Forms
- ACH – One-Time Payment Form
- ACH – Recurring Payment Form
- ACORD 36 – AOR
- ACORD 37 – Statement of No Loss
- ACORD 125 – Commercial Insurance Application
- ACORD 130
- ACORD 175 – Commercial Change Request
- Exemption of Coverage
- Withdrawal of Election of Coverage
- Notice of Election Coverage
- Revocation or Certification of Exemption from Coverage
- Membership Identification Form
- Premium Payment Plans
- Payroll Values for Executive Officers and Sole Proprietors (effective 4/1/2020)
Supplements
At First Benefits Insurance Mutual, we believe in helping our customers create, implement and maintain a safe working environment. We are pleased to offer an array of safety materials to assist in the promotion of a safe working environment for your employees. These materials can be a valuable tool that helps develop a program specific to your company’s individual needs. Should you have additional questions about loss control services and risk management, please email First Benefits Insurance Mutual at losscontrol@firstbenefits.org.
Loss Control Material
- COVID – 19 in the Workplace – Employee Protection – FAQs
- Preventing & Treating Heat-Related Disorders
- COVID – 19 in the Workplace – Employee Protection
- Recommended Practices for Safety and Health Programs
- OSHA Penalty Adjustments to Take Effect After August 1, 2016
- OSHA Workplace Job Safety and Health Information
- OSHA Inspections
- OSHA New Injury Reporting Guidelines Eff. 1/1/15
- OSHA Saving Sudden Cardiac Arrest Victims in the Workplace
- OSHA Personal Protective Equipment
- OSHA Asbestos-Automotive Brake and Clutch Repair Work
- Agricultural Worker Protection Standard (WPS) 2015
- OSHA Protecting Agricultural Workers from Tractor Hazards
- OSHA Preventing Cuts and Amputations from Food Slicers and Meat Grinders
- OSHA Keeping Workers Safe During Disaster Cleanup and Recovery
- Loss Control Services – Tool for Your Tool Box
Training
FREE Responsible Alcohol Seller Program: Available to everyone. The Education and Training Division of the North Carolina Alcoholic Beverage Control Commission conducts free responsible server/seller training for both on-premises and off-premises business owners, managers and employees. The training program lasts two hours and incorporates hands-on training using “fatal vision” goggles, video and open discussion. Click HERE to learn more.
Education Portal: Available to members of NCRMA or CFIC. NCRMA or CFIC have paired up with LearnSomething to offer a variety of online training courses:
- Food Safety (available in English and Spanish)
- Human Resources
- Loss Prevention
- Pharmacy Compliance
Retail University: Available to members of NCRMA or CFIC. NCRMA Retail University is back in 2014 with fresh webinars on pertinent topics. Our free events have been designed with retailers in mind to give you a refresher on core business principles while also providing practical tips and new ideas you can implement in your store. This year there will only be one webinar session per topic. Each webinar will begin at 10:30 am ET, 9:30 am CT, 8:30 am MT, and 7:30 am PT.
First Benefits Insurance Mutual is approved as underlying carrier for umbrella policies by several prominent insurance companies in the NC market.
- West Bend Mutual Insurance Company – new as of 8/12/2019
- Nationwide Mutual Insurance (EL Limits of 100/500/100 except for contractor classes which require 500/500/500)
- Hanover Insurance Group
- EMC Insurance Co. (required EL limits of $500,000 / $500,000 / $500,000)
- Cincinnati Insurance Co. (required EL limits of $1,000,000 / $1,000,000 / $1,000,000)
- Selective Insurance Co. of America
- Erie Insurance Co.
- Penn National Insurance Co. (required minimum EL limits of $1,000,000 / $1,000,000 / $1,000,000)
- Auto-Owners Insurance Company
- All Liberty Mutual companies including Montgomery
- Central Mutual Insurance