Horace Mann Online Enrollment

Horace Mann Enrollment Form 2020-2021


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Complete the enrollment form below and click submit. If you choose to enroll online, you must pay the annual rate in full by credit card. If you’d prefer to pay in full by check, scroll to the bottom of this page to download the enrollment form.

Please note that this is on a secure page and all data is encrypted.

Please enroll me in the Error & Omissions (E&O) Program for Exclusive Agents of Horace Mann Educators Corporation for the policy period of October 1, 2020 to October 1, 2021 I have indicated my credit card authorization for coverage for the policy period ending October 1, 2021. In lieu of a signature, I am providing my credit card authorization to represent my acceptance of all terms and conditions of this policy.

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I agree

 
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First Name

 
 

Middle Initial

 
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Last Name

 
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Address 1

 
 

Address 2

 
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City

 
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State

 
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Zip Code

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Phone

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Fax

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Email

 
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Agent Number

 

I understand and acknowledge I am not eligible for coverage under the Horace Mann Educators Corporation sponsored errors and omissions program unless I am legally contracted to represent Horace Mann Educators Corporation and its covered affiliates as of my coverage effective date. I understand if my contract to represent Horace Mann Educators Corporation or its covered affiliates is terminated, coverage under this program terminates on the same day and I am still responsible for the payment of the full annual rate. All payments are fully earned under this program and there will be no refund. I authorize Affinity Insurance Services, Inc. to process my enrollment. Your submission of this form and/or our preliminary acceptance of payment does not guarantee coverage. Should this submission be determined ineligible for coverage, your payment will be refunded.

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I agree

 

I have reviewed and understand the terms and conditions for the E&O program for Horace Mann Educators Corporation. I understand I will receive a certificate of coverage following my enrollment in this program in 24-48 hours. I will review this information and contact Affinity Insurances Services, Inc. with any questions.

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I agree

 
 
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Credit Card Type

 
Visa
Discover
Master Card
American Express
 
 
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Rates

   
Effective Date Expiration Date $1MM/$1MM $2MM/$2MM
April 2021 October 2021 $348.00 $429.00
May 2021 October 2021 $302.00 $370.00
June 2021 October 2021 $257.00 $311.00
July 2021 October 2021 $211.00 $252.00
August 2021 October 2021 $166.00 $193.00
September 2021 October 2021 $120.00 $134.00
 

* Includes a $75 purchasing group fee in the Agents Professional Liability Service Organization

Other payment options:

If you prefer to pay by check, please follow these instructions:

  • Download and print the Enrollment Form for Horace Mann Educators Corporation
  • Make your check payable to Affinity Insurance Services, Inc.
  • Complete the Enrollment form and mail it with your check to:
Affinity/Agents
PO Box 392071 Pittsburgh, PA
Pittsburgh, PA 15251-9071

Overnight Mailing:
Affinity/Agents Division
Attn: Lockbox 392071
500 Ross Street 154-0455
Pittsburgh, PA 15262-0001