Societies Insurance

Group Self-Insurance Fund Quote Request

Applicant Information:

Business Structure (Optional - choose one)

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Coverage details

What Group Self-Insurance Fund coverage includes

Group self-insurance funds pool employers in the same industry or state to self-insure workers comp together.

Good to know: read the joint-and-several liability terms before joining – if the fund develops a deficit, members can be assessed even after they leave.

Not covered: assessments the fund levies for deficits, which members owe, and operations outside the fund’s approved industry or state.

Insurance Application:

Group Self-Insurance Fund

Required forms

Group Self-Insurance Fund Supplemental Application (PDF)

Download, complete and email to info@societiesinsurance.com, or attach it with your quote request.

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