Publications & forms

Fiscal Year

• FY 2012/2013 Methodology (.pdf)
• FY 2011/2012 Methodology (.pdf)
• FY 2010/2011 Assessments (.pdf)

Newsline

• OSIP announces the release of the new Actuarial Summary form
• OSIP posts FAQs on SB 863 requirements for self-insurers
• OSIP Newsline 7-12 - OSIP announces SB 863 emergency regulations
• OSIP Newsline 6-12 - California’s Alternative Security Program puts $6.17 Billion in Capital Back into Businesses
• OSIP Newsline 5-12 - Issues default order against Administrative Concepts Corp.
• OSIP Newsline 4-12 streamlines testing for claims administrators
• OSIP releases regulatory guidance on developing actuarially based rate plans to self-insured groups
• Office of Self Insurance Plans (OSIP) strengthens oversight of self-insured groups
• OSIP Newsline 01-12 OSIP launches audit web tools
• OSIP Newsline 02-11 OSIP to improve audit procedures in 2012
• OSIP Newsline 01-11 Amended OSIP regulations become effective Oct. 19, 2011
  
  

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Rosters

• OSIP Private self insured employers
• OSIP Joint powers authority (JPA) public list
• OSIP Public stand alone roster
• OSIP Third-party administrators
• OSIP Group self insurers roster

Security deposit

• Information bulletin: Approved securities (.pdf format, 21K)
• Information bulletin: Cash in trust (.pdf format, 87K)
• Information bulletin: Letter of credit (.pdf format, 32K)
• Information bulletin: Surety bond (.pdf format, 13K)

Private self insurers' annual report

• Annual Report Forms

Public self insurers' annual report

For joint and non-joint powers authority and members

• Actuarial Summary
• Form A4-1 (.pdf format, 572K)
  Application for a private entity Certificate of Consent to Self Insure
• Form A4-2 (Rev 2/92) (.pdf format, 21K)
  Application for a Pubilc entity Certificate of Consent to Self Insure
• Form A4-3 (1/94) (.pdf format, 89K)
  Application for a certificate of consent to self insure by a group of employers
• Form A4-3M (1/94) (.pdf format, 88K)
  Application for an affiliate certificate of consent to self insure as a member of a group self insurer
• Form A4-5 (.pdf format, 431K)
  Application for a permanent certificate of consent to self insure by an interim self insurer
• Form A4-50 (.pdf format, 690K)
  Application for a Certificate to Administer W/C Claims
  
• Form A4-6 (Rev 11/97) (.pdf format, 15K)
  Agreement of assumption and guarantee of workers' compensation liabilities
  NOTE: This form must be submitted to SIP as a two-sided form, please print or copy it appropriately.
• Form A4-7 (.pdf format, 244K)
  Request for Interim Certificate for a Group Member
  
• Corporate resolution authorizing application (.pdf format, 7K)
• Resolution of agreement of parental assumption and guarantee (.pdf format, 9K)
• Request for Interim Certificate (.pdf format)

• Life tables for men and women: United States 2008 ( .pdf format, 34K)
  NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2013 and will be utilized by OSIP in 2014 to determine if the figures provided on the 2013 Annual Report are accurate.

• Life tables for men and women: United States 2007 ( .pdf format, 34K)
  NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2011 and will be utilized by SIP in 2012 to determine if the figures provided on the 2011 Annual Report are accurate.