Forms, Publications, and Reports

OSIP Online Services User Guides

Information Bulletin

• Notice to Actuaries Submitting Actuarial Summaries and Studies for Private Self-Insured Employers
• Labor Code §§ 4800 and 4850 Reporting Requirements
• Informational Bulletin: Self Insurance Actuarial Data Analysis – 2013

Fiscal Year

• FY 2015/2016 Methodology
• FY 2014/2015 Methodology
• FY 2013/2014 Methodology
• FY 2012/2013 Methodology
• FY 2011/2012 Methodology
• FY 2010/2011 Assessments

Newsline

• OSIP Seeking Assistance for Self Insurers’ Administrator Exam Review
• OSIP Launches E-filing Portal for Self-Insured Public Agencies
• 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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Statewide Totals

Rosters

Security Deposit

• Information bulletin: Cash in trust
• Information bulletin: Letter of credit
• Information bulletin: Surety bond
• Information bulletin: Approved securities

Forms

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

• Life tables for men and women: United States 2011
  NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2016 and will be utilized by OSIP in 2017 to determine if the figures provided on the 2016 Annual Report are accurate.

• Life tables for men and women: United States 2010
  NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2015 and will be utilized by OSIP in 2016 to determine if the figures provided on the 2015 Annual Report are accurate.