Florida Self Insurance Form

Seleccione aquí para español section 324 171 florida statutes outlines the financial requirements for the department to issue a certificate to qualified individuals or other specified entities as a self insurer.

Florida self insurance form. Hsmv form 83345 can be used by a firm partnership association or corporation. The chief financial officer cfo may have a title different from cfo such as comptroller vice president of finance treasurer etc. You need to prove to the insurance companies that you can cover your own liability risk. Continuing self insurance reporting requirements for terminated self insurers.

How does it work. This form is used to inform florida blue if you currently have or recently had insurance coverage which your florida blue policy will replace. Florida department of revenue the florida department of revenue has three primary lines of business. But the cfo title is unlikely to include.

2 enforce child support law on behalf of about 1 025 000 children with 1 26 billion collected in fy 06 07. Dfs f2 si 1 application for self insurance. Dfs f2 si 4f self insurer s surety bond for fsiga members. When you have self insurance here in florida you are the risk taker.

Please use the forms below to provide the required information to the florida self insurers guaranty association incorporated. Private self insured employers are defined in section 440 38 1 b f s the statute states. Seleccione aquí para español statement of net worth. You either need to have a lot of money in the bank or own a lot of vehicles.

In 2013 the florida legislature removed surety bonds as a means of obtaining self insurance. Insert financial test of self insurance and guarantee when form part b is completed but some facilities are owned operated directly by the guarantor. The change went into effect july 1 2013. Should you have any.

An employer who wants to qualify for self insurance must obtain an application form dfs f2 si 1 from the florida self insurers guaranty association inc. The statement of net worth form can only be used by a natural person. Dfs f2 si 5 self insurer payroll report. Print instructions firm partnership association or corporation for hire passenger transportation vehicles natural person.

This guide is intended to provide your company with information on the filing requirements for individual self insurers for workers compensation pursuant to section 440 38 florida statutes. 3 oversee property tax administration involving 10 9. Underwritten health change application for direct pay individual under age 65 members hmo for plans with coverage that was already in effect before january 2014. The application should be mailed to fsiga along with all items required by the application.

Employers who have provided proof to the florida self insurers guaranty association inc that it has the financial strength necessary to ensure timely payment of all current and future claims individually and on behalf of its subsidiary and affiliated companies with employees in this state and.