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Application For Elective Coverage
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(U-3S)
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| Introduction
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Use the U-3S to add coverage for certain specific employer
types. Ohio employers with one or more employees are required to carry workers' compensation coverage
for those employees. However, coverage is elective for certain business owners or officers, with the
exception of officers of a corporation, since they are considered employees of the corporation.
Submit this form to add coverage for sole proprietors, partners, officers
of limited liability companies acting as a sole proprieter or partnership,
ministers and family farm corporate officers.
To apply for elective coverage, you must already have an existing policy with BWC. To take
out initial coverage, please complete the Application for Workers’
Compensation Coverage (U-3). If you already have a policy number please proceed.
Note: Elective coverage is additional to the existing policy which you are required
to provide for your employees. Please read the payroll reporting and premium obligation information
before adding elective coverage.
Click here for more information on elective coverage.
If you
already have elective coverage and wish to add or remove individuals from your policy
click here for more information.
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| Required information
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- Name of individual for whom you wish to elect coverage
- Residential address, city, state and ZIP code of the individual
- Social Security number
- Title
- Duties of the individual
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| Complete the forms |
The free Adobe Reader
software is required to display and print the application.
Do you have all the required information at hand? If so, you can complete the online form.
When completing the online form, please use the previous and next
buttons located at the bottom of the page to navigate
through the form.
Begin online form now.
Are you missing required information? If so, you may return here at a later
time when you have all the information you need, and complete this online
form. You also may print a blank copy of the form, complete it by hand and
either mail or fax it to BWC.
Print a blank form.
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