Last Updated: August 13, 2021
Application for Self-Insured Liability Plans for Providers
Section Ins 17.50, Wis. Adm. Code
The following address is a link to the administrative code:
The following materials related to an application for self-insured liability plan for providers under s. Ins 17.50, Wis. Adm. Code, must be completed and returned. Note that 1997 Act 11 modifies the coverage limits for self-insured plans to $1,000,000/occurrence, $3,000,000/policy year.
The application forms are available to be downloaded below.
Please direct questions to
firstname.lastname@example.org. (Include your name, phone number, and email address.)