Can this form be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and retention capability. Confirm insurer acceptance and any consumer-facing disclosure requirements before e-submitting.

Is notarization required for all states?

No. Notarization requirements vary by state and by whether the election affects property or other notarizable interests. Check local notary rules or the insurer’s instructions; some states permit remote online notarization subject to identity proofing and recording requirements.

What happens if the signer lacks authority?

If signer lacks authority, insurer may reject the election, require ratification, or void changes. For corporate entities, attach a corporate resolution or power of attorney to demonstrate signing authority and prevent underwriting delays.

How are limit changes reflected in premiums?

Underwriting recalculates premium based on selected limits, effective date, and exposure. Midterm elections may result in prorated premiums or audit adjustments; insurers typically issue endorsements reflecting new limits and revised premium schedules.

Can I revoke or change an election later?

Revocation or amendment depends on policy language and insurer consent. Many carriers allow prospective changes with underwriting approval; retroactive reductions may be denied. Obtain written confirmation of any revocation to avoid disputes.

How long must I keep signed elections?

Retain signed elections per applicable retention rules: at least three years for tax purposes (IRC §6501(a)), six years for HIPAA-related records (45 CFR §164.530(j)), and longer where state law or industry rules require extended retention.

Electronic Signature
Templates
Insurance
Insurance Election of Limits

Insurance Election of Limits

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE ELECTION OF LIMITS

Applicant / Insured Information

Applicant Full Legal Name Mailing Address

Date of Birth:

Phone:

Email Address

Policy Details

Policy Number:

Insurer / Company:

Policy Type

Policy Effective Date:

Policy Expiration Date:

Current Annual Premium:

Selected Deductible:

Coverage Limit Base:

Election of Limits — Available Options

The insured elects coverage limits by selecting one option per coverage type below. Selection is subject to underwriting approval and premium adjustment. By selecting an increased limit the insured authorizes the insurer to amend the policy declarations to reflect the elected limits and acknowledges any additional premium, provisions, and endorsements necessary to effect such election.

Liability Limits (Select one) State Minimum Liability Limits $100,000 / $300,000 / $100,000 $250,000 / $500,000 / $1,000,000 Other elected liability limit:

Uninsured / Underinsured Motorist Basic Statutory UM/UIM Elected UM/UIM Limit:

Coverage Selection and Elective Limits

For each coverage listed below, indicate the current limit and the elected limit. Elected limits supersede prior declarations upon acceptance by the insurer and issuance of any required endorsement.

Bodily Injury Liability

Current Limit:

Elected Limit:

Additional Premium:

Property Damage Liability

Current Limit:

Elected Limit:

Additional Premium:

Comprehensive / Collision (Physical Damage)

Current Deductible:

Elected Deductible:

Additional Premium:

Optional Coverages (check all that apply) Medical Payments Personal Injury Protection Hired & Non-Owned Auto Liability Employment Practices Liability (where applicable)

Exclusions and Conditions

The election of limits is subject to the following material exclusions and conditions. The insured acknowledges these provisions form part of the binding election and that coverage will remain subject to the policy terms, conditions, exclusions, and endorsements:

Coverage shall not apply for loss or liability excluded by the policy, including but not limited to intentional acts, fraudulent acts, punitive damages where excluded, contractual liability beyond endorsement terms, and war or nuclear perils where excluded.
Elected limits shall not increase coverage for any insured not listed on the policy unless specifically endorsed; elections are personal to the named insured and subject to underwriting approval.
Any premium increase resulting from higher elected limits shall be due in accordance with the policy premium billing schedule. Failure to pay additional premium may result in rescission of the election and reinstatement of prior limits.
This election does not amend or waive policy defenses, terms, or warranties contained in the underlying insurance contract unless confirmed in a written endorsement issued by the insurer.

Beneficiary Designation (If Applicable)

Complete beneficiary information only where the elected coverage includes a payable death benefit or designated beneficiary provision. Percentages must total 100% where multiple beneficiaries are named.

Primary Beneficiary Name

Relationship:

Percentage:

Contingent Beneficiary Name

Relationship:

Percentage:

Declarations, Authorizations and Certifications

By signing below, the applicant certifies that the information provided is true and complete to the best of their knowledge, that the applicant has authority to request the elected limits for the named insured, and that the applicant understands the policy will be amended only upon acceptance by the insurer and issuance of any required endorsement. The applicant authorizes the insurer to process premium adjustments and endorsements necessary to effect the elected limits and acknowledges that such changes may affect premiums, coverages, and conditions.

The applicant further acknowledges: (1) any misrepresentation or omission material to underwriting may be grounds for rescission or denial of coverage; (2) election of higher limits may affect other coverages, obligations, and the insured's exposure; and (3) coverage remains subject to the full terms, conditions, limitations, and exclusions of the policy document and any endorsements issued in connection with this election.

Additional Instructions or Notes

Applicant Name:

Signature:

Date:

What the Insurance Election of Limits Is and Why It Matters

An Insurance Election of Limits is a written record in which an insured party selects specific coverage limits, deductibles, and related endorsements under an insurance policy or endorsement. The form is used at application, renewal, or when modifying coverage midterm to document per-occurrence and aggregate limits, deductible elections, and signatory authority. Carriers rely on the election to calculate premiums, determine reinsurance and underwriting needs, and establish the baseline for claims handling. Maintain signed copies for audit, premium reconciliation, and regulatory compliance.

Why Completing an Election of Limits Is Important

A clear written election reduces disputes, aligns premium with exposure, and provides verifiable evidence of coverage choices for underwriting, billing, and claims.

Who Typically Prepares and Signs This Form

Typical users include brokers, risk managers, HR administrators, and individual policyholders completing benefit elections or coverage adjustments.

Insurance brokers submitting client coverage choices during application or renewal workflows.
Employer HR teams electing group policy limits for employee benefits and voluntary coverages.
Individual policyholders selecting personal liability or umbrella limits at point of sale.

Confirm authority to sign and include contact details so the insurer can validate the election and apply correct premium calculations.

Common Signers and Their Roles

Broker

An authorized insurance broker completes the election on behalf of a client, ensuring policy numbers and endorsements are correct and communicating underwriting conditions to the insured.

Authorized Officer

A company officer or HR executive signs on behalf of an entity. Attach a corporate resolution or power of attorney demonstrating signing authority to prevent processing delays.

Essential Elements Found on a Professional Election Form

Core components define what insurers require to accept a limit election: coverage fields, effective dates, signatory authority, and clear numeric limit selections and endorsements.

Coverage Limits

Specify per-occurrence and aggregate dollar amounts. Include note if limits apply per person, per incident, or policy period, and reference any caps for specific coverages.

Deductibles

Identify deductible type and amount (per claim or aggregate). Clarify whether deductible is expressed as flat dollar amounts or percentage of loss, and whether it varies by peril.

Effective Date

State effective and expiration dates using MM/DD/YYYY. The effective date governs when coverage binds and affects premium proration if elected midterm, and note insurer processing lead times and any waiting periods.

Signatory Authority

Provide printed name, title, and contact for the signer. Verify authority (officer, broker, agent) and attach corporate resolution if signing on behalf of an entity.

Endorsements

List applicable endorsements or riders that alter limits or coverage scope. Reference endorsement numbers and attach copies of endorsement language to avoid ambiguity in claims handling.

Premium Impact

Record premium adjustment or series of premiums associated with selected limits. Include billing schedule, payment terms, and whether premium is prorated for midterm elections and deposit requirements.

Step-by-Step: How to Complete and Submit the Election

Follow these steps to complete an Insurance Election of Limits accurately and ensure the insurer records the correct coverage and premium.

01

Prepare document: Gather policy numbers, prior endorsements, and underwriting contact information.
02

Enter limits: Specify per-occurrence and aggregate limits numerically.
03

Confirm dates: Use MM/DD/YYYY for effective and expiration dates.
04

Sign and submit: Signer confirms authority; send to insurer and retain copy.

How Electronic Submission and Routing Typically Works

Typical routing moves documents from preparer to approver to insurer; each step records actions for audit and compliance.

Upload: Preparer uploads completed form to system.
Assign signer: Add signer with title and contact details.
Authenticate: Use email link, SMS, or stronger methods.
Archive: Store signed copy with audit trail.

Configuring an Online Workflow for Elections

Configure online workflows to validate fields, enforce required signatures, and route elections to underwriting and billing teams.

Field	Configuration
Limit Field	Numeric required; two decimal places
Effective Date	MM/DD/YYYY validator; required
Signer Role	Require role selection and email verification
Routing	Auto-forward to underwriting and billing

Platform Capabilities to Confirm Before eSubmission

For digital submission, confirm platform compatibility, authentication methods, and integrations before enabling e-signature workflows across departments.

Integrations: Salesforce, NetSuite, Google Workspace supported
File types: PDF, DOCX, HTML, Excel supported
Auth Methods: Email link, SMS code, SSO, multi-factor

eSignature Pricing and Capability Snapshot for Election Workflows

Compare common eSignature vendor pricing and basic capabilities relevant when handling Insurance Election of Limits and other compliance-sensitive documents.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies	Varies	Varies

Security, Encryption, and Compliance Considerations

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Certifications: SOC 2 Type II; ISO 27001; PCI DSS

Legal Compliance: ESIGN and UETA compliant

Healthcare: HIPAA compliant with BAA required

Audit Trail: Detailed timestamps, IP, and action logs

Accessibility: WCAG 2.0 Level AA support

Key Risks and Penalties from Incorrect Elections

Wrong Limits: May leave exposure underinsured

Incorrect TIN: Triggers backup withholding 24%

Late Submission: Can affect premium proration

Misrepresentation: Insurer may rescind coverage

Regulatory Penalties: Tax penalties under IRC §6721

I-9 Impact: Employment forms must match records

Common Preparation Pitfalls to Avoid

Failing to record exact per-occurrence versus aggregate limits causes confusion during claims and can lead to rejected or reduced payments if ambiguity exists.
Using informal signatures or initials without documented signatory authority increases risk of invalid elections and can require formal ratification by an authorized officer.
Submitting the election after policy effective date may not bind the insurer and could result in higher premiums or denial of requested coverage changes.
Omitting endorsement references or attaching inconsistent exhibits creates interpretation disputes that lengthen underwriting and claims adjudication timelines.

Timing and Deadlines to Keep in Mind

Timelines vary: submit elections before renewal, midterm changes may be limited, and insurer processing time affects effective dates.

Renewal Deadline:

Typically 30–60 days before policy renewal date.

Midterm Changes:

May require underwriting; effective dates can be delayed.

Processing Time:

Insurer review commonly 5–15 business days.

Emergency Adjustments:

Insurers may allow retroactive changes in special circumstances.

Recordkeeping Deadline:

Retain signed election copies per retention policy.

Key Milestones in the Election Lifecycle

Key milestones during an election lifecycle track preparation, approval, insurer processing, and final archiving for compliance and audit trails.

01

Preparation

Gather documents and confirm signatory authority.

02

Approval

Authorized signers review and execute election form.

03

Insurer Processing

Underwriting validates limits and calculates premium adjustments.

04

Archiving

Store executed copy with audit trail for retention.

Real-World Examples of Digital Document Use

Real-world examples show how eSignature accelerates document execution and maintains compliance across insurance and related workflows.

Martin Properties — Tim Martin

Tim Martin used eSignature to manage property-related insurance and lease documents remotely.

Faster turnaround on executed forms.
I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently.

Fertility Centers — John Butler

John Butler’s organization used digital signing to streamline patient and administrative forms while maintaining compliance.

Improved responsiveness and integration.
airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company.

FAQs and Troubleshooting for Insurance Election of Limits

Common user questions and issues when preparing or submitting an Insurance Election of Limits, including signatures, timing, and record retention guidance.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and retention capability. Confirm insurer acceptance and any consumer-facing disclosure requirements before e-submitting.
Is notarization required for all states?
No. Notarization requirements vary by state and by whether the election affects property or other notarizable interests. Check local notary rules or the insurer’s instructions; some states permit remote online notarization subject to identity proofing and recording requirements.
What happens if the signer lacks authority?
If signer lacks authority, insurer may reject the election, require ratification, or void changes. For corporate entities, attach a corporate resolution or power of attorney to demonstrate signing authority and prevent underwriting delays.
How are limit changes reflected in premiums?
Underwriting recalculates premium based on selected limits, effective date, and exposure. Midterm elections may result in prorated premiums or audit adjustments; insurers typically issue endorsements reflecting new limits and revised premium schedules.
Can I revoke or change an election later?
Revocation or amendment depends on policy language and insurer consent. Many carriers allow prospective changes with underwriting approval; retroactive reductions may be denied. Obtain written confirmation of any revocation to avoid disputes.
How long must I keep signed elections?
Retain signed elections per applicable retention rules: at least three years for tax purposes (IRC §6501(a)), six years for HIPAA-related records (45 CFR §164.530(j)), and longer where state law or industry rules require extended retention.

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