Coverage description
An Insurance Services Office (ISO) standard form. It extends personal property and personal liability coverage to a relative of an insured who lives in the assisted living facility named in the Schedule, with special limits for items such as hearing aids and wheelchairs and limited additional living expense.
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.
05 11 edition
May 2011, compared with 10 00The provision that applied only one deductible when a single loss damaged property under both this endorsement and the policy was removed.
10 00
“we will subtract from the total of all loss from that same loss event the deductible amount”
05 11
Removed
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 | 59 | 8 | 37 | Jan 2022 to Aug 2026 |
| 05 11May 2011 | 11 | 8 | 9 | Jan 2022 to Apr 2026 |
| 10 00Oct 2000 | 5 | 15 | 4 | Jun 2022 to Jan 2025 |
Filed by one company only: 08 05 (Westfield Group, 5 filings).
5 other edition dates appear in one or two filings each, often carrier-specific versions: 05 25, 02 22, 06 20, 07 11, 08/01/05.
Where filings record what this form replaced, they name earlier edition 03 22. Only some filings record replacements.
What the filings show
- Edition in use: in the past 12 months, 1 company filed the 03 22 edition and 1 company filed 05 11.
- The 08 05 edition appears only in filings from Westfield Group (5 filings in 5 states since Oct 23, 2023), which suggests a carrier-specific version.
- HO 04 58 (Additional Insured - Household Resident) is filed alongside it most often, in 79 of the same filings (92%).
Data from admitted P&C filings with state insurance departments, submitted Oct 2021 to Aug 2026, excluding withdrawn and rejected filings.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 59, out of 18 in total.
| Carrier | Filings | States | Editions, most filed first | Last filed |
|---|---|---|---|---|
| Armed Forces Insurance Exchange | 31 | 31 | 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 | 05 11 | Apr 24, 2023 |
| 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 |
| American Family Insurance Group3 group companies filed it, led by Grain Dealers Mutual Insurance Company and NGM Insurance Company | 1 | 1 | 10 00 | Jan 17, 2025 |
| Amica Mutual GroupAmica Mutual Insurance Company | 1 | 1 | 02 22 | Jun 28, 2023 |
| Donegal GroupPeninsula Insurance Company | 1 | 1 | 05 11 | May 1, 2023 |
See more forms
Search related forms, compare editions, and research carrier filings with FilingFocus.
States
Number of filings that include HO 04 59 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 58Additional Insured - Household Resident79 filings
- HO 06 14Increased Amount of Insurance for Personal Property Located in a Self- Storage Facility69 filings
- HO 04 10Additional Interests - Residence Premises67 filings
- HO 04 50Increased Amount of Insurance for Personal Property at Other Residences67 filings
- HO 04 12Increased Limits on Business Property65 filings
- HO 04 48Other Structures on the Residence Premises - Increased Limits65 filings
- HO 24 71Designated Business Pursuits Liability Coverage65 filings
- HO 04 65Coverage C Increased Special Limits of Liability64 filings
- HO 24 72Incidental Farming Personal Liability Coverage64 filings
- HO 04 35Supplemental Loss Assessment Coverage63 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 | 07 11 | WSFG-G134947110 |
| May 14, 2026 | Armed Forces Insurance Exchange | MO | 03 22 | ARMD-134865546 |
| 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 |
| Feb 27, 2026 | Armed Forces Insurance Exchange | NE | 03 22 | ARMD-134795835 |
| Sep 18, 2025 | Old Guard Insurance Company | MN | 08 05 | WSFG-G134667554 |
| Jul 18, 2025 | Old Guard Insurance Company | WV | 08 05 | WSFG-G134603209 |
| Jun 30, 2025 | Armed Forces Insurance Exchange | PA | 03 22 | ARMD-134580982 |
| Jun 20, 2025 | Old Guard Insurance Company | TN | 08 05 | WSFG-G134565373 |
| Apr 4, 2025 | Old Guard Insurance Company | KY | 08 05 | WSFG-G134475387 |
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
Search forms by carrier, line of business, state, and wording with FilingFocus.