Pennsylvania Code
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COMMONWEALTH OF PENNSYLVANIA

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67 Pa. Code § 223.3. Proposal.

§ 223.3. Proposal.

 (a)  A person desiring to qualify as a self-insurer shall file a proposal of self-insurance with the Department for approval. The proposal shall include the following:

   (1)  Application for self-insurance.

   (2)  Master self-insurance and security agreement.

   (3)  A balance sheet and income statement which shall reflect the actual financial condition of the person as of the last complete calendar or fiscal year preceding the date of the proposal; and in the case of an individual or nonbusiness entity that it truly reflects his financial condition and income as of that time; and in the case of a corporation or partnership, it will be certified by a certified public accountant or responsible accounting officer of the entity. The information will be confidential, and the Department will not release the information unless it has the prior written consent of the self-insurer.

 (b)  If a certificate of self-insurance is issued, the following information shall be filed annually with the Department on a calendar year basis on or before March 1:

   (1)  Renewal application for self-insurance.

   (2)  A balance sheet and income statement which shall reflect the actual financial condition of the person as of the last complete calendar or preceding fiscal year; and in the case of an individual or nonbusiness entity that it truly reflects his financial condition and income as of that time; and in the case of a corporation or partnership, it shall be certified by a certified public accountant or responsible accounting officer of the entity. The information will be confidential, and the Department will not release the information unless it has the prior written consent of the self-insurer.


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