quickquote testing - PCALIC - Personal Care and Assisted Living Insurance Center

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Email*

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Liability form will be here

Rapid Indication

Please complete all sections of the following rapid quote form. The quote will be forwarded to you by e-mail shortly so be sure your e-mail address is correct.

First Name:
Last Name:
Name on License:
Phone:
Email:
State:
Number of Licensed Beds:
Effective Date Requested:	Open the calendar
Limit of Liability Requestingddd:
Is there a swimming pool on the premises?	Yes No
Is the pool fenced with a locked gate?	Yes No
Does the pool have an alarm in it?	Yes No
Are residents permitted to use the pool?	Yes No
Do you accept residents under age 18?	Yes No
Do you have alarms on all exterior doors?	Yes No
Is your facility inspected by the fire department annually?	Yes No
Do you utilize a Negotiated Risk Agreement with residents?	Yes No
Do you record medication and medical records on a computer system?	Yes No
Do bedridden and wheelchair dependent residents exceed 50% of your residents?	Yes No


Indication Number:
Premium:
Capital Contribution:
Underwriting Fees:

All quotes are subject to pre-approval of underwriting after review of a completed application, copy of your last state inspection report including any deficiencies and past claims history. This liability insurance program is only available to qualified licnesed facilities and homes.

Member Testimonials

I probably would not be in business anymore had it not been for the insurance PCALIC made available. As a small PCH owner I can barely keep my head above water. It is wonderful having an advocate who goes to bat for me.

- Annie Fehnel

Morning Star Manor, Inc
Very much appreciate the quick response and professionalism of your staff! I also love your easy steam lined approach to renewals.

- Ana Walker

Walker’s Group Assisted Living

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Member Testimonials

- Annie Fehnel

Morning Star Manor, Inc

- Ana Walker

Walker’s Group Assisted Living

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