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Apply for Coverage

Apply for medical liability insurance coverage with ISMIE Mutual today. Questions? Please contact us by email at underwriting@ismie.com or at 800-782-4767.

Apply for a new policy or add someone to an existing policy:

Physician Application: Policy application for physicians seeking new coverage, or for existing policyholders seeking to add a physician(s) to an ISMIE policy (MDs and DOs only).

Locum Tenens Coverage Application: Policy application for an existing policyholder to add a temporary physician to fill in while away from practice (e.g. maternity leave, extended travel).

Ancillary Employee Application: Policy application for allied healthcare professionals seeking new coverage when joining an existing ISMIE policy. Allied healthcare professionals included: registered nurses, technicians, medical assistants, and physical therapists.

Non-Physician Professional Application: Policy application for non-physician professionals seeking coverage, or for existing policyholders seeking to add a non-physician professional to an existing ISMIE policy. Non-physician professional examples: physician assistants, nurse practitioners, certified registered nurse anesthetists, midwives, chiropractors, and podiatrists.

Corporation or Clinic Application: Policy application for healthcare corporations or clinics. Common for: physician groups, independent physician groups, private practices, MRI centers, urgent/immediate care centers, and mental health clinics.

Surgicenter Application: Policy application for ambulatory surgery center coverage.

Part-time Rating Application: Application for existing policyholders seeking part-time coverage.

Make changes to a policy:

Clinic/Corporation Application for Risk Manager Premium Discount: For clinics/corporations who employ a dedicated risk management professional (only available to a clinic policyholder).

Change Request Form: Change policy information (e.g. update limits; add a hospital; change mailing or billing address; add employees).

Practice Location Form: Add a new practice location.

Request a Quote Online Form | PDF  

Cancellation Request: existing policyholder cancellation form.

Osteopathic Association Affinity Programs:

Request for quote for members of the Indiana Osteopathic Association (IOA) Online Form | PDF  

Request for quote for members of the Iowa Osteopathic Medical Association (IOMA) Online Form | PDF  

Request for quote for members of the Kentucky Osteopathic Medical Association (KOMA) Online Form | PDF​  

Request for quote for members of the Ohio Osteopathic Association (OOA) Online Form | PDF  

Request for quote for members of the Pennsylvania Osteopathic Medical Association (POMA) Online Form | PDF  ​​

Note: Availability of coverages and program features are subject to state insurance statutes in your particular state(s) of practice.

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