Attn: Treasury Department PO Box 3045 Boca Raton, FL 33431
FOR OVERNIGHT DELIVERY:
NCCI, INC. Attn: Treasury Department 901 Peninsula Corporate Circle Boca Raton, FL 33487-1362
CAN I SEND THE APPLICATION AND PREMIUM ELECTRONICALLY?
Producers may submit applications using NCCI's free RMAPS Online Application Service. Producers should contact NCCI at 800-NCCI-123 and select the products and services option from the phone menu to obtain a user ID and password.
WHAT IS REQUIRED TO APPLY FOR COVERAGE UNDER THE MS PLAN?
A Valid application should include:
Completed ACORD Forms 130 and 133 (Do not use ACORD Form 125)
A Check from the Employer/Application or the Producer made payable to NCCI
An application cannot be processed if any of these items are missing; both ACORD forms must be signed by the producer and the applicant.
DO I HAVE TO PROVIDE A FEDERAL EMPLOYER ID NUMBER TO SUBMIT THE APPLICATION?
Processing of an application comes to an immediate halt is there is no Federal Employer ID Number (or Social Security Number) on the application.
WHAT IS CRITICAL ABOUT THE LEGAL STATUS?
It is always important to include an applicant's legal status; this should be consistent with the applicant's name.
If the name ends in "Inc", legal status = Corporation or "S" CORP
If an individual uses a "DBA", list the individual's name first, then the DBA. Legal status = Individual
Only one name can be used if the legal status is individual. Listing two individuals, connotes a partnership or other entity type.
CAN I LIST STATES OTHER THAN MISSISSIPPI ON THE APPLICATION?
Mississippi applications are for Mississippi coverage only. The ACORD 130 locations section cannot be blank and all locations must be within Mississippi. Part 1 (States) May include MS Only
Part 3 (Other States) Must be left blank
States other than MS will be removed from the application but note that MS employees are covered while temporarily working in other states.
WILL YOU FILL IN THE CLASS IF I DON'T KNOW IT?
Contact NCCI at 800-622-4123 if you are unsure of the class to use. The class and payroll at each location must be supplied in the rating section. Be sure to include the payroll of any person(s) listed as included from the back of the ACORD Form 130.
HOW MUCH PREMIUM MUST I SEND IN? IS THEIR A PAY PLAN AVAILABLE?
For premiums less than $5,000, or if any portion is financed through a Premium Finance Company, the entire amount is due with the application
For premiums between $5,001 - $10,000, remit at least 75% of the total premium; balance due in 6 months
For premiums between $10,001 - $25,000, remit at least 50% of the total premium; balance due in 3 quarterly installments
For premiums over $25,001, remit at least 25% of the total premium; balance due in 9 monthly installments
Do I have to list any individuals?
Be sure to complete the section on the back of the ACORD Form 130 "Entitled Individuals Included/Excluded"
For each person listed, provide all information requested and note whether they are to be included in or excluded from coverage. Note is the employer is:
An individual (List the name again here) / A Partnership (List all partners) / A Corporation (List all officers)
what are the eligibility requirements?
No offers of voluntary coverage have been made;
Applicant must have been turned down by at least two (2) insurance companies;
No outstanding unpaid workers' comp premium due on prior policies.
what commissions are paid?
Producer fees are paid by the assigned carrier after the policy has been issued, according to the fee scale below (please DO NOT deduct the producer fee from the deposit premium):
First $1K - 8%
Next $4K - 5%
Next $95K - 3%
Over $100K - 2%
can i use my old acord forms?
For best results, always use the most current ACORD forms available. Form may be obtained from ACORD by calling 800-444-3341.