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What forms are needed in the state of Rhode Island?

The available forms are listed below. You can open a .pdf version of these forms by clicking on the desired form number in the 'File Attachments' section below.

Rhode Island law requires you to purchase Medical Payments Coverage with a limit of $2,500 per person unless you tell us, in writing, that you do not want this coverage. You may also purchase higher limits for an additional premium. The highest limit of Medical Payments Coverage that you may purchase is $10,000 per person. If you have not previously completed and signed the Medical Payments Selection/Rejection of Coverage Rhode Island or if you want to make changes to your current coverage, please print and complete this form.

Medical Payments Selection/Rejction of Coverage Rhode Island - AU RI78 0909

Rhode Island law requires that we offer you Uninsured/Underinsured Motorists Bodily Injury Coverage with limits equal to your Bodily Injury Liability Coverage limit unless you tell us, in writing, that you want lower limits. The lowest limit allowed by Rhode Island law is $25,000 per person/$50,000 per accident. If your Bodily Injury Liability limit is $25,000/$50,000, you may reject Uninsured/Underinsured Motorists Coverage by signing the separate Uninsured/Underinsured Motorist Bodily Injury Rejection Notice and Warning. If you have not previously completed and signed the Rhode Island Uninsured/Underinsured Motorist Coverage Selection of Limits or if you want to make changes to your current coverage, please print and complete this form.

Rhode Island Uninsured/Underinsured Motorist Coverage Selection of Limits Form: AU RI39 0110

Uninsured/Underinsured Motorist Bodily Injury Rejection Notice and Warning - AU RI49 0313

Once completed, please mail or fax the form to the address or fax number listed below.

Physical Mailing and Overnight Address:

Overnight - Correspondence 21st Century Insurance 3 Beaver Valley Rd - 4th Floor Wilmington, DE 19803
Fax number: 1(866) 447-2611

File Attachments

Medical Payments Selection/Rejction of Coverage Rhode Island - AU RI78 0909.pdf
Rhode Island Uninsured/Underinsured Motorist Coverage Selection of Limits Form: AU RI39 0110.pdf
Uninsured/Underinsured Motorist Bodily Injury Rejection Notice and Warning - AU RI49 0313.pdf

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General Information
Coverage
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