Employee Benefit Plan Administrators

​​​​​Last Updated: August 9, 2021

Employee Benefit Plan Administrator License (EBPA) (Third-Party Administrator)

"Administrator" means a person who directly or indirectly solicits or collects premiums or charges or otherwise effects coverage or adjusts or settles claims for a plan under s. 633.01, Wis. Stat. This section also defines the persons who do not need to be licensed as an EBPA. Licenses are required under s. 633.13, Wis. Stat.

Exemptions are granted for the following and should be filed using the EBPA Application for Exemption application:

  • The applicant collects only contributions to self-funded employee benefit plans as defined by the Employee Retirement Income Security Act (ERISA) of 1974;
  • The applicant does not collect or administer premiums for stop-loss coverage; and
  • The applicant does not perform any function with respect to a multi-employer welfare arrangement as defined under ERISA.

Pharmacy Benefit Manager (PBM) 

If a PBM entity solicits or collects ​premiums, effects coverage, or settles claims the entity must obtain an EBPA firm license. If the PBM administers or manages the pharmacy benefits for an insurer or another entity that provides prescription drug benefits to Wisconsin residents and does not collect premium or affect claims, the PBM must obtain a Pharmacy Benefit Manger license.

Applying for an EBPA License (Individual and Firm)

Initial Licensing Requirements

  1. Apply online at nipr.com  or via paper EBPA/PBM application.​ Individual EBPAs must be actively licensed in Wisconsin as an Intermediary Individual.
  2. Submit financial statement for the administrator's most recently completed fiscal year, prepared on a generally accepted accounting basis including: assets, liabilities, and net worth (balance sheet); and the results of operations (income statement). NOTE: The financial statements must be those of the applicant. If the financial statements combine the applicant with parent or affiliated entities, they must include a deconsolidating spreadsheet breaking out the applicant's balance sheet and income statement. Statements cannot be marked as confidential and are not required to be audited.
  3. Submit a new original performance bond (signed and sealed). Must be sent directly to OCI.
  4. Pay initial license fee of $100.
  5. After your application has been approved, you can confirm your new license expiration date by using the License Search at State Based Systems (SBS) .
  6. Licenses may be printed for free at State Based Systems (SBS) 
  7. Mail an original performance bond meeting the requirements of s. Ins 8.28, Wis. Adm. Code , to:
    OCI Agent Licensing
    Attn: EBPA License
    P.O. Box 7872
    Madison, WI 53707-7872

Records that MUST be Retained by Administrators

Records for all transactions between the administrator, insurers and insured persons must be retained for five years following the end of the contractual relationship.

Renew an EBPA License

Please Note: Renewal notifications will be sent to the business email address on record for the EBPA 60 days prior to the expiration date. Renewal notifications will only be sent via email to the business email address on file. 

Renewal Requirements

  1. Renew annually online by August 1 at nipr.co​m  or via paper EBPA/PBM​ application.
  2. If any changes in bond coverage, a new original bond (signed and sealed) must be sent directly to OCI.
  3. Financial statements of the applicant (balance sheet and income statement) for previous completed fiscal year must be submitted via email to ociagentlicensing@wisconsin.gov or be mailed directly to OCI.
  4. Pay annual renewal fee of $100.
  5. After your application has been approved, you can confirm your new license expiration date by using the License Search at Stat​e Based Systems (SBS) ​.
  6. Renewed licenses may be printed for free at State Based​ Systems (SBS) 

Required Notifications Per s. Ins 8.30, Wis. Adm. Code

An administrator shall notify OCI in writing of any of the following within 30 days after the date of the occurrence:

  • The cessation of business activities as an administrator. A notification under this subsection shall include the name and address of the custodian of the administrator's business records and the location of those records.
  • Any change in the administrator's business mailing address or the location of its business records.
  • Formal administrative action in this state or another state by an agency that regulates the business of administrators, insurance, real estate, securities or financial institutions against the administrator or any officer, director, partner or other individual having comparable responsibilities in the corporation or partnership.
  • The conviction in this state or another state of a felony or misdemeanor, other than a misdemeanor related to the use of a motor vehicle or the violation of a fish and game regulation, of the administrator or any of the officers, directors, partners or other persons having comparable responsibilities in the corporation or partnership.

Licensing Updates

Submit a written statement including updates to officers, partners, or owners, address changes, and email to ociagentlicensing@wisconsin.gov.

Name changes require an updated bond to be submitted to the Commissioner's office. Mail a signed and sealed performance bond with the new entity name to OCI.

Mailing Address
Agent Licensing
125 S. Webster St.
Madison, WI 53707

For more information, send an email with inquiries to ociagentlicensing@wisconsin.gov.