GreenWood International's activities are directed by guidelines required by the various carriers on whose behalf we conduct business and states in which our policyholders are located. In general, most states require that agencies/agents and TPAs be licensed and appointed with a carrier in order to solicit and sell business in the individual states. The regulations and laws vary from state to state, and as a result, the carriers with whom we have partnered have developed simple procedures that will help our agencies/agents and TPAs comply with these regulations.

Agent/Agency Appointment Procedures:

All carriers and states require that both the individual agent soliciting business/signing applications and the agency receiving commissions be licensed and appointed with them in the state in which the case is located. Even if premium is remitted net of commissions, both the agent and agency must be licensed and appointed with the carrier. Appointment requests must be submitted to GreenWood International before a case is bound.

Guidelines for Agent/Agency Appointment:

  • Complete and sign the Boston Mutual Agent Appointment Questionnaire for medical stop loss insurance policies, QBE Insurance Corporation Agent Appointment Form for medical stop loss insurance policies, or the ACE USA Accident & Health Licensing Information Form for Personal Accident and Occupational Accident Insurance Policies.
  • Submit a copy of the Accident and Health License for the Agency for the state in which the case is located.
  • Submit a copy of the Accident and Health License for the Agent who will sign the applications on behalf of the Agency for the state in which the case is located

TPA Approval Procedures:

In accordance with the individual state regulations, carriers require that the Third Party Administrator responsible for managing premium and/or administering claims on behalf of the policyholder must be licensed and appointed with them in the state in which the case is located. As with agent/agency appointments, TPA approval requests must be submitted to GreenWood International before a case is bound.

Guidelines for TPA Approval with Boston Mutual Life Insurance Company:

  • Complete and sign the Boston Mutual Third Party Administrator Questionnaire
  • Submit a copy of the TPA license for the state in which the case is located
  • Submit proof of fidelity bond/crime policy coverage listed on an Acord Form/Certificate of Insurance noting Boston Mutual - 120 Royall Street, Canton, MA 02021 - as the certificate holder. Please note that listing Boston Mutual as the certificate holder simply requires the fidelity bond carrier to notify them in the event that the policy is canceled prior to the expiration date. The TPA should contact their fidelity bond carrier to obtain this form.
  • Submit a copy of the most recent audited financial statement
  • Submit proof that the premium funds are held in a fiduciary account listing "premium trust" in the title of the account. A copy of the top portion of the TPA's bank statement will satisfy this requirement.

Guidelines for TPA Approval with QBE Insurance Corporation:

  • Complete and sign the SIIA Third Party Administrator Appointment Questionnaire
  • Submit a copy of the TPA license for the state in which the case is located

Agent/agency appointment requests and TPA approval requests may be faxed, mailed or e-mailed to Krystn Richardson - Compliance Coordinator, at the following addresses:

Physical Address:
GreenWood International Insurance Services, Inc.
50 Federal Street
Boston, MA  02110 

Fax: (617) 728-8268

E-mail: krichardson@gwigroup.com

Phone: If you have any questions or require any assistance, please feel free to call Krystn Richardson at (617) 502-3000.