio Treasurer” in the amount of $300.00;

2.Provide proof of fidelity bond or other comparable insurance policy coverage for all employees as required by R.C. 3959.11 and OAC 3901-8-05 (D)(5). (Documentation must include the name of the carrier, policy number and effective dates.)

3.Provide proof of professional liability insurance coverage and/or E&O insurance as required by ERISA. (Documentation must include the name of the carrier, policy number and effective dates.); and

4.If necessary, any required supporting details or documents.

Requirements for Licensure

1.All business entity TPA applicants must be registered with the Ohio Secretary of State.

2.Non-Resident TPA applicants must be registered with the home state Secretary of State.

INS3213 (Rev. 02/2021)

Page 3 of 3

⇩ Ohio Ins3213 PDF

Document Properties

Fact Name	Fact Detail
Form Identification	The form is identified as INS3213, used by the Ohio Department of Insurance for business entity TPA (Third Party Administrator) license renewal/continuation.
Director Information	Judith L. French is listed as the Director on the Ohio INS3213 form.
Licensing Options	The form provides options for applying as either a Resident License or a Non-Resident License applicant.
Background Questions	Applicants must disclose convictions, administrative proceedings, bond and insurance coverage, and compliance with financial management laws.
Governing Laws	The form requires compliance with various Ohio Revised Codes (R.C.) and Ohio Administrative Codes (OAC), including but not limited to R.C. 3959.11 and OAC 3901-8-05.

Detailed Instructions for Using Ohio Ins3213

Filling out the Ohio INS3213 form is a crucial step for Third-Party Administrators (TPA) in maintaining compliance with state insurance regulations. This process may seem complicated, but breaking it down into manageable steps can simplify the task. Whether you're applying for a new license or renewing an existing one, correctly completing the form ensures that your organization adheres to Ohio's insurance laws and regulations. Here’s a straightforward guide to help you through each section of the form.

Start by identifying the type of license you are applying for at the top of the form: check either the "Resident License" or "Non-Resident License" box.
Under "Identify Home State," fill in the state where your business entity is originally registered. Next to this, provide your "Home State License #."
Proceed to the "Demographic Information" section. Enter the following details:
- Business Entity’s Name
- FEIN (Federal Employer Identification Number)
- Ohio License Number (if applicable)
- National Producer Number (NPN)
- Indicate whether your business is affiliated with a financial institution or bank by checking "Yes" or "No."
- For questions 6 through 18, provide your business and mailing addresses, phone number, fax number, email, and website information as requested.
In the "Designated/Responsible Licensed Producer" section, list at least one person responsible for the entity's compliance with state insurance laws. Include their name, SSN, and NPN.
Address the "Background Questions" by answering "Yes" or "No" as they apply to your entity and its key personnel. For any "Yes" responses, you will need to attach additional documentation explaining the circumstances and outcomes.
Under "Business Entity TPA License Renewal/Continuation," respond to the questions about administrative proceedings, fidelity bonds, professional liability/E&O insurance, record maintenance, changes in Excess Insurers, and the types of claims your TPA will handle. For each "Yes" answer, provide required documents or explanations as specified.
Ensure understanding and compliance with the obligations stated in questions 11 through 14 regarding the handling of funds, changes in officers or ownership, and the operation as a Pharmacy Benefit Manager (PBM).
The "Applicant’s Certification and Attestation" section must be completed by an authorized individual. They must certify the truthfulness of the application, designate an agent for service of process, and acknowledge compliance with child support obligations, among other certifications.
Sign and date the application in the designated area. Make sure the signatory prints their name, title, and provides their contact information.
Attach the required documents listed under "Application Attachments," including the non-refundable fee, proof of fidelity bond, professional liability insurance coverage, and any other necessary documents.
Before submitting, review the entire application to ensure accuracy and completeness. Missing or incorrect information can delay the processing of your application.

Once your form is submitted, the Ohio Department of Insurance will review your application to ensure it meets all necessary criteria. It's important to provide clear and precise information to facilitate a smooth review process. Compliance with these steps demonstrates your commitment to uphold the standards required for operating as a Third-Party Administrator within Ohio.

What You Should Know About Ohio Ins3213

What is the purpose of the Ohio Ins3213 form?

The Ohio Ins3213 form is designed for business entities operating as Third-Party Administrators (TPAs) who are seeking to either renew or continue their license with the Ohio Department of Insurance. The form collects detailed information about the business entity, including demographic information, background information concerning legal and professional conduct, and operational details such as insurance coverage and compliance with state regulations.

Who needs to complete the Ohio Ins3213 form?

Any business entity that wishes to operate as a Third-Party Administrator for insurance or benefit plans within the state of Ohio must complete the Ohio Ins3213 form. This includes entities applying for a renewed license or those seeking to maintain an existing license for the continued operation in Ohio. It is applicable to both resident and non-resident entities insofar as they conduct business in Ohio.

What information is required on the Ohio Ins3213 form?

The form requires a comprehensive range of information, including: - The type of license requested (Resident or Non-Resident) and identifying details about the home state and license number; - Extensive demographic details of the business entity, such as its name, Federal Employer Identification Number (FEIN), Ohio License Number, and National Producer Number (NPN); - Information on any affiliation with financial institutions or banks; - Complete contact and address details; - Details of the Designated/Responsible Licensed Producer(s); - A thorough background check regarding convictions, administrative proceedings, and compliance with Ohio insurance regulations; and - Information on financial responsibility, such as fidelity bonds, professional liability and Error & Omissions (E&O) insurance.

Are there any specific exclusions to misdemeanor convictions that need not be reported on this form?

Yes, certain misdemeanor convictions or pending misdemeanor charges are excluded and need not be reported on the Ohio Ins3213 form. These include traffic citations, driving under the influence (DUI), driving while intoxicated (DWI), driving without a license, reckless driving, or driving with a suspended or revoked license. Additionally, juvenile adjudications (offenses where the individual was adjudicated delinquent in juvenile court) are also excluded.

What should an applicant do if they answer "Yes" to any background questions?

If an applicant answers "Yes" to any of the background questions—indicating a misdemeanor or felony conviction, involvement in administrative proceedings, or any of the other queried circumstances—they must provide detailed documentation. This includes a written statement explaining the circumstances of each incident, a copy of the charging document, and a copy of the official document demonstrating the resolution of the charges or any final judgment. This additional documentation is crucial for the thorough evaluation of the application.

Is there an application fee, and if so, how much is it?

Yes, there is a non-refundable application fee for processing the Ohio Ins3213 form. The required fee is $300.00, which should be made payable to the “State of Ohio Treasurer”. This fee must accompany the application and any required attachments for the application to be considered complete and processed accordingly.

Common mistakes

Filling out the Ohio INS3213 form is an essential step for business entities seeking licensure or renewal as a Third Party Administrator (TPA) with the Ohio Department of Insurance. However, mistakes in this process can lead to delays, rejections, or even penalties. Here are six common mistakes to avoid:

Not checking the applicable boxes for the type of license requested. The form distinguishes between Resident License and Non-Resident License, which is crucial for identifying the correct regulatory requirements.
Failure to provide accurate and complete Demographic Information. Every field from the business entity’s name to its web address contributes to the identity verification process.
Omitting Designated/Responsible Licensed Producer details. These individuals are essential for ensuring the business entity’s compliance with state laws, rules, and regulations. Not identifying at least one responsible person can significantly impede the application.
Inaccurate or incomplete responses to Background Questions. This section requires a truthful declaration of past misdemeanors, felonies, military offenses, or any involvement in administrative proceedings related to professional or occupational licenses.
Ignoring the insurance requirements. The application asks if the TPA holds a fidelity bond or other comparable insurance policy coverage and professional liability/E&O insurance. Providing proof of these insurances is mandatory for avoiding processing delays.
Failing to sign and date the Applicant’s Certification and Attestation section. This affirmation under penalty of perjury verifies that all information on the form is true and complete. An unsigned or undated application is considered incomplete and will not be processed.

Equally important is ensuring that all necessary attachments are submitted with the application, such as proof of the relevant insurance coverage and a non-refundable fee. Careful attention to these details will facilitate a smoother licensure process.

Documents used along the form

When preparing or renewing a license with the Ohio INS3213 form, several additional documents and/or forms typically come into play to ensure compliance and completeness of the licensing process. Understanding the purpose and requirement for each document helps streamline the application process and avoids potential delays or complications.

Proof of Fidelity Bond or Comparable Insurance Policy: This is essential to demonstrate that the TPA has secured a bond or insurance that meets state requirements, protecting against fraud or theft by employees.
Proof of Professional Liability and/or E&O Insurance: Demonstrates that the TPA carries insurance to cover errors and omissions for the services provided, which is a critical component for protecting the business and its clients.
Documentation of Business Entity Registration: Includes certification or evidence that the TPA is registered with the Ohio Secretary of State or, for non-residents, with the appropriate authority in the home state.
Letter of Explanation for Plan Sponsor and Insurer Fund Handling: If the TPA handles funds in a manner not explicitly detailed in the standard options, a detailed explanation is required to ensure clarity and compliance with regulations.
Statements of Compliance: Written statements affirming the TPA’s understanding and commitment to remain in compliance with relevant insurance laws, regulations, and any specific jurisdictional requirements.
Change of Ownership or Business Address Documentation: If there have been any changes to the information previously reported to the Department, appropriate documentation must be submitted to update the records.
Attachments for Background Questions Responses: If any background questions on the INS3213 form are answered affirmatively, detailed explanations, official documents, and charging documents must be attached to provide context and details of the incidents.
1033 Consent Waiver (if applicable): For applicants with a felony conviction involving dishonesty or a breach of trust, a waiver approved by the home state is required under 18 USC 1033, indicating permission to engage in the insurance business.

This list encompasses documents commonly associated with the Ohio INS3213 form but is not exhaustive. Each applicant's circumstances might necessitate additional forms or documentation. Careful review of the specific requirements and timely, accurate submission of all requisite materials will facilitate a smoother licensing process.

Similar forms

The Ohio Ins3213 form, essential for business entities seeking third-party administrator (TPA) license renewal or continuation in Ohio, has significant parallels with the Uniform Business Entity Application. Both documents require comprehensive information about the business entity, such as legal name, federal employer identification number (FEIN), and business addresses. Moreover, they necessitate disclosures regarding any legal or administrative actions against the business or its principals, emphasizing the integrity and legal compliance of entities operating in the insurance domain.

Similarly, the application process for a National Producer Number (NPN) echoes aspects of the Ohio Ins3213 form, particularly in collecting detailed demographic information and background checks. The NPN application, like the Ins3213, mandates disclosure of any criminal history or regulatory sanctions involving the entity or its leaders, ensuring that only qualified and reputable entities engage in insurance-related activities. This parallel underlines the industry-wide emphasis on transparency and accountability.

The Individual Insurance Producer License application shares similarities with the Ohio Ins3213 form. While the former is often more focused on individuals, both require the disclosure of any criminal offenses or actions that might affect the applicant’s suitability to operate within the insurance industry. Such parallels highlight the insurance sector's consistent approach to safeguarding against malpractice by both individual and business entity registrants.

The application for a Pharmacy Benefit Manager (PBM) License also mirrors the Ins3213 form in several ways. Both applications demand detailed information about the entity's operations, including compliance with specific insurance laws and financial handling protocols. Additionally, they seek information on the applicant’s adherence to state insurance regulations, fidelity bonds, and professional liability insurance coverage requirements, demonstrating the regulatory oversight's depth in healthcare and insurance services.

The ERISA Fidelity Bond coverage submission, requisite for entities managing pension plans, aligns with the fidelity bond and professional liability insurance disclosure requirements on the Ohio Ins3213 form. These documents ensure that entities have adequate protective measures against mishandling of funds or fiduciary neglect, safeguarding stakeholders' interests within the insurance and financial service sectors.

Applications for a Financial Institution Insurance License share similarities with the Ohio Ins3213 in the way they assess a business entity’s eligibility and risk profile. Both require detailed information about the business entity's affiliations with financial institutions or banks and the reporting of any legal or regulatory issues faced. This comparison underscores the regulatory focus on the intertwined nature of insurance services and financial stability, particularly when banking institutions are involved.

The Company (Insurer) Licensing Application, required for insurers seeking to operate within a state, also parallels the Ohio Ins3213 form. This similarity is evident in the thorough vet been previously reported to this insurance departmentting process, including disclosures about criminal history, regulatory compliance, and financial solvency. Both documents underscore the regulatory bodies' role in ensuring that entities across the insurance spectrum operate within a framework that protects consumers and maintains market integrity.

Dos and Don'ts

When filling out the Ohio INS3213 form, there are a few important things to keep in mind to ensure the application process is smooth and successful. Below is a guide on what to do and what not to do during this process.

Do ensure all information provided is accurate and up to date. This includes personal details, business entity information, and any other required data.
Do check the appropriate boxes for the type of license requested, making sure to distinguish between a Resident License and a Non-Resident License accurately.
Do include your FEIN, Ohio License Number, National Producer Number (NPN), and all other requested identifiers.
Do answer all background questions truthfully and provide all necessary attachments if you answer "Yes" to any of those questions.
Do attach proof of fidelity bond or other insurance coverage as required, including details about the carrier, policy number, and effective dates.
Don't leave any fields blank. If a question does not apply, mark it as "N/A" instead of leaving it empty.
Don't forget to sign and date the application form. Unsigned forms will not be processed.
Don't include information or documents not relevant to the form's specific requirements or that haven't been explicitly requested.
Don't hesitate to double-check your answers and documents before submitting, ensuring everything is complete and correct.
Don't disregard the need to provide any changes of officers, directors, partners, members, trustees, shareholders, or business address that haven't been previously reported, as required by the form's instructions.

By following these guidelines, applicants can help ensure their Ohio INS3213 form is accurately completed and submitted, minimizing the likelihood of delays or issues in processing.

Misconceptions

When dealing with the Ohio INS3213 form, several misconceptions can lead to confusion and errors during the application process. It's crucial to address these misunderstandings to ensure that applications are filled out accurately and comply with Ohio's regulations. Here are six common misconceptions:

License Types Are Interchangeable: Some applicants believe that the choice between a Resident License and a Non-Resident License is flexible and can be changed without consequence. However, this choice is significant and should match the applicant's primary business operations and legal domicile.
All Misdemeanors Must Be Reported: Another common mistake is the belief that all misdemeanor convictions or charges need to be disclosed. The form explicitly excludes certain types of misdemeanors, such as traffic citations and DUI offenses, from being reported unless they have not been disclosed previously.
Background Questions Apply Only to the Entity Itself: It's a misconception that the background questions pertain solely to the business entity. In fact, these questions also extend to any owner, partner, officer, director, or manager/member of a limited liability company associated with the entity.
Professional Liability Insurance Is Optional: Some applicants think that holding professional liability and/or E&O insurance is a choice. However, the form clearly states that this type of insurance is required if the TPA performs activities governed by ERISA.
Maintenance of Bonds or Insurance Policies Is Not Monitored: There's a false assumption that once the initial proof of bond or insurance policy coverage is provided, there's no need to maintain or update these documents throughout the licensure period. The truth is that maintaining current documents is a requirement.
Reporting Changes Is Unnecessary If Small: Lastly, there's a misconception that minor changes in the business entity's information, such as a slight change in ownership percentage or a change in business address, don't need to be reported. Any change, regardless of its perceived size, must be reported to ensure that the Department of Insurance has the most current information.

Understanding these details is essential for ensuring that your application is correctly filled out and processed efficiently. Clearing up these misconceptions can save time and prevent potential legal complications in the future.

Key takeaways

Filling out and using the Ohio INS3213 form is an important procedure for business entities seeking to renew or continue their Third-Party Administrator (TPA) license in Ohio. Here are six key takeaways to guide businesses through this process:

Attention to detail: It's critical to ensure that all information provided on the INS3213 form is accurate and complete. Errors or omissions can lead to delays, or worse, the revocation of the license.
Disclosure of past offenses: The form requires disclosure of any misdemeanors or felonies by the business entity or its associates, except for certain traffic violations and juvenile adjudications. Honest disclosure, accompanied by the required documentation, is essential for the review process.
Insurance and bond requirements: The form asks for proof of fidelity bond or comparable insurance coverage for employees, as well as professional liability and/or E&O insurance coverage as mandated by ERISA. Maintaining these throughout the licensure period is a requirement.
Recordkeeping practices: Businesses must affirm that their recordkeeping practices comply with Ohio administrative codes, reflecting all administered transactions, maintaining detailed accounts, and ensuring the availability of records throughout the term of administration agreements.
Changes and updates: If there have been any changes in the business entity’s officers, directors, partners, members, trustees, shareholders, owners, or business address since the last application or renewal, these need to be reported to the Ohio Department of Insurance as per the instructions on the form.
Compliance with state laws: By signing the form, the applicant asserts their understanding and willingness to comply with Ohio insurance laws and regulations. This includes not commingling personal assets with those of plan sponsors or participants and supervising the actions of any personnel or subcontractors adjusting or settling claims on behalf of the applicant.

Properly completing and submitting the Ohio INS3213 form, along with the required attachments and fee, enable business entities to legally operate as TPAs in Ohio. The process underscores the importance of compliance with state regulations, transparency, and the ongoing obligation to maintain sufficient insurance coverage and accurate records.

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