You will find specific applications here for Home Care, Medical Staffing, Medical Facilities, Human Services Organizations and Senior Care/Long Term Care Facilities. If you do not see an application for a particular type of health care firm, please send a request to alliedhealthsubmissions@one80.com so we can provide the best option.
Primary Applications
- Professional & General Liability Insurance Application – Home Healthcare, Hospice, Personal/Companion Care, Visiting Nurse Associations (VNAs) & Medical Staffing Firms (ed. May 2023)
- Workers’ Compensation Supplemental Application – Home Healthcare, Hospice, Personal/Companion Care, Visiting Nurse Associations (VNAs) and Adult Day Care (ed. May 2023)
- Human Services Organizations Application – 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 – please complete this “main” application, along with the following supplemental application for misc. med. risks: - Cyber Liability/Data Breach Response Application (standalone coverage)
- Long Term Care Facilities Professional/General Liability Application
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 Workers’ 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