Application

Deductible Program Application

If you qualify for the Deductible Program, you may select a deductible from the established options ($500 to $250,000 per claim).

All employers will be notified of the status of their application after review.  Until such time, the employer is required to continue timely payments under its current plan.  Upon approval, your deductible coverage shall be effective. You will be in the Deductible Program for one year and will have to reapply for deductible coverage on an annual basis.

BrickStreet will contact the employer if additional information is needed to process the application.  The employer must provide any additional information requested in order to be considered for approval.

Application (pdf)