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Please click the “Add Additional Insureds” link below to add Additional Insureds to your policy. Any Additional Insureds you add will protect them from any liability that might arise from your work. As an example, if you’re an independent trainer going into different gyms to train, you’ll likely want to add these places of work to your policy. Cost per Additional Insureds: $10 for 1 year and $15.95 for a 2 year policy.
You are entitled up to free additional insureds.
Throughout your policy lifetime, you may need to add additional insureds. Save with the Unlimited Package for just $30.
Please enter your name EXACTLY how it will appear on your certificate of insurance. *All items marked with an asterisk are required fields.
Your free website will be available as soon as we process this application.
The insurance membership will be effective upon the effective date entered at the top of the form. Membership term is 12 or 24 months depending on your policy selection. Insurance Plus is not responsible for discontinuing any payroll deductions/automatic credit card payments which you may have with any other Professional Liability providers.
As of this date it is understood and agreed that I have no knowledge of any past, pending or current: (a) claims, lawsuits, complaints, allegations, (b) acts, errors or omissions which may reasonably be expected to become a claim or lawsuit. I further represent that, to the extent required, I am licensed to practice in accordance with all relevant federal, state and local requirements and my license is current and active. I understand and agree that I am covered for the modalities listed on the Insurance Plus website only to the extent that they are included in the scope of work as defined by the federal, state or local jurisdiction that regulates my professional activities. I acknowledge that the Effective Date of coverage must be either the application submission date or a future date. Applications cannot be submitted with an Effective Date of coverage that precedes the date of application. In addition, I acknowledge that professional services rendered under the influence of drugs or alcohol are excluded from coverage.
My primary practice and/or area of specialization does not fall within any of the following areas: Addiction Counselor / Therapist; Alcohol, Drug, or Substance Counselor / Therapist; Psychiatric / Mental Health Counselor; or Criminal Justice / Correctional Counselor / Therapist services.
For a list of full policy details, covered professional services and exclusions, please refer to the master policy.
In order to be covered for Stand-up Paddleboard Yoga (SUP), I represent the following:
In order to be covered for Pole Dance Instruction, I represent the following:
I represent that the above statements are true and no material facts have been suppressed or misstated.
Upon submission of this application, your policy becomes effective on the date selected above. Your payment will be reflected on your credit card statement this month. Pricing includes a $50.00 Risk Purchasing Group Fee, 3% Delaware State Surplus Lines Taxes, and identity fraud protection. Other fees are applicable based upon individual applicants’ coverage selections. All policy related documents and communications are delivered in electronic format where allowable by law. By enrolling in this insurance policy, the applicant agrees to become a non-voting member of Healthcare Professionals Purchasing Group, LLC ("HPPG"). HPPG is a Delaware non-profit corporation that provides liability insurance for its members as a "Purchasing Group" in accordance with the Federal Liability Risk Retention Act (15 U.S.C. §§ 3901-3906). Each member of HPPG is covered for separate limits of liability and is required to pay all premiums when due.
