You will find specific applications here for Home Care, Allied Health and Human/Social Services organizations. We have also outlined the additional information thatâs required for each submission.
Primary Applications
- Professional & General Liability Insurance Application â Home Health Care, Hospice, Personal/Companion Care, Visiting Nurse Associations (VNAs) & Medical Staffing Firms (ed. May 2023)
- Workersâ Compensation Supplemental Application â Home Health Care, Hospice, Personal/Companion Care, Visiting Nurse Associations (VNAs) and Adult Day Care (ed. May 2023)
- Medical Staffing Program â Workersâ Comp Supplemental Application (ed. Feb 2021)
- Assisted Living Work Comp Supplemental Application
- Nursing Home Work Comp Supplemental Application
- Human Services Work Comp Supplemental Application
- Human Services Organizations Application â Professional/General Liability
Including Residential Facilities, Outpatient Facilities, Substance Abuse Programs, Behavioral Health Programs, Adult Day Care, and Adoption/Foster Care. - Miscellaneous Medical Professional Liability Application
Note â please complete this âmainâ application, along with the following supplemental application for misc. med. risks: - Cyber Liability/Data Breach Response Application (standalone coverage)
ACORD applications are acceptable for all other lines of business (i.e. property, crime, owned auto, etc.)
Submission Requirements
Please include the following attachments with your submission:
- Currently valued insurance company loss reports for the past three to five years
- Most recent Experience Modification Worksheet (for Workersâ Compensation submissions)
- Resumes of owner/operators (to verify management experience in health care), pro-forma financials and a business plan (if available) for firms that are new in business (less than two years)
Send your completed application(s) and supporting documents to:
alliedhealthsubmissions@one80.com