Excess Workers' Compensation Program


SELF provides Workers' Compensation coverage at statutory limits for 2008/2009 and up to $2 million in Employers Liability coverage. SELF also provides coverage for Terrorism per the Federal TRIA act. Following are the rates and retention levels we offer:

SIR
2008-2009
$350,000 retention
$0.3901/$100 of payroll
$500,000 retention
$0.3353/$100 of payroll
$750,000 retention
$0.276/$100 of payroll
$1 million retention
$0.1794/$100 of payroll
Rates will be subject to a loss experience modifier


Members who would like to join the Excess Workers' Compensation Program will be underwritten separately by ACE, the excess insurance company for the program, and will be reviewed separately to determine if they are eligible for the current SELF rate. The reason is that the underwriter has new restrictions in the amount of premium growth allowed for their percentage of California Public entities. New members will be evaluated based on their own experience and should expect their rates to be higher than the listed rates.

ACE is also requiring additional material of new members joining the program. A revised application form is available in the New Members section.


Excess Workers' Compensation Renewal

The following forms are required of all current Excess Workers' Compensation members desiring to renew their coverage with SELF.

Questionnaire for Excess Workers' Compensation Coverage

Renewal Loss Data Request

Employee Concentration Data Form

Once the forms have been completed, please e-mail (info@selfjpa.org), fax (916-321-5311) or mail them to the SELF Office (1531 I Street, Suite 300, Sacramento, CA 95814).


Additional Forms

Third Party Administrator Questionnaire

Once the form has been completed, please e-mail (info @selfjpa.org), fax (916-321-5311) or mail to the SELF Office (1531 I Street, Suite 300, Sacramento, CA 95814).