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Application for or Request to Cancel Elective Coverage (U-3S)

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 proprietor or partnership, ministers and family farm corporate officers. If coverage is no longer needed, you will submit the form and note the individual or individuals you no longer want to cover for workers’ compensation.

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). Otherwise, proceed with this form.
Note: Elective coverage is in addition 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.

Required information

  • Name of individual for whom you wish to elect coverage or cancel elective coverage
  • Residential address, city, state and ZIP code of the individual
  • Social Security number
  • Title
  • Duties of the individual
  • Date of birth for the newly added individual    

If you have all the required information at hand, simply click the start button to begin.