Coverage description
An Insurance Services Office (ISO) standard form. It insures a named household member who is not otherwise an insured, plus anyone under 21 in that person's custody, for personal property and Section II liability coverage, but not for Coverages A and B or fair rental value.
How the form has changed
1 change across 1 revision, newest first. Each edition is compared with the one before it, using wording from filed copies.
02 17 edition
Feb 2017, compared with 05 11A home-sharing occupant cannot be the person insured under this endorsement, in the same way as a tenant, roomer or boarder.
05 11
“tenant, roomer or boarder”
02 17
“or boarder or "home-sharing occupant"”
Editions
Edition dates as filed, newest first. Filing counts include every state submission that lists the edition.
| Edition | Filings | Companies | States | Filed |
|---|---|---|---|---|
| 03 22Mar 2022Latest | 65 | 12 | 40 | Jan 2022 to Aug 2026 |
| 02 17Feb 2017 | 13 | 10 | 10 | Jan 2022 to Jul 2025 |
| 05 11May 2011 | 5 | 5 | 5 | Jan 2023 to Apr 2026 |
| 10 00Oct 2000 | 3 | 12 | 3 | Nov 2022 to Apr 2023 |
Filed by one company only: 08 05 (Westfield Group, 6 filings).
2 other edition dates appear in one or two filings each, often carrier-specific versions: 05 25, 08/01/05.
Where filings record what this form replaced, they name other forms ML-433. Only some filings record replacements.
What the filings show
- Edition in use: in the past 12 months, 4 companies filed the 03 22 edition and 2 companies filed 05 11.
- The 08 05 edition appears only in filings from Westfield Group (6 filings in 6 states since Oct 23, 2023), which suggests a carrier-specific version.
- HO 04 59 (Assisted Living Care Coverage) is filed alongside it most often, in 79 of the same filings (82%).
Filed under
Data from admitted P&C filings with state insurance departments, submitted Oct 2021 to Aug 2026, excluding withdrawn and rejected filings. One filing can cover several affiliated companies.
Carriers filing this form
The 10 carrier groups with the most filings that include HO 04 58, out of 23 in total.
| Carrier | Filings | States | Editions, most filed first | Last filed |
|---|---|---|---|---|
| Armed Forces Insurance Exchange | 32 | 32 | 03 2210 00 | Aug 27, 2026 |
| QBE Insurance Group2 group companies filed it, led by Regent Insurance Company and QBE Insurance Corporation | 16 | 9 | 03 22 | Nov 26, 2024 |
| Westfield Group3 group companies filed it, led by Old Guard Insurance Company and American Select Insurance Company | 10 | 9 | 08 0505 2508/01/05 | May 29, 2026 |
| Insurance Services Office, Inc.Advisory Organization | 8 | 8 | 03 22 | Dec 4, 2024 |
| Encova Mutual Insurance Group4 group companies filed it, led by Motorists Mutual Insurance Company and Iowa Mutual Insurance Company | 7 | 7 | 02 17 | Apr 24, 2023 |
| NEW London Cnty Group3 group companies filed it, led by New London County Mutual Insurance Co. and Danbury Insurance Company | 3 | 3 | 03 22 | Apr 17, 2026 |
| Cabrillo Holding GroupUS Coastal Property and Casualty Insurance Company | 2 | 2 | 02 17 | Jul 17, 2025 |
| THE Hanover Insurance Group2 group companies filed it, led by Citizens Insurance Company of America and Massachusetts Bay Insurance Company | 2 | 2 | 05 11 | Feb 3, 2026 |
| Utica GroupUtica Mutual Insurance Company | 2 | 2 | 03 22 | Dec 5, 2023 |
| ACP Insurance Mgmt LLC GroupAccelerant National Insurance Company | 1 | 1 | 05 11 | Apr 7, 2026 |
How the largest insurers handle HO 04 58
Groups among the largest homeowners insurers that filed HO 04 58 or their own version in the past five years.
- Allstate Insurance GroupFiles its own version: AVP589 Additional Insured - Household Resident (1 state)
See more forms
Search related forms, compare editions, and research carrier filings with FilingFocus.
States
Number of filings that include HO 04 58 in each state, Oct 2021 to Aug 2026. Darker states have more filings.
Often filed with
Standard-style form numbers that appear in the same filings most often.
- HO 04 59Assisted Living Care Coverage79 filings
- HO 04 10Additional Interests - Residence Premises76 filings
- HO 04 41Additional Insured - Residence Premises73 filings
- HO 04 90Personal Property Replacement Cost Lost Settlement72 filings
- HO 04 48Other Structures on the Residence Premises - Increased Limits71 filings
- HO 04 50Increased Amount of Insurance for Personal Property at Other Residences71 filings
- HO 04 65Coverage C Increased Special Limits of Liability71 filings
- HO 24 71Designated Business Pursuits Liability Coverage71 filings
- HO 00 03Homeowners 3 - Special Form70 filings
- HO 04 92Specific Structures Away From the Residence Premises - Actual Cash Value Loss Settlement70 filings
Recent filings
Latest filings that include this form number. Filed copies open in FilingFocus.
| Submitted | Company | State | Editions | Tracking number |
|---|---|---|---|---|
| Aug 27, 2026 | Armed Forces Insurance Exchange | CA | 03 22 | ARMD-134961669 |
| May 29, 2026 | Old Guard Insurance Company | MI | 08 05 | WSFG-G134947110 |
| May 14, 2026 | Armed Forces Insurance Exchange | MO | 03 22 | ARMD-134865546 |
| Apr 17, 2026 | New London County Mutual Insurance Co. | RI | 03 22 | NLCC-134891646 |
| Apr 7, 2026 | Accelerant National Insurance Company | WA | 05 11 | SPRO-G134894244 |
| Apr 3, 2026 | American Select Insurance Companyand 1 more | PA | 05 25 | WSFG-G134882776 |
| Mar 23, 2026 | Armed Forces Insurance Exchange | AR | 03 22 | ARMD-134879857 |
| Mar 17, 2026 | Danbury Insurance Companyand 1 more | MA | 03 22 | NLCC-134869733 |
| Feb 27, 2026 | Armed Forces Insurance Exchange | NE | 03 22 | ARMD-134795835 |
| Feb 3, 2026 | Massachusetts Bay Insurance Company | ME | 05 11 | HNVR-G134821698 |
| Nov 14, 2025 | New London County Mutual Insurance Co. | CT | 03 22 | NLCC-134739293 |
| Oct 10, 2025 | Slide Specialty Insurance Company | SC | 03 22 | SLID-134701865 |
Most filed ISO HO forms
- HO 00 03 Homeowners 3 Special Form
- HO 04 90 Personal Property Replacement Cost Loss Settlement
- HO 04 10 Additional Interests - Residence Premises
- HO 04 41 Additional Insured - Residence Premises
- HO 04 48 Other Structures on the Residence Premises - Increased Limits
- HO 04 16 Premises Alarm Water Leak Detection or Fire Protection System
- HO 04 98 Refrigerated Property Coverage
- HO 04 35 Supplemental Loss Assessment Coverage
- HO 04 77 Ordinance or Law Increased Amount of Coverage
- HO 00 06 Homeowners 6 - Unit- Owners Form
- HO 24 13 Incidental Low Power Recreational Motor Vehicle Liability Coverage Endorsement
- HO 04 40 Structures Rented to Others - Residence Premises
See more carrier forms
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