Policy Information
Policy Renewal Date
Estimated Annual Revenue
Type of Coverage:
Claims Made
Occurrence
Practice Information
Practice Name
No. Physicians
Individual
Less than 10
11+
Practice Type
Private Practice
Hospital
Group Retroactive Date
Fill out the following for each physician.
Physician Name
Specialty
Administrative
AerospaceMedicine
Allergy/Immunology
Anesthesiology
Bariatrics (Major Surgery)
Bariatrics (No Surgery)
Cardiovascular Disease (Major Surgery)
Cardiovascular Disease (Minor Surgery)
Cardiovascular Disease (No Surgery)
Colon & Rectal Surgery (Major Surgery)
Colon & Rectal Surgery (Minor Surgery)
Dentists
Dermatology
Diabetes
Emergency Medicine (Major Surgery)
Emergency Medicine (No Surgery)
Endocrinology
Family/General Practice (Major Surgery)
Family/General Practice (Minor Surgery)
Family/General Practice (No surgery)
Forensic Medicine/Legal Medicine
Gastroenterology (Major Surgery)
Gastroenterology (Minor Surgery)
Gastroenterology (No Surgery)
General Surgery (Major Surgery)
Genetics
Geriatrics (Minor Surgery)
Geriatrics (Major Surgery)
Geriatrics (No Surgery)
Gynecology (No Surgery)
Hand (Major Surgery)
Head and Neck (Major Surgery)
Hematology (Minor Surgery)
Hematology (No Surgery)
Infectious Disease (Minor Surgery)
Infectious Disease (No Surgery)
Intensive Care Medicine (Minor Surgery)
Internal Medicine (Major Surgery)
Internal Medicine (Minor Surgery)
Internal Medicine (No Surgery)
Neonatology/Perinatilogy (No Surgery)
Nephrology (Major Surgery)
Nephrology (Minor Surgery)
Nephrology (No Surgery)
Neurology (Major Surgery)
Neurology (Minor Surgery)
Neurology (No Surgery)
Nuclear Medicine
Nutrition
OB/GYN (Major Surgery)
OB/GYN (Minor Surgery)
OB/GYN (No Surgery)
Occupational Medicine
Oncology (Minor Surgery)
Oncology (No Surgery)
Opthalmology (Minor Surgery)
Opthalmology (No Surgery)
Oral/Maxill Facial (Major Surgery)
Orthopedic Surgery (no spinal)
Orthopedic Surgery (with spinal)
Orthopedics
Otolaryngology (Minor Surgery, no plastic)
Otolaryngology (with plastic)
Otolaryngology (No surgery, no plastic)
Pain Management
Pathology (Minor Surgery)
Pathology (No Surgery)
Pediatrics (Minor Surgery)
Pediatrics (No Surgery)
Pharmacology
Physical Medicine & Rehabilitation (Minor Surgery)
Physical Medicine & Rehabilitation (No Surgery)
Physician - N.O.C. (Minor Surgery)
Physician - N.O.C. (No Surgery)
Plastic Surgery
Podiatry (Major Surgery)
Podiatry (No Surgery)
Psychiatry (Minor Surgery)
Psychiatry (No Surgery)
Public Health/Preventative Medcine
Pulmonary Medicine
Radiation - Therapy
Radiology - Diagnostic/Oncology (Minor Surgery)
Radiology - Diagnostic/Oncology (No Surgery)
Radiology - Interventiional
Rheumatology
Telemedicine
Thoracic
Trauma
Urgent Care
Urology (Major Surgery)
Urology (Minor Surgery)
Urology (No Surgery)
Vascular
Limit
$100K/$300K
$1M/$3M
$200K/$600K
$250K/$750K
$2M/$4M
$2M/$5M
$300K/$900K
$3M/$5M
$3M/$6M
$400K/$1.2M
$4M/$7M
$4M/$8M
$500K/$1.5M
$5M/$10M
$5M/$8M
$6M/$10M
$750K/$2.25M
Retroactive Date
Claims free for...
10+ years
5+ years
<5 years
No Claims
Employment Time
Full-time
Part-time
Board Certified?
Yes
No
Medical board actions within 5 years?
No
Yes
+ Add Another
Physicians
Please fill the following information for each specialty.
Specialty
Administrative
AerospaceMedicine
Allergy/Immunology
Anesthesiology
Bariatrics (Major Surgery)
Bariatrics (No Surgery)
Cardiovascular Disease (Major Surgery)
Cardiovascular Disease (Minor Surgery)
Cardiovascular Disease (No Surgery)
Colon & Rectal Surgery (Major Surgery)
Colon & Rectal Surgery (Minor Surgery)
Dentists
Dermatology
Diabetes
Emergency Medicine (Major Surgery)
Emergency Medicine (No Surgery)
Endocrinology
Family/General Practice (Major Surgery)
Family/General Practice (Minor Surgery)
Family/General Practice (No surgery)
Forensic Medicine/Legal Medicine
Gastroenterology (Major Surgery)
Gastroenterology (Minor Surgery)
Gastroenterology (No Surgery)
General Surgery (Major Surgery)
Genetics
Geriatrics (Minor Surgery)
Geriatrics (Major Surgery)
Geriatrics (No Surgery)
Gynecology (No Surgery)
Hand (Major Surgery)
Head and Neck (Major Surgery)
Hematology (Minor Surgery)
Hematology (No Surgery)
Infectious Disease (Minor Surgery)
Infectious Disease (No Surgery)
Intensive Care Medicine (Minor Surgery)
Internal Medicine (Major Surgery)
Internal Medicine (Minor Surgery)
Internal Medicine (No Surgery)
Neonatology/Perinatilogy (No Surgery)
Nephrology (Major Surgery)
Nephrology (Minor Surgery)
Nephrology (No Surgery)
Neurology (Major Surgery)
Neurology (Minor Surgery)
Neurology (No Surgery)
Nuclear Medicine
Nutrition
OB/GYN (Major Surgery)
OB/GYN (Minor Surgery)
OB/GYN (No Surgery)
Occupational Medicine
Oncology (Minor Surgery)
Oncology (No Surgery)
Opthalmology (Minor Surgery)
Opthalmology (No Surgery)
Oral/Maxill Facial (Major Surgery)
Orthopedic Surgery (no spinal)
Orthopedic Surgery (with spinal)
Orthopedics
Otolaryngology (Minor Surgery, no plastic)
Otolaryngology (with plastic)
Otolaryngology (No surgery, no plastic)
Pain Management
Pathology (Minor Surgery)
Pathology (No Surgery)
Pediatrics (Minor Surgery)
Pediatrics (No Surgery)
Pharmacology
Physical Medicine & Rehabilitation (Minor Surgery)
Physical Medicine & Rehabilitation (No Surgery)
Physician - N.O.C. (Minor Surgery)
Physician - N.O.C. (No Surgery)
Plastic Surgery
Podiatry (Major Surgery)
Podiatry (No Surgery)
Psychiatry (Minor Surgery)
Psychiatry (No Surgery)
Public Health/Preventative Medcine
Pulmonary Medicine
Radiation - Therapy
Radiology - Diagnostic/Oncology (Minor Surgery)
Radiology - Diagnostic/Oncology (No Surgery)
Radiology - Interventiional
Rheumatology
Telemedicine
Thoracic
Trauma
Urgent Care
Urology (Major Surgery)
Urology (Minor Surgery)
Urology (No Surgery)
Vascular
Number of Physicians
Claims free for...
10+ years
5+ years
<5 years
No Claims
Medical board actions within 5 years?
No
Yes
Limit
$100K/$300K
$1M/$3M
$200K/$600K
$250K/$750K
$2M/$4M
$2M/$5M
$300K/$900K
$3M/$5M
$3M/$6M
$400K/$1.2M
$4M/$7M
$4M/$8M
$500K/$1.5M
$5M/$10M
$5M/$8M
$6M/$10M
$750K/$2.25M
+ Add Another
Number of Allieds
Enter the amount of employees in each position below.
NP's
PA's
CRNA's
CNM's
Current Premium
Promo Code
Submit Application
