State of Arizona (i.e., Department of Economic Security, Department of Behavioral Health, etc.)
	Regional Behavioral Health Authority
	City
	County

Once eligibility is established, standard insurance applications and supplemental SSCIP applications/questionnaires (as required) must be completed and forwarded to the Administrator, Southwest Risk Services (SWRS).

You must contact and engage the services of a licensed Arizona insurance agent, as Southwest Risk Services (SWRS) does not write coverage directly. If you do not have a preferred insurance agent, you may contact one of the agencies listed under the Participating Agents link, or contact Southwest Risk Services (SWRS) for additional information. Your insurance agent will assist you in completing the required forms and supplements.

Once completed, the applications are submitted to Southwest Risk Services (SWRS), Administrator, 14902 North 73rd Street, Scottsdale, Arizona 85260.

Upon receipt of the application, Southwest Risk Services (SWRS) will prepare a quotation, provided to the agent. If the quotation is accepted, a premium deposit is required in order to issue a binder of coverage.

A Member Agreement is also required. The Member Agreement form is included in the FORMS section. The agreement outlines the conditions of participation, term, termination, loss control provisions and duties of the Member.

*Evidence of a contract is required when submitting applications.