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Property & Casualty Applications
Property & Casualty - Applications

*Complete and submit the application below for an Ohio Plan membership proposal.

Please note that current Ohio Plan members are provided annual updates of the attached application through their respective Ohio Plan Representative. Prospective Ohio Plan members may submit a completed application to Jason Chapman. An Ohio Plan Representative in your area will present the membership proposal at your convenience.

Questions and applications should be directed to:

Hylant Administrative Services
Attn: Jason Chapman
P.O. Box 2083
Toledo, OH 43603-2083

Email: Jason.Chapman@ohioplan.org
Phone: 800-248-5268
Fax: 419-259-6099

*A confirmation notice will be sent within 2 business days upon receipt of application.