Self Insurance Plans (SIP)

Private self insurers' annual report

The 2007 Private Self Insurer’s Annual Report is available as a fillable pdf. form. Letters have been sent to self insured employers and third party administrators to notify them of their user IDs and passwords to access the form (at the link below). Please call the Office of Self Insurance Plans at (916) 574-0300 if you have not received your user ID and password.

SECURITY NOTE: Each user ID and corresponding password enables the self-insured employer or third party administrator to access the Self Insurer’s Annual Report Form for that specific self-insured employer or third party administrator. Each form will contain some “pre-filled” identifying data related to the specific user. The pre-filled data consists only of the name, address, and certificate number of the user and is entirely non-confidential in nature. The link below leads to the instructions on how to download the form to your computer desktop for completion. The user can then print and mail the form to Self Insurance Plans.

Public self Insurers' annual report

For joint and non-joint powers authority and members

The 2007/08 Public Self Insurer’s Annual Report is available as a fillable pdf. form. This year the JPA’s and stand alone self insurer’s annual report has been consolidated into one form, but it’s split into two sections. One for the employer to complete and the other for the TPA to complete. Letters have been sent to self insured employers and third party administrators to notify them of their user IDs and passwords to access the form (at the link below). Please call the Office of Self Insurance Plans at (916) 574-0300 if you have not received your user ID and password.

SECURITY NOTE: The user ID and passwords enable you to access the form with some completely non-confidential “pre-filled” information. The pre-filled data on the forms consists of the names, certificate numbers and addresses of the self insured employer and claims administration adjusting locations for that self insured employer (all public information). There is no confidential information on the otherwise blank annual report form obtained from this site. Instructions obtained from the additional link below show how to download the form to your desktop, from where you can prepare the report in a completely secure manner and mail it to Self Insurance Plans.