Special Risk Division Activity Report Form

To send us your activity report for upcoming events, fill out the form below. Please choose your organization type before entering your information. When finished, click “Submit” at the bottom of the page.

All group participants must be included for coverage.

Have questions? Visit our FAQ section.

If you have any issues with this form, please contact Erin Bain at efbain@ailife.com or at 800-849-4820 ext. 5

Existing policyholders can submit activity reports here.


Policy Number is required. Exceeds the maximum number of characters allowed.
Organization is required. Exceeds the maximum number of characters allowed.
First Name is required. Exceeds the maximum number of characters allowed.
Last Name is required. Exceeds the maximum number of characters allowed.
Group Name is required. Exceeds the maximum number of characters allowed.
Phone Number is required. Exceeds the maximum number of characters allowed.
Email is required. Exceeds the maximum number of characters allowed. Please enter a valid email address.
Address is required.
City is required.
State is required.
Zip is required.
County is required.

At least one activity must be filled out below.

Description is required.
Start Date is required.
End Date is required.
Participants is required.
Rate is required.

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FAQ

AIL Special Risk Division policies are for youth, adult participants, and volunteers. Coverage is not provided for spectators or members of the general public. We provide blanket policies, which means that all participants must be included on the activity report. Use your best estimate of participants when you submit your report, and afterwards use the actual number to calculate the premium due.

The AIL Special Risk Division does not insure people less than age 5 for any activity.

You may request coverage anytime before the first event (up to a day before!); however, you must submit your activity report before the event(s) begin. While denials are rare, we do like the opportunity to review each request in advance of your events so that we can identify any potential problems and contact you with questions if needed.

Please email both serial numbers to specialrisk@ailife.com, and indicate which is the correct/active coverage request. We will delete the duplicate request from our records.

Any covered individual who is injured or ill will face out-of-pocket medical expenses. Our benefits can be applied towards deductibles, co-payment requirements, and expenses excess of personal insurance limits.

If you have an annual policy for your 4-H/Extension group, there are situation where it is wise to purchase special activities coverage:

  • Resident camps and other overnight travel outside the county
  • Downhill winter sports (skiing, snowboarding, tubing), which are excluded by the annual policy
  • Guests and other participants in events sponsored by 4-H/Extension who are not enrolled in your program.

We understand that you many have several different funding streams or ways of processing payments. If you are unable to submit check requests in a traditional way, some options to consider my be purchase orders or checks requests from your affiliated university. If none of these options are available to you, please contact our office so that we can assist.

No. Blanket accident and illness policies from AIL Special Risk Division are not liability insurance.

If you’re not sure whether your group or event meets our requirements to be insured, please feel free to contact us. We are available by phone each weekday from 8:30-5:00 Eastern Time, and we respond to e-mails within 1-2 business days. Get in touch via email or by phone: 800-849-4820.

American Income Life logo Special Risk Division

Thank you!

We have received your application. For further inquiries, contact us.

Please review your information below:

Contact First Name: {{vm.contact.firstname}}
Contact Last Name: {{vm.contact.lastname}}
Phone: {{vm.contact.phone}}
Email: {{vm.contact.email}}
Organization Name: {{vm.contact.organizationname}}
Group Name: {{vm.contact.groupname}}
Policy Number: {{vm.contact.policynumber}}
Mailing Address: {{vm.contact.address1}}
Mailing Address 2: {{vm.contact.address2}}
City: {{vm.contact.city}}
State: {{vm.contact.statecode}}
Zipcode: {{vm.contact.zipcode}}
County: {{vm.contact.county}}
Comments: {{vm.contact.comments}}
Description: {{activity.description}}
Start Date: {{activity.startdate}}
End Date: {{activity.enddate}}
Number of Participants: {{activity.numberofparticipants}}
Rate: {{activity.rate}}