Campania offers a full range of surety bond including Florida Medicaid and Licensing, employee dishonesty, ERISA pension trust fund and patient trust fund bonds. Campania has access to several bond markets including CNA, Campmed Casualty & Indemnity and NOVA Casualty. The application, Indemnity Agreement and Personal Financial Statement for the Florida Medicaid and Licensing bond and the Renewal Questionnaire can be downloaded from this site.
Florida Medicaid and Licensing Surety Bond
The Medicaid Surety Bond is required by the Florida Agency for Health Care Administration to secure a Medicaid Provider Number and participate in the Medicaid Program. This same bond may also be used to receive a Florida HME License through AHCA. The face value of the bond is $50,000 bond and it must be renewed annually by Medicaid participants. Subject to underwriting review, the annual price for this bond is $600 plus a 1% Florida Hurricane Catastrophe Assessment surcharge for a total of $606.
Fax the items requested below to 703-242-3815 for a quote:
* Completed application and signed Indemnity Agreement
* Fully completed Personal Financial Statement - provide bank or brokerage
statements to verify balances over $15,000. Do not need transaction detail -
only balance summary information. Block out account numbers.
* Current Business Financial or if new business, resume for all
owners
* Most recent personal tax return of owner(s)
* Proof of General Liability Insurance
Before the bond can be issued, Campania MUST receive:
1. The original of the completed application
2. The original, properly signed Indemnity Agreement
3. Payment of $606 - check payable to Campania Insurance Agency
For fastest service, mail the 3 items listed above the same day you fax the submission.
Mail to: Campania Insurance Agency, 111 Berry St SE, Vienna, VA 22180
Medicaid Bond Renewal Questionnaire
A completed questionnaire along with all attachments requested in question #8 and the $606 annual premium and fee is needed to complete the bond renewal.
For information on these and other bonds, contact:
Adriana Saulnier
Campania Insurance Agency
111 Berry St, S.E.
Vienna, VA 22180
Ph: 800-831-9506/ Fax: 703-242-3815
Email: asaulnier@thecampaniagroup.com