Program Applications

Streamlining the Submission Process

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.

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)
    • Most current annual financial statement – audited or compiled (for D&O applicants)
    • Please note – Additional information may be requested by your underwriter once a submission is received and reviewed for eligibility
  • Send your completed application(s) and all required attachments to:
  • If you do not see a particular application or class code, contact us at

If you have already completed an application for another program, we can often provide review of eligibility and a premium indication from a competitor’s application. We would just ask for our program application to be signed and completed when you choose to bind coverage with us.

Partnering with Us:
We’re Dedicated to Insuring the Health Care Industry

Our programs and insurance products are offered exclusively through licensed agents and brokers in all states (we do not sell directly to health care firms). Clients have the advantage of working with their local insurance agent or broker of choice.

If you are an insurance agent or broker, please visit our Agent/Broker Resource Center to download/complete our Producer Agreement and start working with us.

If you are a health care firm, please share information on our program and our website with your local insurance agent; they can quickly access our program on your behalf to obtain a competitive quote.

For more information about our insurance programs, please call us at 1-855-972-9399.