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OhioBWC - Employer - Form: (U-20; U-21) - Introduction
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Application for Individual-Retrospective Rating Plan
Private Employers (U-20); Public Employers (U-21)
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Introduction to individual-retrospective rating |
Individual-retrospective rating is an alternative rating plan that allows the employer
to initially pay BWC less premium than it would without the plan.
An employer participating in the individual-retrospective rating plan may earn a possible premium
reduction by assuming a portion of the risk. The greater the portion of the risk
assumed, the greater potential reduction in premiums.
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| Additional information |
Program info
Eligibility requirements
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| Required information |
- Policy number
- Tier type consideration
- Claim limit
- Maximum premium
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- Owner/Party/Officer name
- Owner/Party/Officer title
- Owner/Party/Officer signature
- Payroll amount
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| Complete the forms |
The free Adobe Reader
software is required to display and print the application.
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You may print a blank copy of the U-20 or U-21 to complete by hand and
either mail or fax it to BWC.
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Do you have all the required information at hand? If so, you are ready to begin
completing the form.
I have been authorized to sign and execute this application for the individual-retrospective
rating plan on behalf of the company.
I have read and understand the individual-retrospective rating plan rules
(
4123-17-41 to 4123-54 of the Administrative Code for Public Sector Employers,
or
4123-17-41 to 4123-53 of the Administrative Code for Private Sector Employers)
in their entirety and agree to comply with the terms of the individual-retrospective rating plan,
including payment of the annual claims billings in accordance with the plan and the
governing rules.
Begin online form now.
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If you need additional assistance, please contact BWC's retrospective rating unit at (614) 466-6773
or e-mail the unit.
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