You will find specific applications here for Home Care, Allied Health and Human/Social Services organizations. We have also outlined the additional information that’s required for each submission.
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)
- Medical Staffing Program – Workers’ 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 – 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)
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