Applications & Submission Requirements

To facilitate the underwriting and quote process, we have provided access to several applications on-line. If you need additional information, please feel free to call us at 800-970-9778.

Recommended Supplemental Applications

ACORD Applications
ATP Supplemental Application (pdf)
ATP Renewal Application (pdf)
Methadone Clinics Supplemental Application (pdf)
Sober Living Application (pdf)
Special Events Supplemental Application (pdf)
Physicians and Psychiatrists Supplemental Application (pdf)
Property Statement of Values (Excel)
4 Years Carrier Loss Runs
Executive Director Resume for New Ventures

Learn More About Our Addiction Treatment Providers Insurance Program

We invite you to learn more about our program and how we can help you enter or expand your footprint in this growing and exciting niche. We have a passion for what we do, which has translated into developing a successful program that is an established industry leader working with thousands of treatment programs across the country. Please call Krista Mayes, Program Manager, at 610-808-9556, or complete the contact form on this page, for more information.