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)

Send your completed application(s) and supporting documents to: