CCY3536-SkilledNursing

These applications are generic and will be sent to several of our preferred Underwriters,

Skilled Nursing Home Application – 149kb

Supplemental Claims Applications

Medical Supplemental Application – 34kb

  1. Most Recent State Survey.
  2. Copy of your facility current license.
  3. Copy current and past 5 years loss history, please request them from your current broker/agent.
  4. Copy of your marketing brochure.
  5. Copy of your current policy declaration page from your professional liability insurance, this helps to make sure we match coverage`s, to avoid leaving out any coverage. We must match what you currently have and /or offer more coverage`s for less cost.
  6. Copy of Administrator resume and the DON