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Please note that home aide organizations have a separate application. Franchisees of the following home aide organizations are currently qualified for our insurance program:
- Comfort Keepers
- Homewatch International
- Home Helpers
- LAS/Visiting Angels
- Synergy Home Care
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- Comforcare Senior Services
- Right at Home
- Home Instead
- Age in Place
- Seniors Choice
- Age Advantage
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Complete an Application On-line
In response to customer concerns about ease of doing business with us, we are pleased to provide our "On-Line Application". The application has been designed to simplify the submission process by asking those questions that are relevant to your organization. We hope that completing the application on-line will save you time and expense. Thank you for your business. We look forward to a long-term relationship.
Begin On-line Application - Begin New Application Now
Return to Saved Application - Return to Saved Application Now
Download an Application
In this section you will find our Application for Insurance, available for download in Adobe Acrobat® format.
Click below to download the appropriate application in Adobe Acrobat format.
HCCIS Insurance Application (new) - Download Now
HCCIS Insurance Application (Home Aides)- Download Now
If you do not have the Acrobat Reader® installed you may download it for free from Adobe.com.
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