Private Self-Insured Employers Termination

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A private self-insured employer who obtains replacement coverage and desires to terminate its self-insurance authorization shall advise the Florida Self-Insurers Guaranty Association (FSIGA), in writing within thirty (30) days of the desired termination date and shall provide proof of replacement coverage in the form of a Certificate of Insurance effective as of the desired termination date. Please review the rules and required documentation for requesting termination of self-insurance privilege.

Rule:

• Termination (69L-5.228, F.A.C.)

Required documents:

• A letter stating the reason for termination,
• The effective date to be terminated, and
• Proof of replacement coverage in the form of a certificate of insurance effective as of the termination date.

Mailing Address:

• Florida Self-Insurers Guaranty Association, Incorporated,
  1427 East Piedmont Drive, 2nd Floor,
  Tallahassee, Florida 32308

Contact FSIGA:

• Telephone Number: (850) 222-1882
• Website: https://fsiga.org