Sample Policy Forms (updated 2024)

Sample policy forms are displayed below starting with country-wide forms and followed by state-specific forms.

For sample policy forms for policies prior to July 1, 2024, please contact us.
 

Policy forms for all states

• CNA101495XX (7-23) - Scheduled Insured Entity Endorsement Shared Professional Liability Limits
• CNA101500XX (7-23) - Deletion Of Endorsement
• CNA101513XX (7-23) - Specified Employment Exclusion Endorsement
• CNA101514XX (7-23) - Professional Liability Coverage Limitation Endorsement
• CNA101515XX (7-23) - Prior Acts Period And Schedule Endorsement
• CNA101429XX (7-23) - General Terms And Conditions
• CNA101430XX (7-23) - Dentists Professional Liability Coverage Part Occurrence
• CNA101431XX (7-23) - Dentists Professional Liability Coverage Part Claims Made And Reported
• CNA101434XX (7-23) - Dentists Policy Declarations
• CNA101434XX (7-23) - Dentists Policy Declarations
• CNA101435XX (7-23) - General Liability Coverage Part
• CNA101437XX (7-23) - Employee Benefits Liability Coverage Part
• CNA101438XX (7-23) - Employment Practices Liability Coverage Part
• CNA101439XX (7-23) - Erisa Fiduciary Liability Coverage Part
• CNA101443XX (7-23) - Media Expenses Supplementary Benefit Endorsement
• CNA101444XX (7-23) - Employment Practices Liability Coverage Part Defense Costs Only
• CNA101447XX (7-23) - Additional Insured Lessor Of Equipment Endorsement General Liability
• CNA101448XX (7-23) - Additional Insured Manager Or Lessor Of Premises Endorsement General Liability
• CNA101451XX (7-23) - Additional Locations Endorsement General Liability
• CNA101452XX (7-23) - Specified Procedure Exclusion Endorsement
• CNA101456XX (7-23) - Prescriptive Authority Exclusion Endorsement
• CNA101458XX (7-23) - Hipaa Proceedings Supplementary Benefits Endorsement
• CNA101464XX (7-23) - Billing Errors And Omissions Coverage Endorsement
• CNA101468XX (7-23) - Shared Professional Limits Of Liability Applicable To All Insureds Endorsement
• CNA101469XX (7-23) - Dentists Purchased Extended Reporting Period Endorsement
• CNA101470XX (7-23) - Laboratory Endorsement
• CNA101471XX (7-23) - Medical Waste Expense Supplementary Benefits Endorsement
• CNA101472XX (7-23) - Coverage Restriction For Specified Entities Endorsement
• CNA101473XX (7-23) - Addition Of Locum Tenens Endorsement
• CNA101474XX (7-23) - Leave Of Absence Endorsement Disability Period
• CNA101475XX (7-23) - Dental Faculty Members Other Practice Exclusion Endorsement
• CNA101477XX (7-23) - Dentists Additional Insured Endorsement
• CNA101479XX (7-23) - Cyber Liability And First Party Loss Including Privacy Endorsement
• CNA101480XX (7-23) - Professional Liability Split Limits Endorsement Retroactive Date
• CNA101481XX (7-23) - Professional Liability Split Limits Endorsement By Specified Insured
• CNA101482XX (7-23) - Dentists Cyber Liability And First Party Loss Including Privacy Purchased Extended Reporting Period Endorsement
• CNA101484XX (7-23) - Schedule Of Named Insureds Endorsement
• CNA101485XX (7-23) - Amendment Of Schedule Of Named Insureds Endorsement
• CNA101486XX (7-23) - Policy Aggregate Limit Endorsement
• CNA101487XX (7-23) - Deductible Endorsement Applicable To Professional Liability And Or Employment Practices Liability Coverages
• CNA101488XX (7-23) - Military Leave Of Absence Endorsement Suspension Of Professional Liability Coverage
• CNA101489XX (7-23) - Military Leave Of Absence Endorsement Reinstatement Of Professional Liability Coverage
• CNA101490XX (7-23) - Hired And Non Owned Auto Liability Endorsement
• CNA101492XX (7-23) - Policy Period Extension Endorsement
• CNA101493XX (7-23) - Specified Individual Or Entity Exclusion Endorsement
• CNA101494XX (7-23) - Waiver Of Consent To Settle Endorsement

State-specific policy forms

Alabama

• CNA100351AL (11-20) - Punitive Damages Endorsement Alabama
• CNA101512AL (07-23) - Cancellation And Non Renewal Amendatory Endorsement Alabama

Alaska

• CNA68615AK (01-16) - Alaska Attorneys Fees - Notice To Insureds - Coverage Notice A
• CNA68616AK (6-12) - Alaska Attorneys Fees - Notice To Insureds - Coverage Notice B
• CNA101479AK (10-23) - Cyber Liability And First Party Loss (Including Privacy) Endorsement - Alaska
• CNA101482AK (10-23) - Dentists Cyber Liability And First Party Loss (Including Privacy) Purchased Extended Reporting Period Endorsement - Alaska
• CNA101490AK (10-23) - Hired And Non-Owned Auto Liability Endorsement - Alaska
• CNA101512AK (2-24) - Cancellation And Non-Renewal Amendatory Endorsement - Alaska
• CNA101515AK (2-24) - Prior Acts Period And Schedule Endorsement - Alaska
• CNA101521AK (2-24) - Amendatory Endorsement (General Terms And Conditions) - Alaska
• CNA101523AK (4-24) - Amendatory Endorsement - Alaska (Dentists Professional Liability Coverage Part)
• CNA101525AK (4-24) - Amendatory Endorsement (General Liability Coverage Part) - Alaska
• CNA101526AK (4-24) - Amendatory Endorsement (Employee Benefits Liability Coverage Part) - Alaska

Arkansas

• CNA98115AR (11-23) - Important Information For Our Arkansas Policyholders
• CNA101469AR (07-23) - Dentists Purchased Extended Reporting Period Endorsement Arkansas
• CNA101479AR (08-23) - Cyber Liability And First Party Loss Including Privacy Endorsement Arkansas
• CNA101482AR (07-23) - Dentists Cyber Liability And First Party Loss Including Privacy Purchased Extended Reporting Period Endorsement Arkansas
• CNA101512AR (07-23) - Cancellation And Non Renewal Amendatory Endorsement Arkansas
• CNA101521AR (07-23) - Amendatory Endorsement Arkansas General Terms And Conditions

Arizona

• CNA101512AZ (07-23) - Cancellation And Non Renewal Amendatory Endorsement Arizona
• CNA101521AZ (07-23) - Amendatory Endorsement Arizona General Terms And Conditions

Colorado

• CNA101512CO (07-23) - Cancellation And Non-Renewal Amendatory Endorsement Colorado

Connecticut

• CNA101512CT (07-23) - Cancellation And Non Renewal Amendatory Endorsement Connecticut
• CNA101521CT (07-23) - Amendatory Endorsement Connecticut General Terms And Conditions

District of Columbia

• CNA101512DC (07-23) - Cancellation And Non Renewal Amendatory Endorsement District Of Columbia

Delaware

• CNA101512DE (07-23) - Cancellation And Non Renewal Amendatory Endorsement Delaware

Florida

• CNA77863FL (02-14) - Policyholder Notice Florida
• CNA81758FL (12-21) - Policyholder Notice Florida Terrorism Coverage
• CNA101512FL (10-23) - Cancellation And Non Renewal Amendatory Endorsement Florida
• CNA101521FL (07-23) - Amendatory Endorsement Florida General Terms And Conditions
• CNA62832FL (09-12) - Policyholder Notice Florida

Georgia

• CNA101512GA (07-23) - Cancellation And Non Renewal Amendatory Endorsement Georgia
• CNA101521GA (07-23) - Amendatory Endorsement Georgia General Terms And Conditions

Hawaii

• CNA101512HI (07-23) - Cancellation And Non Renewal Amendatory Endorsement Hawaii

Idaho

• CNA101512ID (07-23) - Cancellation And Non Renewal Amendatory Endorsement Idaho

Illinois

• CNA100201IL (1-21) - Civil Union Endorsement - Illinois
• CNA101479IL (2-24) - Cyber Liability And First Party Loss (Including Privacy) Endorsement - Illinois
• CNA101490IL (1-24) - Hired And Non-Owned Auto Liability Endorsement - Illinois
• CNA101512IL (7-23) - Cancellation And Non-Renewal Amendatory Endorsement - Illinois
• CNA101521IL (1-24) - Amendatory Endorsement (General Terms And Conditions) - Illinois
• CNA101523IL (1-24) - Amendatory Endorsement (Dentists Professional Liability Coverage Part) - Illinois
• CNA101525IL (2-24) - Amendatory Endorsement (General Liability Coverage Part) - Illinois
• CNA101527IL (1-24) - Amendatory Endorsement (Employment Practices Liability Coverage Part) - Illinois

Indiana

• CNA101465IN (07-23) - Dentists Professional Liability Coverage Part Claims Made And Reported Indiana Pcf Endorsement
• CNA101466IN (07-23) - Dentists Professional Liability Coverage Part Occurrence Indiana Pcf Claims Endorsement
• CNA101512IN (09-23) - Cancellation And Non Renewal Amendatory Endorsement Indiana
• CNA62835IN (09-12) - Policyholder Notice Claim Settlement Practices Indiana

Iowa

• CNA101512IA (07-23) - Cancellation And Non Renewal Amendatory Endorsement Iowa

Kansas

• CNA101512KS (1-24) - Cancellation And Non Renewal Amendatory Endorsement Kansas_01012024.Pdf
• CNA101521KS (07-23) - Amendatory Endorsement Kansas General Terms And Conditions

Kentucky

• CNA96821KY (09-19) - Policyholder Notice Kentucky Surcharge Firefighters And Law Enforcement Officials Fund
• CNA101512KY (07-23) - Cancellation And Non Renewal Amendatory Endorsement Kentucky

Louisiana

• CNA101464LA (12-23) - Billing Errors And Omissions Coverage Endorsement - Louisiana
• CNA101510LA (12-23) - Louisiana Pcf Claims Limits Of Liability Endorsement
• CNA101512LA (7-23) - Cancellation And Non-Renewal Amendatory Endorsement - Louisiana
• CNA101521LA (12-23) - Amendatory Endorsement (General Terms And Conditions) - Louisiana
• CNA101523LA (12-23) - Amendatory Endorsement (Professional Liability Coverage Part - Abuse And Molestation) - Louisiana
• CNA101525LA (12-23) - Amendatory Endorsement (General Liability Coverage Part) - Louisiana

Maine

• CNA101512ME (07-23) - Cancellation And Non Renewal Amendatory Endorsement Maine
• CNA101521ME (09-23) - Amendatory Endorsement Maine General Terms And Conditions

Maryland

• CNA79802MD (08-14) - Maryland Policyholder Notice Notice Of Ability To Cancel Binder Or Policy
• CNA81753MD (03-15) - Cap On Losses From Certified Acts Of Terrorism Endorsement Maryland
• CNA81758MD (12-21) - Maryland Offer Of Terrorism Coverage Disclosure Of Premium
• CNA101512MD (07-23) - Cancellation And Non Renewal Amendatory Endorsement Maryland
• CNA101523MD (07-23) - Amendatory Endorsement Maryland Dentists Professional Liability Coverage Part.Pdf
• CNA62842MD (09-12) - Policyholder Notice Maryland

Michigan

• CNA101512MI (07-23) - Cancellation And Non Renewal Amendatory Endorsement Michigan
• CNA62841MI (01-16) - Policyholder Notice Michigan Commercial Exempt Risk

Minnesota

• CNA93294MN (10-22) - Minnesota Signature Endorsement
• CNA101512MN (11-23) - Cancellation And Non Renewal Amendatory Endorsement Minnesota
• CNA101521MN (1-24) - Amendatory Endorsement Minnesota General Terms And Condition
• CNA103510MN (11-20) - Policyholder Notice Minnesota

Missouri

• CNA93296MO (10-22) - Missouri Property And Casualty Insurance Guaranty Association Endorsement
• CNA101512MO (07-23) - Cancellation And Non Renewal Amendatory Endorsement Missouri
• CNA101521MO (11-23) - Amendatory Endorsement Missouri General Terms And Conditions
• CNA101523MO (11-23) - Amendatory Endorsement Missouri Dentists Professional Liability Coverage Part
• CNA101525MO (11-23) - Amendatory Endorsement Missouri General Liability Coverage Part
• CNA62845MO (09-12) - Policyholder Notice Missouri

Mississippi

• CNA101512MS (07-23) - Cancellation And Non Renewal Amendatory Endorsement Mississippi
• CNA101521MS (07-23) - Amendatory Endorsement Mississippi General Terms And Conditions

Montana

• CNA101512MT (09-23) - Cancellation And Non Renewal Amendatory Endorsement Montana
• CNA101516MT (09-23) - Amended Abuse And Molestation Sublimits Endorsement Montana Where Required By Written Contract
• CNA101521MT (07-23) - Amendatory Endorsement Montana General Terms And Conditions
• CNA101553MT (07-23) - Table Of Contents For General Terms And Conditions Form
• CNA101554MT (07-23) - Table Of Contents For Dentists Professional Liability Claims Made Form
• CNA101555MT (07-23) - Table Of Contents For Dentists Professional Liability Occurrence Form
• CNA101558MT (07-23) - Table Of Contents For Employment Practices Liability Form
• CNA101559MT (07-23) - Table Of Contents For Employment Practices Liability Defense Only Form
• CNA101560MT (07-23) - Table Of Contents For Employee Benefits Liability Form
• CNA101561MT (07-23) - Table Of Contents For Erisa Fiduciary Liability Form
• CNA101562MT (07-23) - Table Of Contents For General Liability Form

Nebraska

• CNA101512NE (07-23) - Cancellation And Non Renewal Amendatory Endorsement Nebraska

New Hampshire

• CNA101512NH (07-23) - Cancellation And Non Renewal Amendatory Endorsement New Hampshire
• CNA101521NH (10-23) - Amendatory Endorsement New Hampshire General Terms And Conditions
• CNA101525NH (07-23) - Amendatory Endorsement New Hampshire General Liability Coverage Part

New Mexico

• CNA101512NM (10-23) - Cancellation And Non Renewal Amendatory Endorsement New Mexico

North Carolina

• CNA101512NC (07-23) - Cancellation And Non Renewal Amendatory Endorsement North Carolina
• CNA101521NC (07-23) - Amendatory Endorsement North Carolina General Terms And Conditions

North Dakota

• CNA101512ND (07-23) - Cancellation And Non Renewal Amendatory Endorsement North Dakota
• CNA101521ND (07-23) - Amendatory Endorsement North Dakota General Terms And Conditions
• CNA101530ND (07-23) - Amendatory Endorsement North Dakota Employment Practices Liability Coverage Part Defense Costs Outside.Pdf

New Mexico

• CNA101512NM (10-23) - Cancellation And Non Renewal Amendatory Endorsement New Mexico

Ohio

• CNA81758OH (12-21) - Ohio Notice Of Terrorism Coverage Disclosure Of Premium
• CNA101512OH (07-23) - Cancellation And Non Renewal Amendatory Endorsement Ohio

Oklahoma

• CNA81753OK (03-15) - Cap On Losses From Certified Acts Of Terrorism Endorsement Oklahoma
• CNA81758OK (12-21) - Oklahoma Offer Of Terrorism Coverage; Disclosure Of Premium
• CNA101512OK (07-23) - Cancellation And Non Renewal Amendatory Endorsement Oklahoma
• CNA101521OK (09-23) - Amendatory Endorsement Oklahoma General Terms And Conditions
• CNA101532OK (07-23) - Policyholder Notice Oklahoma Fraud

Oregon

• CNA101464OR (10-23) - Billing Errors And Omissions Coverage Endorsement Oregon
• CNA101501OR (10-23) - Agreement To Provide Notice Of Cancellation To Specified Person And Or Entity Endorsement Oregon
• CNA101512OR (10-23) - Cancellation And Non Renewal Amendatory Endorsement Oregon
• CNA101521OR (11-23) - Amendatory Endorsement Oregon General Terms And Conditions
• CNA101525OR (11-23) - Amendatory Endorsement Oregon General Liability Coverage Part

Pennsylvania

• CNA101512PA (07-23) - Cancellation And Non Renewal Amendatory Endorsement Pennsylvania
• CNA101521PA (08-23) - Amendatory Endorsement Pennsylvania General Terms And Conditions

Rhode Island

• CNA101512RI (12-23) - Cancellation And Non Renewal Amendatory Endorsement Rhode Island

South Carolina

• CNA101512SC (07-23) - Cancellation And Non Renewal Amendatory Endorsement South Carolina

South Dakota

• CNA101479SD (09-23) - Cyber Liability And First Party Loss Including Privacy Endorsement South Dakota
• CNA101512SD (07-23) - Cancellation And Non Renewal Amendatory Endorsement South Dakota
• CNA101521SD (09-23) - Amendatory Endorsement South Dakota General Terms And Conditions

Tennessee

• CNA101501TN (10-23) - Agreement To Provide Notice Of Cancellation To Specified Person Endorsement Tennessee
• CNA101512TN (07-23) - Cancellation And Non Renewal Amendatory Endorsement Tennessee

Texas

• CNA80079TX (07-16) - Policyholder Notice Texas Risk Control Professional Liability Notice
• CNA97490TX (07-23) - Policyholder Notice Texas Consumer Complaint Information
• CNA101512TX (07-23) - Cancellation And Non Renewal Amendatory Endorsement Texas
• CNA101521TX (07-23) - Amendatory Endorsement Texas General Terms And Conditions
• CNA101525TX (07-23) - Amendatory Endorsement Texas General Liability Coverage Part
• CNA101526TX (07-23) - Amendatory Endorsement Texas Employee Benefits Liability Coverage Part
• CNA101527TX (07-23) - Amendatory Endorsement Texas Employment Practices Liability Coverage Part
• CNA101528TX (07-23) - Amendatory Endorsement Texas Employment Practices Liability Coverage Part Defense Costs Only

Utah

• CNA101512UT (07-23) - Cancellation And Non Renewal Amendatory Endorsement Utah

Washington

• CNA101479WA (11-23) - Cyber Liability And First Party Loss Including Privacy Endorsement Washington
• CNA101512WA (12-23) - Cancellation And Non Renewal Amendatory Endorsement Washington
• CNA101521WA (11-23) - Amendatory Endorsement Washington General Terms And Conditions
• CNA101525WA (11-23) - Amendatory Endorsement Washington General Liability Coverage Part

Wisconsin

• CNA101512WI (07-23) - Cancellation And Non Renewal Amendatory Endorsement Wisconsin
• CNA101521WI (07-23) - Amendatory Endorsement Wisconsin General Terms And Conditions
• CNA101523WI (07-23) - Amendatory Endorsement Wisconsin Dentists Professional Liability Coverage Part
• CNA62862WI (09-12) - Policyholder Notice Wisconsin
• CNA62863WI (09-12) - Policyholder Notice Wisconsin

West Virginia

• CNA101512WV (07-23) - Cancellation And Non Renewal Amendatory Endorsement West Virginia
• CNA101521WV (4-24) - Amendatory Endorsement West Virginia General Terms And Conditions
• CNA101521WV (07-23) - Amendatory Endorsement West Virginia General Terms And Conditions
• CNA62866WV (07-23) - Policyholder Notice West Virginia Surcharge

Wyoming

• CNA101487WY (10-23) - Deductible Endorsement Wyoming Applicable To Professional Liability And or Employment Practices Liability Coverages
• CNA101512WY (10-23) - Cancellation And Non Renewal Amendatory Endorsement Wyoming
• CNA101521WY (10-23) - Amendatory Endorsement Wyoming General Terms And Conditions
• CNA101575WY (10-23) - Wyoming Notice Defense Costs Inside Limits