You can not add these as options buyer's to select.
Insurance is for seller's not the buyers so you'd need to add it in to your shipping cost if you want your packages insured.
As for signature confirmatoin, a lot of buyer's probably wouldn't want it because they'd have to be home to sign for their package and might not be able to get to the post office to pick up.
Priority does come with $100 worth of insurance if you print the label on Etsy, $50 if you print the label on Paypal or take to the Post office.
You can add a packaging fee under package preferences to account for insurance cost if you have boxes/mailers listed there.
This way the fee is only adder per order.
If you put a handling fee in your shipping profile, it is added per item.