Submission Requirements

Home Healthcare Agencies

The following submission items are required for a proposal. Most of our markets will require their company specific supplemental applications in order to bind. However, we can provide a quote based on a competitor's application.

• Completed & signed ACORD applications with names of all entities to be covered under the policy
• Complete supplemental applications signed by insured
• Five years currently valued loss runs by line of business and policy period
• Five years of premium history by line of business and policy period
• Most recent financial statements, including balance sheet, income and expense sheets, & notes
• Currently insurance policy declaration page
• Marketing brochure and literature
• Descriptive materials provided to clients
• Sample copies of staffing contract and patient service agreements

Click here for the supplemental applications.