How To Insure Your Health Care Costs

Size: px
Start display at page:

Download "How To Insure Your Health Care Costs"

Transcription

1 A L L I E D H E A LT H P R O G R A M S ALLIED HEALTH Our program o ers Professional Liability and General Liability to a variety of professionals. ALLIED HEALTH COVERAGES Group Homes Home Health Long Term Care Facilities Assisted and Intermediate Care Outpatient Medical Facilities (Labs, Clinics, Surgical, Rehab) Social Service Agencies Medical Clinics Imaging Labs HIPAA Professional and General Liability. Sexual Misconduct, HNOA, Privacy, Property, and other ancillary coverage lines. Limits are available up to $5,000,000 with minimal deductibles. Other Options: We can also o er the same program for your Medical Professional and Nursing Sta Registry accounts. To receive pricing information, call our o ce Oncology Centers Pharmacies Physical Therapy Clinics Dialysis Centers Audiologists Dietician Nutritionist Music Therapist Occupational Therapist Speech Pathologist Perfusionists We know the Allied Health Industry.

2 A N T I - A G I N G P R O G R A M S AN T I - A G I N G ANTI-AGING COVERAGES Anti-Aging Centers are becoming popular across America, and have a need for insurance coverage. Nutritional Counseling Dietitian Services Wellness Analysis Lipotropics Cellulite Reduction Vitamin Treatments Hormone Treatments Yoga & Pilates Policy packages the full General and Professional Liability and can include Property Coverage. $ 3,000,000 aggregate available. Excess Liability is available up to $ 5,000,000. Competitive premiums with no minimum. Low deductibles. T o receive pricing information, call our o ce Medispas Products Liability Weight Loss including: Hcg, Phentermine, Phendimetrazine & Didrex W e k n o w t h e A n t i - A g i n g I n d u s t r y.

3 B E A U T Y P R O G R A M S BE A U T Y Beauty insurance is available for an individual technician or the entire facility. Our Beauty programs have always been BEAUTY COVERAGES for services that other carriers might not, and can be designed to meet the unique needs of today's ever changing beauty salon. Estheticians Facials & Peels Microdermabrasion Electrolysis LED / Microcurrent Body Wraps Massage Eyelash Enhancement Professional Liability (Malpractice) General Liability (Premises or Slip & Fall ) Property Insurance (Physical damage to your equipment) T o receive pricing information, call ce Pilates & Yoga Eyebrow Enhancement Airbrush Tanning Tanning Salons Hair Salons Nail Salons Hydro Massage Wax Removal Sauna & Spas W e k n o w t h e B e a u t y I n d u s t r y.

4 M E D I C A L A E S T H E T I C S I N S U R A N C E L A S E R C E N T E R S B O D Y C O N T O U R I N G Policies can be purchased on behalf of who host Cosmetic / Medical Aesthetic Services or by the doctor, nurse, aestheticians or anyone who can legally operate within their state. (Invasive Serives available to MD only) COVERAGES We can cover the entire facility or individuals operating in single or multiple locations. Body Contouring Laser Insurance Laser Hair Removal Cellulite Reduction Radio Frequency IPL Insurance Ultrasound Assisted Lipolysis Ablative & Non-Ablative Lasers CO2 Fractional Laser Laser Assisted Lipolysis Policy packages the full General and Professional Liability and can include Property coverage. $3,000,000 aggregate available. Excess Liability is available up to $ 2,000,000. Competitive premiums with no minimum. To receive pricing information, call our o ce Lipotropic Medical Assistant Coverage Medical Director Coverage Tumescent Liposuction We k n o w t h e M e d i c a l A e s t h e t i c s I n d u s t r y.

5 B O D Y P I E R C I N G P R O G R A M S BODY PIERCING Professional Liability coverage for Body Piercing Shops is available for the owner and can include all employees and independent contractors. BODY PIERCING COVERAGES Body Piercing Shop Insurance with all Piercers Body Piercing Insurance for Independent Contractors Option to include Tattoo Insurance Professional Liability for Piercing Shops General Liability for Shops Piercing of Minors Landlord endorsements to meet leases Guest Piercers Package coverage to include your General and Professional Liability. Policies can include coverage for your Business Personal Property. Coverage available for the entire shop, individuals or independent contractors. Claims on communicable disease are on the increase, Competitive pricing. T o receive pricing information, call ce Coverage at Conventions Mobile Units (including General Liability) Communicable Disease Sexual Abuse Apprenticeship Programs Property Coverage for Fire, Theft, & other related perils Coverage for Signs, Glass, Flash, Loss of Business Income W e k n o w t h e B o d y P i e r c i n g I n d u s t r y.

6 C L A I M S M A D E P R O D U C T S L I A B I L I T Y P R O G R A M S CLAIMS MADE PRODUCTS LIABILITY This coverage is available for risks that are Manufacturing, Importing / Exporting, Distributing and Private Labeling. CLAIMS MADE PRODUCTS LIABILITY COVERAGES Manufacturers Distributors Private Label Risks Importers Exporters True Worldwide coverage is available for claims brought anywhere in the world. Limits available up to $5,000,000 with various deductible options. Retroactive coverage is available for risks renewing from another carrier. T o receive pricing information, call our o ce Tattoo Medical Devices Research & Development We know the Claims Made Products Liability Industry.

7 D A Y S P A P R O G R A M S DAY SPA DAY SPA COVERAGES Day Spa Insurance is available for an individual technician or the entire facility. If coverage is needed for a new procedure or the Day Spa has a unique exposure or other insurance issues, contact us. Our program can be designed to meet the unique needs of today's ever changing Day Spa. Facial & Peels M icrodermabrasion Wax Removal Massage B ody Wrap Eyelash Enhancement Eyebrow Enhancement Professional Liability (Malpractice) General Liability (Premises or Slip & Fall ) Property Insurance (Physical damage to your equipment) Other Options: Sexual Abuse, Excess Liability, and Franchisors. T o receive pricing information, call ce Airbrush Tanning Hair & Nails LED / M icrocurrent Elec trolysis Produc ts Liabilit y Permanent Makeup W e k n o w t h e D a y S p a I n d u s t r y.

8 G R A P H I C D E S I G N P R O G R A M S GR A P H I C DESIGN Our Graphic Designer's Insurance policy protects against claims including defense costs, alleging errors, omissions or negligent acts arising out of graphic design. GRAPHIC DESIGN COVERAGES I ndividual Graphic Designers Graphic Design Businesses Services covered: Logo design for new companies and/or branding, logo redesign, corporate identity; stationary, flyer, brochure, catalog, annual report, point of sale, signage, and web site design. Professional Liability. Designer I nterns General Liability. (Can be added.) We know the Graphic Design Industry.

9 H O M E B A S E D M A N U F A C T U R E R S P R O G R A M S HOME BASED MANUFACTURERS HOME BASED MANUFACTURERS COVERAGES Manufacturers Distributors Private Label Risks We are offering coverage to home based risks that are manufacturing cosmetics products (ie: lotions, creams, soaps, salt scrubs,) out of all natural ingredients. Coverage is offered for risks that design their own packaging formulation and distribution for the product line. Only available for distribution and sales of the products in the United States. Allows for risks that have gross receipts up to $50,000 per year. Low minimuns. We know the Home Based Manufacturers Industry.

10 H O S P I C E P R O G R A M S HO S P I C E We offer comprehensive General Liability, Professional Liability and Property insurance programs designed specifically to meet the needs of Hospice facilities. HOSPICE COVERAGES Medical Director Liability Sexual Misconduct Physical Abuse Hired and non-owned automobile liability. Commercial property and business interruption. Indemnity to mortgagees landlords or lessors of leased equipment. Limits available up to $ 5,000,000 Contractual Liability Other Options: We can also offer the same program for your Allied Health, Medical Professional and Nursing Staff Registry accounts. Tenants Liability Network Security Loss Mitigation Medical Expense W e k n o w t h e H o s p i c e I n d u s t r y.

11 L A S E R C E N T E R P R O G R A M S LASER CENTERS Coverage is available to professionals within the Laser industry including: Technicians, Aestheticians (where state law allows it); Nurses, Doctors and MediSpas. LASER COVERAGES Laser Hair Removal Laser Professionals (which includes Photo Facials, Age/Sun Spots, Veins, Acne Reduction, Rosacea) Cellulite Reduction with Cold Level Lasers or Class III & IV Lasers Radio Frequency including Thermage Lasers / IPL Policy packages the full General and Professional Liability and can include Property Coverage. $3,000,000 aggregate available. Excess Liability is available up to $ 5,000,000. Competitive premiums with no minimum. Ultrasound Assisted Lipolysis (can include fat transfers) Laser Toe Fungus Removal Laser Tattoo Removal Ablative & Non-Ablative Laser Work CO2 Fractional Laser Laser Smoking Cessation Laser Acupuncture Laser Allergy Relief W e k n o w t h e L a s e r I n d u s t r y.

12 L O C U M T E N E N S P R O G R A M S LOCUM TENENS Our programs for Locum Tenens offers coverage for group policies with multiple providers receiving individual limits of liability, with 1, 2, 3, year tail options. LOCUM TENENS COVERAGES Doctors Nurses Nurse Practitioners Physician Assistant Medical Assistant Medical Directors Claims made Professional Liability Coverage with a written demand trigger and consent-to-settle with hammer. Limits available up to $ 1,000,000 / $ 3,000,000. Broadened coverage which may include incident coverage trigger, defense outside the limit, limited DD&R provision and supplementary payments. Preferred pricing available for select risks with favorable claims history. Low acuity specialty and other merits. To receive pricing information, call our office Home Health Care Long Term Health Care Hospice E-health Telemedicine W e k n o w t h e L o c u m Te n e n s I n d u s t r y.

13 L O N G T E R M H E A LT H C A R E P R O G R A M S LO N G T E R M HEALTH CARE We offer comprehensive General Liability, Professional Liability meet the needs of Long Term Health Care facilities. LONG TERM HEALTH CARE COVERAGES Professional and General Liability. Assisted Living I ndependent Living Long Term Care Home Health Care Adult Day Care Centers Sexual Misconduct, HNOA, Privacy, Property, and other ancillary coverage lines. Limits are available up to $ 5,000,000 with minimal deductibles. Other Options: We can also offer the same program for your Allied Health, Medical Professional and Nursing Staff Registry accounts. Medical Direc tors To receive pricing information, call our office Housekeeper Sitter Host Home Live -in Companion Group Home Residence Manager Hospice Care We know the Long Term Health Care Industry.

14 M A S S A G E P R O G R A M S MA S S A G E Massage insurance is available for an individual technician or the entire facility. MASSAGE COVERAGES Professional Liability (Malpractice) Facial & Peels M icrodermabrasion Wax Removal Massage B ody Wraps Eyelash Enhancement General Liability (Premises or Slip & Fall ) Property Insurance (Physical damage to your equipment) Coverage is available in all states. Other Options: Sexual Abuse, Excess Liability, and Franchisors. Eyebrow Enhancement Airbrush Tanning Hair & Nails LED / Microcurrent Elec trolysis Produc ts Liabilit y Permanent Makeup W e K n o w T h e M a s s a g e I n d u s t r y.

15 M E D I C A L A E S T H E T I C S P R O G R A M S ME D I C A L AESTHETICS MEDICAL AESTHETICS COVERAGES We can cover the entire facility or individuals operating in single or multiple locations. Hormone Treatments B otox / Dermal Fillers Cellulite Reduc tion Dietitians/Wellness Analysis Hair Restoration hcg Weight Loss Endovenous Treatment Limits available up to $ 5,000,000. Doctors, Nurses, PA's, Aestheticians and any others that can legally operate within their state. Low deductibles. Competitive pricing. Laser & IPL M edical Direc tors M edical Peels M esotherapy & Lipodissolve M icrodermabrasion Permanent Cosmetics S clerotherapy Vitamin I njec tions Weight Loss We Know The Medical Aesthetics Industry.

16 M E D I C A L D E V I C E P R O G R A M S ME D I C A L DEVICES MEDICAL DEVICE COVERAGES Manufac turers Distributors Clinical Trials Research & Development I mpor ters Coverage is available for Manufacturers and Distributors of Medical Devices. Most risks that are selling devices to hospitals or other healthcare professionals are eligible for coverage. Products Liability. Including or excluding General Liability. Business Property. Professional Liability for Clinical Trials. Worldwide coverage is available. Limits available up to $ 5,000,000 with deductibles. W e K n o w T h e M e d i c a l D e v i c e I n d u s t r y.

17 M E D I C A L D I R E C T O R P R O G R A M S ME D I C A L DIRECTORS We have written coverage for Medical Directors in many kinds of facilities and are considering new ones every day. MEDICAL DIRECTOR INSURANCE COVERAGES Occupational Therapy Clinics Women's Health Clinics Research Laboratories Prison Systems Large Businesses Medical Spas Colleges, Schools, & Universities Medical Director Insurance is available for direct, in-direct and no patient care. Retroactive coverage is available. No deductibles. Limits available up to $ 1,000,000 & $ 3,000,000. Competitive pricing. Long Term Care Facilities Salons & Spas Animal Ranches Tattoo Businesses We know the Medical Director Industry.

18 M E D I C A L L A B O R A T O R I E S & C L I N I C S P R O G R A M S LABS & CLINICS We offer Professional Liability Coverage for Laboratories and Clinics. MEDICAL LABORATORIES & CLINICS COVERAGES Medical Testing Facilities Imaging Facilities Individual Technicians Doctors Laboratory Technicians Medical Technicians Pathology Laboratories Clinical Microbiology Laboratories Genetic Laboratories Coverage can include Medical Directors for their administrative duties and for their direct patient care. Professional Liability and General Liability on a claims made basis with prior acts is available as needed. Programs for: Medical Testing Facilities, Imaging Facilities, Doctors, RNs, PAs, and Laboratory Technicians. Property coverage. Limits available up to $ 5,000,000. Low deductibles. Clinical Biochemistry Laboratories Hematology Laboratories Drug & Alcohol Screening Laboratories Mobile Drug / Alcohol Testing We know the Medical Labs & Clinics Industry.

19 M M E D I C A L & R E C R E AT I O N A L M A R I J U A N A P R O G R A M S EDICAL & RECREATIONAL MARIJUANA Our Marijuana Program is available in all states where marijuana is legal (recreational and medical marijuana). We can cover most aspects of the marijuana industry including: MEDICAL & RECREATION A L MARIJUANA COVERAGE S Indoor Growing Outdoor Growing Dispensaries Recreational Retail Dispensaries and Retail Outlets Growing Operations Indoor and outdoor including greenhouses Indoor Crop Bakeries Infusion Centers Testing Labs Products Liability Lessors risk for landlords leasing to marijuana facilities Schools Optional Coverages Include: Governmental actions reimbursement Property Coverage including coverage for buildings, tenant improvements, business personal property, finished stock, indoor crop Products Liability Transportation of marijuana from grower to dispensary or dispensary to patient Equipment breakdown, money & securities, accounts receivable and valuable papers Bakeries Infusion Centers Co-ops Hydroponic Stores Edible Manufacturers Testing Laboratories We know the Medical & Recreational Marijuana Ind u s t r y.

20 M E D I S P A P R O G R A M S ME D I S P A Policies can be purchased on behalf of MediSpas who host the Cosmetic / Medical Services or by the doctor, nurse, aestheticians or anyone who can legally operate within their state. MEDISPA COVERAGES We can cover the entire facility or individuals operating in single or multiple locations. BioIdentical Hormones Botox Dysport Xeomin Carboxy Therapy Cellulite Reduction Colon Hydrotherapy Dermal Fillers Dietitians / Wellness Analysis hcg Endovenous Treatment Vitamins Laser Assisted Lipolysis Vaser Assisted Lipolysis Lasers, IPLs, & LEDs Latisse Prescriptions Lipotropic Medical Assistant Coverage Medical Director Coverage Medical Peels Mesotherapy Microdermabrasion Permanent Cosmetics Radio Frequency Sclerotherapy Wart Removal Weight Loss Policy packages the full General and Professional Liability and can include Property coverage. $3,000,000 aggregate available. Excess Liability is available up to $ 5,000,000. Competitive premiums with no minimum. W e k n o w t h e M e d i S p a I n d u s t r y.

21 O U T P A T I E N T M E D I C A L F A C I L I T Y P R O G R A M S OU T P A T I E N T MEDICAL FACILITIES We offer comprehensive General Liability, Professional Liability and Property insurance programs designed specifically to meet the needs of Outpatient Medical facilities. OUTPATIENT MEDICAL FACILITY COVERAGES Medical Spas Laser Centers Occupational Therapy Clinics Long Term Care Facilities Mental Health Facilities Outpatient Medical Facilities (Labs, Clinics, Surgical, Rehab) Professional and General Liability. Sexual Misconduct, HNOA, and Privacy. Property and other ancillary coverage lines. Limits are available up to $5,000,000 with minimal deductibles. Other Options: We can also offer the same program for your Allied Health, Medical Professional and Nursing Staff Registry accounts. Clinical Trials Research Facilities Spas & Salons Hormone Treatment Centers Weight Loss Centers Medical "Banks" We know the Outpatient Medical Facility Industry.

22 P E R F U S I O N I S T P R O G R A M S PE R F U S I O N I S T S Our program for Perfusionists can cover the entity including its employees and/or independent contractors. PERFUSIONISTS COVERAGES Clinical Perfusionist Cardiovascular Perfusionist Independent Contractors Employees Coverage automatically includes sexual abuse and Privacy Liability. Standard Limits of $ 1,000,000 / $ 3,000,000 with options available up to $ 5,000,000 / $ 5,000,000. Option to include General Liability. Can cover the entity including its employees and/or independent contractors. Non auditable policy. Claims made coverage with the option to include retro where needed. W e k n o w t h e P e r f u s i o n i s t I n d u s t r y.

23 P E R M A N E N T C O S M E T I C S P R O G R A M S PE R M A N E N T COSMETICS Our specialized Permanent Cosmetic insurance program is among the most comprehensive in the industry. Coverage is available for facilities and for individuals. PERMANENT COSMETICS COVERAGES Professional Liability (Malpractice) Permanent Cosmetics Insurance for Eyes, Brows, & Lips Nipple Areola Cheek Blush Permanent Cosmetic Teachers (no per student charge) General Liability (Premises or Slip & Fall ) Property Insurance (Physical damage to your equipment) Other Options: and Communicable Disease. Teaching, Pigment Lightening / Removal Pigment Removal Needling/Mutitrepannic Collagen Actuation (MCA) Aesthetic Services Landlords We know the Permanent Cosmetics Industry.

24 P H A R M A C I E S P R O G R A M S PH A R M A C I E S INCLUDING COMPOUND Our Pharmacy (including Compounding) program is available on a claims made form. PHARMACIES COVERAGES Pharmacies Compounding Closed Door Wholesale & Retail Operations Veterinar y Medicines Limits available up to $ 5,000,000. General Liability can be included. Retroactive coverage available where needed. Network/Data Breach Policies also available for this class. W e K n o w T h e P h a r m a c i e s I n d u s t r y.

25 S SMOKE SHOP AND E-CIGARETTE PROGRAMS MOKE SHOPS This rapidly growing market requires special coverage. We provide insurance for the following: SMOKE SHOP COVERAGE S Vape Shops Hooka Lounges Cigarette Shops Cigar Shops Vape Shops Hooka Lounges Cigarette Shops Cigar Shops General Liability Building Coverage Business Personal Property Inventory Including Theft Loss of Business Income Signs and Glass Limits to 2 million. Offered in all states, except for MS, AL and WV. If you don t see the type of services you offer listed above, contact our office to see if we can consider. To receive pricing information, call our office We k now the Smoke Shop Industry.

26 TA N N I N G A N D D AY S PA P R O G R A M S TANNING & DAY SPA DAY SPA / TANNING COVERAGES Insurance is available for an individual technician or the entire facility. Our Tanning and Day Spa programs have always been able to keep current with new trends and to offer coverage for services that other carriers might not, and can be designed to meet the unique needs of today's ever changing Day Spa or Tanning Shop. Tanning Salons Estheticians Facials & Peels Microdermabrasion Electrolysis Professional Liability (Malpractice) General Liability (Premises or Slip & Fall ) Property Insurance (Physical damage to your equipment) LED / Microcurrent Body Wraps Massage Eyelash Enhancement To receive pricing information, call our office Eyebrow Enhancement Airbrush Tanning Hair Salons Nail Salons Hydro Massage Wax Removal Sauna & Spas W e k n o w t h e Ta n n i n g I n d u s t r y.

27 T A T T O O P R O G R A M S TA T T O O Professional Liability coverage for Tattoo Shops is available for the owner and can include all employees and independent contractors. TATTOO COVERAGES Tattoo Parlor including all Artists Tattoo Artist as Independent Contractors Professional Liability General Liability Minor Tattooing Guest Artists Body Piercing Permanent Cosmetics (Eyeliner, Brows, Lips) Package coverage to include your General and Professional Liability. Policies can include coverage for your Business Personal Property. Coverage available for the entire shop, individuals or independent contractors. Claims on communicable disease are on the increase, our policy offers the option for this coverage. Non-auditable policy. Competitive pricing. Pigment Lightening / Removal Communicable Disease Sexual Abuse Apprenticeship Programs MCA/Needling Landlords Property Insurance W e k n o w t h e T a t t o o I n d u s t r y.

28 T E A C H I N G P R O G R A M S TE A C H I N G Our program covers Professional Liability for the facility and students. It is available for individual technicians, facilities, national chains and franchises. TEACHING COVERAGES Professional & General Liability. Property insurance. Laser (Facilities or Individual Instructors) Cosmetology & Beauty Schools Aesthetician Programs Medical Spa (Facilities or Individual Instructors) No location limitation. No per student rate. Limits available up to $5,000,000. To receive pricing information, call our office Massage Schools Company trainers for Botox & Dermal Fillers Tattoo & Body Piercing Instructors / Apprenticeships Medical Assistant Schools Doctors & Nurses Providing Hands on Training W e k n o w t h e Te a c h i n g I n d u s t r y.

29 T R A N S L A T I N G & I N T E R P R E T I N G P R O G A M S TRANSLATOR & INTERPRETER TRANSLATOR & INTERPRETER COVERAGES Our Professional Liability policies protect you against claims alleging errors, omissions and/or negligent acts from your Translating Services. Our policies are rated based on gross receipts and can include coverage for sub contractors and/or employees as long as those receipts are included (Sub-contractors and/or employees must be working under named insured on policy). Translators I nterpreters M edical I nterpreters (Coverage for Bodily Injur y and/or Proper t y Damage) Alleging Error Omissions & Claims (Can include editing, t ypesetting, proofreading, printing and/ or publishing) Liability limit options available are $ 250,000, $ 500,000 $ 1,000,000 with optional aggregate limits of $ 2,000,000 and $ 3,000,000. Coverage for Professional Liability is offered on a claims made basis. Optional coverage for General Liability is available on an occurrence form at a low additional premium. Additional insured Certificates are available at no additional premium. Defense Cost Coverage Negligent Ac ts Employees & Sub - Contrac tors We know the Translating & Interpreting Industries.

30 W E I G H T L O S S P R O G R A M S WEIGHT LOSS Weight loss centers are rapidly becoming popular across America. Centers that offer weight loss, appetite suppressants and other wellness services have a need for insurance coverage. WEIGHT LOSS COVERAGES hcg Phentermine Phendimetrazine Lipotropics Didrex Nutritional Counseling Policy packages the full General and Professional Liability and can include Property Coverage. $ 3,000,000 aggregate available. Excess Liability is available up to $ 5,000,000. Competitive premiums with no minimum. Dietitian Services Wellness Analysis Cellulite Reduction Vitamin Treatments Hormone Treatments Yoga & Pilates Medispas Products Liability W e k n o w t h e W e i g h t L o s s I n d u s t r y.

31 W E L L N E S S P R O G R A M S WE L L N E S S Wellness Centers are becoming popular and have a need for insurance coverage. WELLNESS COVERAGES Policy packages the full General and Professional Liability and can include Property Coverage. Nutritional Counseling Dietitian Services Wellness Analysis Lipotropics Mesotherapy Fat Transfers Tumescent Liposuction $ 3,000,000 aggregate available. Excess Liability is available up to $ 5,000,000. Competitive premiums with no minimum. Laser Assisted Lipolysis Ultrasound Lipolysis Cellulite Reduction Vitamin Treatments Hormone Treatments Yoga & Pilates Medispas Products Liability Weight Loss including: Hcg, Phentermine, Phendimetrazine & Didrex W e k n o w t h e W e l l n e s s I n d u s t r y.

PPIB Programs 2015 ALLIED HEALTH: Our program offers Professional Liability and General Liability to a variety of professionals. Other available coverages may include: Outpatient Medical Facilities (Labs,

More information

MEDICAL SPA/ANTI-AGING CLINICS SUPPLEMENTAL APPLICATION PROFESSIONAL LIABILITY INSURANCE

MEDICAL SPA/ANTI-AGING CLINICS SUPPLEMENTAL APPLICATION PROFESSIONAL LIABILITY INSURANCE MEDICAL SPA/ANTI-AGING CLINICS SUPPLEMENTAL APPLICATION PROFESSIONAL LIABILITY INSURANCE I. GENERAL INFORMATION Attach a separate sheet of paper on your letterhead whenever additional space is needed.

More information

Corporation, Partnership or Other Legal Entity Application

Corporation, Partnership or Other Legal Entity Application Corporation, Partnership or Other Legal Entity Application Please legibly print all responses in full. If more room is required than is provided here, please respond at the end of this application or supplement

More information

APPLICATION FOR DENTAL COSMETIC PROFESSIONAL LIABILITY INSURANCE

APPLICATION FOR DENTAL COSMETIC PROFESSIONAL LIABILITY INSURANCE APPLICATION FOR DENTAL COSMETIC PROFESSIONAL LIABILITY INSURANCE Notice: The policy for which application is made applies only to Claims first made during the "Policy Period". The limits of liability shall

More information

Medical personnel are growing more aware of the extent of an esthetician s

Medical personnel are growing more aware of the extent of an esthetician s Chapter 1 Defining Roles Medical personnel are growing more aware of the extent of an esthetician s training and realizing the potential value in bringing an esthetician into the medical environment. Working

More information

APPLICATION FOR MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE (CLAIMS MADE)

APPLICATION FOR MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE (CLAIMS MADE) 1. Full Name of Applicant: APPLICATION FOR MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE (CLAIMS MADE) (Include all dba s and subsidiaries seeking coverage under the policy for which you are applying.)

More information

MEDICAL MALPRACTICE PUBLIC & PRODUCTS LIABILITY INSURANCE APPLICATION Beauty Therapists

MEDICAL MALPRACTICE PUBLIC & PRODUCTS LIABILITY INSURANCE APPLICATION Beauty Therapists MEDICAL MALPRACTICE PUBLIC & PRODUCTS LIABILITY INSURANCE APPLICATION Beauty Therapists Section 1 - The Insured Details Where did you hear about us? If you are a member of the APAA, please provide Membership

More information

MEDICAL SPA AND ANTI-AGING CLINICS APPLICATION PROFESSIONAL LIABILITY

MEDICAL SPA AND ANTI-AGING CLINICS APPLICATION PROFESSIONAL LIABILITY All questions MUST be completed in full. MEDICAL SPA AND ANTI-AGING CLINICS APPLICATION PROFESSIONAL LIABILITY If space is insufficient to answer any question fully, attach a separate sheet. I. GENERAL

More information

Salon & Spa Application

Salon & Spa Application 3660 N Lake Shore Dr, Suite 2602, Chicago 60613 Salon & Spa Application General Information Named Insured: Entity Type: Primary Address, City, State, Zip: Mailing Address, City, State, Zip: Contact Person:

More information

New Business Proposal Static

New Business Proposal Static MEDICAL MALPRACTICE COMBINED LIABILITY AND PROPERTY INSURANCE STATIC FOR BEAUTY THERAPISTS Important Notice: This is for a Medical Malpractice Combined Liability Policy issued on a claims made and notified

More information

New Business Proposal Mobile

New Business Proposal Mobile MEDICAL MALPRACTICE COMBINED LIABILITY AND PROPERTY INSURANCE FOR MOBILE BEAUTY THERAPISTS Important Notice: This is for a Medical Malpractice Combined Liability policy issued on a claims made and notified

More information

Fall 2014 Prices subject to change

Fall 2014 Prices subject to change Fall 2014 Prices subject to change LASER HAIR REMOVAL Ask about our choose 2 body parts, pay for 1 package price. Face 100 Lip or chin 50 Underarms 85 Bikini line 100 Mexican 150 Brazilian 200 Half legs

More information

Esthetician Schools and Core Classes. Licensing and Education Information. How to Find the Right School

Esthetician Schools and Core Classes. Licensing and Education Information. How to Find the Right School Esthetician Schools and Core Classes Esthetician schools will typically offer diploma or certificate programs and will prepare their students for the certification exam after they have graduated. An esthetician

More information

PUBLIC LIABILITY / PROFESSIONAL INDEMNITY FACILITY.

PUBLIC LIABILITY / PROFESSIONAL INDEMNITY FACILITY. PUBLIC LIABILITY / PROFESSIONAL INDEMNITY FACILITY. 1) Principal (s) or Firm(s): 2) Postal Address: 3) Situation of Salon(s): (If mobile, please note accordingly). 4) Business operated as: Corporation

More information

Student Medical Malpractice and Student Intern

Student Medical Malpractice and Student Intern Student Medical Malpractice and Student Intern Health Specialty Allied Health Care Worker Alcohol and Drug Counseling Anesthesia Tech Art Therapist Athletic Trainer Audiologist BAS Basic Patient Care Biologist

More information

BIC PROFESSIONAL LIABILITY INSURANCE APPLICATION

BIC PROFESSIONAL LIABILITY INSURANCE APPLICATION BIC PROFESSIONAL LIABILITY INSURANCE APPLICATION Please fax or mail the attached application for a free no obligation price quotation One International Blvd., Suite 300 Mahwah, New Jersey 07495 Toll Free:

More information

STUDENT PROFESSIONAL LIABILITY INSURANCE PROGRAM (SPLIP) Coverage Summary

STUDENT PROFESSIONAL LIABILITY INSURANCE PROGRAM (SPLIP) Coverage Summary STUDENT PROFESSIONAL LIABILITY INSURANCE PROGRAM (SPLIP) Coverage Summary This is a claims- made policy. Coverage is only provided for claims which are both: (1) first made against the Insured during the

More information

Allied Healthcare Professional (AHP) Professional Liability Application

Allied Healthcare Professional (AHP) Professional Liability Application Allied Healthcare Professional (AHP) Professional Liability Application Coverys RRG, Inc. Agency Name NOTICE: This policy is issued by your risk retention group. Your risk retention group may not be subject

More information

9555 W. Sam Houston Pkwy Ste. 475 Houston, Texas 77099. www.medplusllc.com. info@medplusllc.com t:713 995 1842 f:713 995 0692

9555 W. Sam Houston Pkwy Ste. 475 Houston, Texas 77099. www.medplusllc.com. info@medplusllc.com t:713 995 1842 f:713 995 0692 INTRODUCTION TO MALPRACTICE INSURANCE 9555 W. Sam Houston Pkwy Ste. 475 Houston, Texas 77099 www. info@ t:713 995 1842 f:713 995 0692 What is Malpractice Insurance? Malpractice Insurance The common term

More information

allied medical GET THERE TOGETHER

allied medical GET THERE TOGETHER allied medical Allied Medical allied medical. Complete insurance coverage options for social services industries, miscellaneous healthcare facilities and long term care facilities not written by the standard

More information

Professional Insurance Portfolio Aesthetic proposal from Medical malpractice

Professional Insurance Portfolio Aesthetic proposal from Medical malpractice The Hiscox Professional Insurance Portfolio is designed to meet all the insurance needs of a professional business. You must inform us of any changes, or claims pending and the sign the Declaration. General

More information

5900 Hiatus Road Tamarac, FL 33321 Phone: (954) 724-7014 Fax: (954) 603-2027

5900 Hiatus Road Tamarac, FL 33321 Phone: (954) 724-7014 Fax: (954) 603-2027 5900 Hiatus Road Tamarac, FL 33321 Phone: (954) 724-7014 Fax: (954) 603-2027 Professional Liability Product Information offered by SLB Professional, a division of SLB Insurance Group. INSURANCE AGENTS

More information

Professional Liability Insurance Application for Allied Healthcare Businesses (Group)

Professional Liability Insurance Application for Allied Healthcare Businesses (Group) Professional Liability Insurance Application for Allied Healthcare Businesses (Group) Section I: APPLICANT INFORMATION 1. Business Name: 2. Mailing Address (If you have multiple locations please list separately):

More information

Laser and Cosmetic Center

Laser and Cosmetic Center Laser and Cosmetic Center A Patient s Guide to Cosmetic Dermatology WELCOME Experts You Can Trust The Massachusetts General Hospital Dermatology Laser and Cosmetic Center s depth of experience is unmatched.

More information

ALLIED & MISCELLANEOUS PROGRAM

ALLIED & MISCELLANEOUS PROGRAM ALLIED & MISCELLANEOUS PROGRAM PROGRAM HIGHLIGHTS A.M. Best rated A+ or better carrier. Mid-Continent s allied health care program includes individual health care providers and facilities (some exclusions

More information

APPLICATION FOR LOCUM TENENS AND CONTRACT STAFFING ORGANIZATIONS PROFESSIONAL LIABILITY

APPLICATION FOR LOCUM TENENS AND CONTRACT STAFFING ORGANIZATIONS PROFESSIONAL LIABILITY APPLICATION FOR LOCUM TENENS AND CONTRACT STAFFING ORGANIZATIONS PROFESSIONAL LIABILITY (CLAIMS MADE BASIS) APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach

More information

GUIDELINES ON AESTHETIC FACIAL PROCEDURES FOR DENTAL PRACTITIONERS

GUIDELINES ON AESTHETIC FACIAL PROCEDURES FOR DENTAL PRACTITIONERS GUIDELINES ON AESTHETIC FACIAL PROCEDURES FOR DENTAL PRACTITIONERS INTRODUCTION 1. This document serves as a guideline on aesthetic facial procedures for dental practitioners. It does not include aesthetic

More information

ALLIED PROFESSIONAL NEW BUSINESS APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE CLAIMS MADE COVERAGE INFORMATION REQUIRED CHECKLIST

ALLIED PROFESSIONAL NEW BUSINESS APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE CLAIMS MADE COVERAGE INFORMATION REQUIRED CHECKLIST 231 South Bemiston, Suite 1000, St. Louis, MO 63105 Email: submissions@galeninsurance.com ALLIED PROFESSIONAL NEW BUSINESS APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE CLAIMS MADE COVERAGE INFORMATION

More information

Sports & Fitness Insurance Application for Health Clubs, Martial Arts Studios, Dance Studios, Yoga Studios, Pilates Studios, and CrossFit

Sports & Fitness Insurance Application for Health Clubs, Martial Arts Studios, Dance Studios, Yoga Studios, Pilates Studios, and CrossFit P.O. Box 1967 Madison, MS 39130-1937 Phone: 601-898-8464 Toll Free: 800-844-0536 Fax: 601-707-1037 www.sportsfitness.com Print Form Submission Requirements 1.Waiver/Hold Harmless Agreement 2.Membership/Client/Student

More information

APPLICATION FOR PHARMACY PROFESSIONAL LIABILITY INSURANCE

APPLICATION FOR PHARMACY PROFESSIONAL LIABILITY INSURANCE APPLICATION FOR PHARMACY PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a separate sheet. 2. Application

More information

Professional Liability Application for Allied and Miscellaneous Services

Professional Liability Application for Allied and Miscellaneous Services Professional Liability Application for Allied and Miscellaneous Services Send submissions to submissions@modernins.com. Instructions: Answer all questions; applicant s name must include the names of all

More information

1. Full Name of Applicant (include ALL Firm names, trade names or dba s under which the Applicant operates, including subsidiaries):

1. Full Name of Applicant (include ALL Firm names, trade names or dba s under which the Applicant operates, including subsidiaries): ADMIRAL INSURANCE COMPANY 1255 Caldwell Road Cherry Hill, NJ 08034 Phone: 856-429-9200 Fax # 856-429-8611 Internet: http://ww.admiralins.com MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY APPLICATION (CLAIMS-MADE

More information

Ontario Lawn Bowls Association

Ontario Lawn Bowls Association COMMERCIAL INSURANCE PROGRAM FOR: November 1, 2015 January 1, 2017 PRESENTED BY: Dan Lawrie Insurance Brokers Brenda McClung, CIP Associate Broker bmcclung@danlawrie.com Sport Liability Insurance- an Overview

More information

1. NAME OF APPLICANT: 2. MAILING ADDRESS: (If multiple name and locations, please attach list) PHONE NO.

1. NAME OF APPLICANT: 2. MAILING ADDRESS: (If multiple name and locations, please attach list) PHONE NO. APPLICATION FOR ALLIED HEALTH PROFESSIONAL & GENERAL LIABILITY INSURANCE 1. NAME OF APPLICANT: 2. MAILING ADDRESS: (If multiple name and locations, please attach list) PHONE NO. 3. a) DATE ESTABLISHED

More information

Application for Admission to the New Mexico Patients Compensation Fund

Application for Admission to the New Mexico Patients Compensation Fund Application for Admission to the New Mexico Patients Compensation Fund This application will aid our determination of the appropriate terms of coverage in the New Mexico Patients Compensation Fund (NMPCF)

More information

Victorian Purchasing Guide for SIB10 Beauty Training Package Version No 1.2. December 2011

Victorian Purchasing Guide for SIB10 Beauty Training Package Version No 1.2. December 2011 Victorian Purchasing Guide for SIB10 Beauty Training Package Version No 1.2 December 2011 State of Victoria (Department of Education and Early Childhood Development) 2012. Copyright of this material is

More information

Building a Profile of the Beauty Industry

Building a Profile of the Beauty Industry Building a Profile of the Beauty Industry Survey Results Analysis March 2013 12 Introduction In order to assist with the process of developing a profile for the beauty industry, Service Skills Australia

More information

How To Get A Liability Coverage From Ani/Niac

How To Get A Liability Coverage From Ani/Niac General Liability Highlighted Features of our General Liability Coverage ANI and NIAC are 501(c)(3) nonprofits whose sole (All mission included is at to no additional charge, Nonprofits unless noted) OWN

More information

Hanover Human Services Advantage. Professional Liability, General Liability, and Abuse & Molestation Coverage

Hanover Human Services Advantage. Professional Liability, General Liability, and Abuse & Molestation Coverage Hanover Human Services Advantage Professional Liability, General Liability, and Abuse & Molestation Coverage HANOVER HUMAN SERVICES ADVANTAGE Avoid being blind-sided by the unforeseen. Your job is to help

More information

Health Professionals Insurance Plan

Health Professionals Insurance Plan Aon New Zealand Health Professionals Insurance Plan Professional Indemnity/Medical Malpractice Legal and disciplinary defence costs Loss of earnings during hearing/enquiry INTRODUCTION Changes to Accident

More information

MISCELLANEOUS HEALTH CARE HOME HEALTH PROFESSIONAL AND GENERAL LIABILITY APPLICATION

MISCELLANEOUS HEALTH CARE HOME HEALTH PROFESSIONAL AND GENERAL LIABILITY APPLICATION U.S. Risk Underwriters, Inc. Boston (617.227.1310) Dallas (800.232.5830) Houston (800.833.8803) MISCELLANEOUS HEALTH CARE HOME HEALTH PROFESSIONAL AND GENERAL LIABILITY APPLICATION CLAIMS MADE AND REPORTED

More information

Home Health Care General Liability Application

Home Health Care General Liability Application P.O. Box 14770, Scottsdale, AZ 85267-4770 8475 E. Hartford Dr., Scottsdale, AZ 85255 (480) 991-7889 WATS (800) 848-8860 Fax (480) 948-1394 Toll Free (866) 240-8807 P.O. Box 571770, Murray, UT 84157-1770

More information

Facts About Landscape LINIC privacy

Facts About Landscape LINIC privacy 1 MEDICAL INDEMNITY INSURANCE HIGHLY REGULATED RETAIL PRODUCT COMPULSORY FEATURES INCLUDE: Ø MIN $20M ANY ONE AND ANNUAL LIMIT Ø UNDERWRITING RESPONSES LIMITED Ø CIVIL LIABILITY COVER EXTENSIVE GOVERNMENT

More information

SALON INSURANCE QUESTIONNAIRE CUSTOMER INFORMATION

SALON INSURANCE QUESTIONNAIRE CUSTOMER INFORMATION Universal Insurance Programs 1220 E Osborn Rd Phoenix, AZ 85014 Phone: 602-222-8300 Fax: 866-512-2272 www.uiprograms.com SALON INSURANCE QUESTIONNAIRE EMAIL TO: processing@uiprograms.com CLIENT ID #: (Office

More information

Rockbridge Underwriting Agency Limited 3700 Buffalo Speedway, Suite 300 Houston, TX 77098 (713) 874-8800 (713) 874-8899 fax

Rockbridge Underwriting Agency Limited 3700 Buffalo Speedway, Suite 300 Houston, TX 77098 (713) 874-8800 (713) 874-8899 fax Rockbridge Underwriting Agency Limited 3700 Buffalo Speedway, Suite 300 Houston, TX 77098 (713) 874-8800 (713) 874-8899 fax Corporate Locum Tenens Underwriting Questionnaire and Application for Professional

More information

ALLIED PROFESSIONAL NEW BUSINESS APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE CLAIMS MADE COVERAGE

ALLIED PROFESSIONAL NEW BUSINESS APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE CLAIMS MADE COVERAGE 231 South Bemiston, Suite 1000 St. Louis, MO 63105 Email: submissions@galeninsurance.com ALLIED PROFESSIONAL NEW BUSINESS APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE CLAIMS MADE COVERAGE INFORMATION

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE EACH OCCURRENCE AGGREGATE WC STATU- TORY LIMITS E.L. EACH ACCIDENT OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY

More information

Specified Medical Professions for Professional Liability Application

Specified Medical Professions for Professional Liability Application APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a separate sheet. 2. Application must be signed and dated by owner, partner or officer. 3. Please do not

More information

Professional Liability Application for Social Services With No Residential Exposure

Professional Liability Application for Social Services With No Residential Exposure Professional Liability Application for Social Services With No Residential Exposure Instructions: Answer all questions; applicant s name must include the names of all businesses and locations for which

More information

Do you have the right insurance coverage? Insurance Options as shown on application form A B C D E F G

Do you have the right insurance coverage? Insurance Options as shown on application form A B C D E F G Do you have the right insurance coverage? The CAND recommends that all naturopathic doctors, regardless of where they practice, carry malpractice (Errors & Omissions) liability insurance. In regulated

More information

General Liability. www.insurancefornonprofits.org A Head for Insurance. A Heart for Nonprofits. (800) 359-6422

General Liability. www.insurancefornonprofits.org A Head for Insurance. A Heart for Nonprofits. (800) 359-6422 General Liability Highlighted Features of our General Liability Coverage ANI and NIAC are 501(c)(3) nonprofits whose sole (All mission included is at to no additional charge, Nonprofits unless noted) OWN

More information

BODY PIERCING & TATTOO LIABILITY INSURANCE APPLICATION

BODY PIERCING & TATTOO LIABILITY INSURANCE APPLICATION BODY PIERCING & TATTOO LIABILITY INSURANCE APPLICATION 1.1 Business Name: Phone Applicant Name(s): Mailing Address: Business Address: 1.2 Operating as: Corporation Partnership Individual Independent contractor

More information

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis)

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a

More information

Home Business Insurance Application

Home Business Insurance Application ANY CHANGES MADE TO AN ANSWER ON THIS APPLICATION MUST BE INITIALED BY THE APPLICANT RLI Insurance Company Peoria, Illinois Home Business Insurance Application Agency Name Address City State Zip RLI Administrator/Brokering

More information

Hair & Beauty Qualification Gateway. Rules of Combination January 2015 Version 1

Hair & Beauty Qualification Gateway. Rules of Combination January 2015 Version 1 Hair & Beauty Qualification Gateway Rules of Combination January 2015 Version 1 Contents Hair & Beauty Portfolio Qualification Approval Gateways 3 1 Introduction to Qualification Approval Gateways 4 2

More information

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis)

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a

More information

BCACC Insurance Program Summary of Insurance. Professional Liability (Errors & Omissions) Insurance

BCACC Insurance Program Summary of Insurance. Professional Liability (Errors & Omissions) Insurance BCACC Insurance Program Summary of Insurance Benefits & Features 2012 2013 TERM Professional Liability (Errors & Omissions) Insurance This coverage protects the member &/or their legal entity private practice

More information

United National Group MEDICAL TESTING LABORATORIES APPLICATION INSTRUCTIONS: Return to:

United National Group MEDICAL TESTING LABORATORIES APPLICATION INSTRUCTIONS: Return to: United National Group Return to: MEDICAL TESTING LABORATORIES APPLICATION INSTRUCTIONS: A. Please type or print clearly. Answer ALL questions completely. B. If any question, or part thereof, does not apply,

More information

SECTION I GENERAL INFORMATION:

SECTION I GENERAL INFORMATION: MEDICAL TRANSPORTATION PROGRAM PROFESSIONAL LIABILITY APPLICATION (CLAIMS-MADE FORM) www.shellyins.com NOTE: COMPLETION AND SUBMISSION OF THIS APPLICATION IS FOR THE PURPOSE OF SECURING A PREMIUM QUOTATION

More information

TATTOO & BODY PIERCING INSURANCE APPLICATION

TATTOO & BODY PIERCING INSURANCE APPLICATION TATTOO & BODY PIERCING INSURANCE APPLICATION National A Rated Company Preferred Rate Plan 24/7 Claims Service Payment Plans Available Producer: APPLICANT INFORMATION (Required) APPLICANT S NAME (include

More information

HOME HEALTH CARE AND NON-PHYSICIAN MEDICAL STAFFING Professional and General Liability Insurance Application

HOME HEALTH CARE AND NON-PHYSICIAN MEDICAL STAFFING Professional and General Liability Insurance Application HOME HEALTH CARE AND NON-PHYSICIAN MEDICAL STAFFING Professional and General Liability Insurance Application This is an application (the Application ) for a Claims Made Insurance Policy. Please answer

More information

Selinsgrove, Pennsylvania

Selinsgrove, Pennsylvania Selinsgrove, Pennsylvania Skin Care at FPC offers patients a wide array of aesthetic services and products in a relaxing and serene environment. Body Contouring Treatments Now you can have the body you

More information

PHARMACEUTICAL AND BIOTECHNOLOGY LIABILITY INSURANCE APPLICATION

PHARMACEUTICAL AND BIOTECHNOLOGY LIABILITY INSURANCE APPLICATION PHARMACEUTICAL AND BIOTECHNOLOGY LIABILITY INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS MADE POLICY. FOR PURPOSES OF THE INSURANCE COMPANIES ACT (CANADA), THIS DOCUMENT WAS ISSUED IN THE COURSE

More information

THE CLINIC MR JAMES KITCHEN DR HUGO KITCHEN 25 YEARS AESTHETIC EXPERIENCE AT THE FOREFRONT OF COSMETIC MEDICINE.

THE CLINIC MR JAMES KITCHEN DR HUGO KITCHEN 25 YEARS AESTHETIC EXPERIENCE AT THE FOREFRONT OF COSMETIC MEDICINE. TREATMENT BROCHURE THE CLINIC Dr. Hugo J. Kitchen studied Medicine at Birmingham University Medical School and qualified as a fully registered medical practitioner in 1982. DR HUGO KITCHEN In 1988 Dr.

More information

$1,000,000 /$1,000,000 $1,000,000 /$2,000,000 Other: /

$1,000,000 /$1,000,000 $1,000,000 /$2,000,000 Other: / Section- 1 - General Information: Legal Business Name: DBA: Mailing address: Email address: Main contact: Phone number: TYPE: Corporation Partnership LLC Individual Non-profit For Profit USE: Recreational

More information

HEALTHCARE FACILITY PROFESSIONAL LIABILITY INSURANCE APPLICATION NEW

HEALTHCARE FACILITY PROFESSIONAL LIABILITY INSURANCE APPLICATION NEW HEALTHCARE FACILITY PROFESSIONAL LIABILITY INSURANCE APPLICATION NEW Instructions: Assessable Policy IMPORTANT: This is a NEW BUSINESS application for medical professional liability insurance from the

More information

Regenerative Medicine

Regenerative Medicine January 2014 LIVING WATERS MEDICAL SPA AND WELLNESS CENTER Happy New Year A New Year: A New YOU! Regenerative Medicine We have all made numerous New Year s Resolutions in our life times, many I m sure

More information

Medefense EPLI. and more

Medefense EPLI. and more 2013 Benefits you Medefense Cyber Liability Trust Rewards EPLI and more Rated A (Excellent) by A.M. Best Company TMLT is the only health care liability claim trust created and endorsed by Texas Medical

More information

INSURANCE COVERAGE REQUEST

INSURANCE COVERAGE REQUEST INSURANCE COVERAGE REQUEST 1. Requested coverage effective date 2. Requested limits Professional Liability: $ /$ per claim aggregate Claims Made Retroactive Date: General Liability: $ /$ Claims Made Retroactive

More information

HEALTH CARE FACILITY PROFESSIONAL/GENERAL LIABILITY INSURANCE APPLICATION (NON-GAP)

HEALTH CARE FACILITY PROFESSIONAL/GENERAL LIABILITY INSURANCE APPLICATION (NON-GAP) HEALTH CARE FACILITY PROFESSIONAL/GENERAL LIABILITY INSURANCE APPLICATION (NON-GAP) I. GENERAL INFORMATION A. Name and Address of Applicant: Phone Number: ( ) Federal Tax ID Number: Fax Number: ( ) B.

More information

CSURMA Fitting the Pieces Together Annual Conference

CSURMA Fitting the Pieces Together Annual Conference The California State University CSURMA Fitting the Pieces Together Annual Conference Student Professional Liability November 6, 2006 Charlene M. Minnick, CSU Chief Risk Officer Rob Leong, CSURMA Program

More information

THE MEDICAL PROTECTIVE COMPANY MULTI-SPECIALTY HEALTHCARE PROFESSIONAL PROFESSIONAL LIABILITY INSURANCE APPLICATION

THE MEDICAL PROTECTIVE COMPANY MULTI-SPECIALTY HEALTHCARE PROFESSIONAL PROFESSIONAL LIABILITY INSURANCE APPLICATION APPLICATION INSTRUCTIONS If previously covered with Medical Protective, or joining a current Medical Protective Healthcare Professional group policy, please enter the Policy Number: THE MEDICAL PROTECTIVE

More information

DISCLOSURE FORM CLAIMS MADE POLICY IMPORTANT NOTICE TO POLICYHOLDER

DISCLOSURE FORM CLAIMS MADE POLICY IMPORTANT NOTICE TO POLICYHOLDER DISCLOSURE FORM CLAIMS MADE POLICY IMPORTANT NOTICE TO POLICYHOLDER THIS DISCLOSURE FORM IS NOT YOUR POLICY. IT DESCRIBES SOME OF THE MAJOR FEATURES OF OUR CLAIMS MADE POLICY FORM. READ YOUR POLICY CAREFULLY

More information

THE MEDICAL PROTECTIVE COMPANY MULTI-SPECIALTY HEALTHCARE PROFESSIONAL PROFESSIONAL LIABILITY INSURANCE APPLICATION

THE MEDICAL PROTECTIVE COMPANY MULTI-SPECIALTY HEALTHCARE PROFESSIONAL PROFESSIONAL LIABILITY INSURANCE APPLICATION APPLICATION INSTRUCTIONS If previously covered with Medical Protective, or joining a current Medical Protective Healthcare Professional group policy, please enter the Policy Number: THE MEDICAL PROTECTIVE

More information

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE Claims Made Basis APPLICANT S INSTRUCTIONS: 1. Answer ALL questions. If the answer requires detail, please attach a separate

More information

Allied Healthcare Services Mainform Application

Allied Healthcare Services Mainform Application Applicant Information 1. Applicant name: 2. Principal business address (attach separate sheet if more than one location): Street: County: City: State: Zip: Phone: Website: 3. Date established: (if applicant

More information

Home Healthcare Agency / Nurse Registry / Allied Healthcare Staffing Application

Home Healthcare Agency / Nurse Registry / Allied Healthcare Staffing Application Home Healthcare Agency Nurse Registry Allied Applicant Information 1. Applicant name: 2. Principal business address (attach separate sheet if more than one location): 3. Telephone number: 4. Date established:

More information

March Inland Port Aviation Insurance MINIMUM COVERAGES AND LIMITS FOR TENANTS

March Inland Port Aviation Insurance MINIMUM COVERAGES AND LIMITS FOR TENANTS March Inland Port Aviation Insurance MINIMUM COVERAGES AND LIMITS FOR TENANTS Effective 01/09 A. WITH RESPECT TO FIXED BASE OPERATORS (i.e. rental and instruction, charter operators (other than air ambulance

More information

1. Full Name of Applciant: 2. Mailing Address: 3. Location Address: 4. Medical License # and State of Issuance: 5. Date of Birth: Place of Birth:

1. Full Name of Applciant: 2. Mailing Address: 3. Location Address: 4. Medical License # and State of Issuance: 5. Date of Birth: Place of Birth: ADMIRAL INSURANCE COMPANY 6455 East Johns Crossing, Suite 240 Duluth, GA 30097 Phone: 770-476-1561 Fax: 770-418-9597 Internet: http://www.admiralins.com MEDICAL DIRECTOR S PROFESSIONAL LIABILITY APPLICATION

More information

BODY PIERCING & TATTOO LIABILITY INSURANCE APPLICATION

BODY PIERCING & TATTOO LIABILITY INSURANCE APPLICATION BODY PIERCING & TATTOO LIABILITY INSURANCE APPLICATION 1.1 Your Name: Phone Business Name(s): Email Address: Website: Mailing Address: Business Address #1: Business Address #2: 1.2 Your Business structure:

More information

THOMCO Allied Health Insurance Application Note: All questions must be answered or application will be returned

THOMCO Allied Health Insurance Application Note: All questions must be answered or application will be returned THOMCO Allied Health Insurance Application te: All questions must be answered or application will be returned Effective Date Requested: APPLICANT INFORMATION: Date Quotation Desired: Name (Legal Entity):

More information

Professional Liability Insurance. Application. (For Professional Corporations or Other Legal Entities)

Professional Liability Insurance. Application. (For Professional Corporations or Other Legal Entities) Professional Liability Insurance Application (For Professional Corporations or Other Legal Entities) Application for Professional Liability Insurance (For Professional Corporations or Other Legal Entities)

More information

Volunteers Insurance Service Association, Inc. (VIS )

Volunteers Insurance Service Association, Inc. (VIS ) Volunteers Insurance Service Association, Inc. (VIS ) CONTENTS Message To Volunteers Excess Accident Medical Coverages Accidental Death and Dismemberment Coverage Exclusions and Limitations Volunteer Liability

More information

Health and Wellness Preference Data Segments Arts & Entertainment > Reading > Health Baby Health & Safety Beauty, Health & Fitness > Cosmetics &

Health and Wellness Preference Data Segments Arts & Entertainment > Reading > Health Baby Health & Safety Beauty, Health & Fitness > Cosmetics & Health and Wellness Preference Data Segments Arts & Entertainment > Reading > Health Baby Health & Safety Beauty, Health & Fitness > Cosmetics & Beauty Products Beauty, Health & Fitness > Fitness & Exercise

More information

Federal checks require a second set of 10-digit fingerprint cards

Federal checks require a second set of 10-digit fingerprint cards HOME HEALTH CARE QUESTIONNAIRE Please attach an Acord Application Name of organization: Website address (URL): Date Business operations started: / / CURRENT FORM OF INSURANCE: Professional Liability: Occurrence

More information

ANCILLARY APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE

ANCILLARY APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE ANCILLARY APPLICATION FOR PROFESSIONAL LIABILITY INSURANCE MIDWEST MEDICAL INSURANCE COMPANY 7650 EDINBOROUGH WAY, SUITE 400, MINNEAPOLIS, MN 55435-5978 PH. (952)838-6700 or 1-800-328-5532 FAX (952)838-6808

More information

Proposal for Practice Indemnity Insurance

Proposal for Practice Indemnity Insurance Proposal for Practice Indemnity Insurance Support Protect Promote This is a proposal for a Practice Indemnity Policy underwritten by MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271

More information

Corporate Healthcare Professional Liability Application

Corporate Healthcare Professional Liability Application Corporate Healthcare Professional Liability Application Requested Effective Date Required Documents In addition to this application, the following information is required: 1. Loss runs, dated within 60

More information

APPLICATION FOR ADULT DAYCARE CENTERS PROFESSIONAL AND GENERAL LIABILITY INSURANCE

APPLICATION FOR ADULT DAYCARE CENTERS PROFESSIONAL AND GENERAL LIABILITY INSURANCE APPLICATION FOR ADULT DAYCARE CENTERS PROFESSIONAL AND GENERAL LIABILITY INSURANCE APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a separate sheet. 2. Application

More information

Good Business Practices

Good Business Practices Good Business Practices To make good business decisions regarding what equipment to purchase, you must follow careful planning guidelines. These include financial impact, insurance liability, and the ability

More information

Allied Health Professions. PRESENTED BY: Harry E. Douglas, III, DPA Interim President Charles R. Drew University of Medicine and Science

Allied Health Professions. PRESENTED BY: Harry E. Douglas, III, DPA Interim President Charles R. Drew University of Medicine and Science Allied Health Professions PRESENTED BY: Harry E. Douglas, III, DPA Interim President Charles R. Drew University of Medicine and Science November 5, 2004 HEALTH CAREERS THE ALLIED HEALTH PROFESSIONS The

More information

SPECIMEN. 2. Principal business address (attach separate sheet if more than one location): Individual, employee of (provide name of employer):

SPECIMEN. 2. Principal business address (attach separate sheet if more than one location): Individual, employee of (provide name of employer): Applicant information 1. Applicant name: 2. Principal business address (attach separate sheet if more than one location): Street: City: State: Phone: County: Zip: Website: 3. Date established: (if applicant

More information

NonProfit 101. Notes: Session 1B: Insurance, What you do not know can hurt you! From Survivability to Sustainability. June 10, 2015 Session 1B page 1

NonProfit 101. Notes: Session 1B: Insurance, What you do not know can hurt you! From Survivability to Sustainability. June 10, 2015 Session 1B page 1 Session 1B: Insurance, What you do not know can hurt you! Notes: June 10, 2015 Session 1B page 1 Session 1B: Insurance, What you do not know can hurt you! Notes: June 10, 2015 Session 1B page 2 June 10,

More information

Allied Health Professions

Allied Health Professions Allied Health Professions Presented By: Dorothy M. Hendrix Assistant Dean College of Science and Health Charles R. Drew University of Medicine and Science HEALTH CAREERS THE ALLIED HEALTH PROFESSIONS The

More information

INSURANCE 101 YOUR USER FRIENDLY HANDBOOK A CO-OPERATIVE EFFORT BETWEEN THE ORGANIZATION FOR PARENT PARTICIPATION IN CHILDCARE AND EDUCATION, ONTARIO

INSURANCE 101 YOUR USER FRIENDLY HANDBOOK A CO-OPERATIVE EFFORT BETWEEN THE ORGANIZATION FOR PARENT PARTICIPATION IN CHILDCARE AND EDUCATION, ONTARIO INSURANCE 101 YOUR USER FRIENDLY HANDBOOK A CO-OPERATIVE EFFORT BETWEEN THE ORGANIZATION FOR PARENT PARTICIPATION IN CHILDCARE AND EDUCATION, ONTARIO AND TABLE OF CONTENTS Introduction...Page 3 The Basic

More information

HOUSE OF REPRESENTATIVES FINAL BILL ANALYSIS SUMMARY ANALYSIS

HOUSE OF REPRESENTATIVES FINAL BILL ANALYSIS SUMMARY ANALYSIS HOUSE OF REPRESENTATIVES FINAL BILL ANALYSIS BILL #: CS/HB 639 FINAL HOUSE FLOOR ACTION: SPONSOR(S): Health Quality Subcommittee; Harrell and others 117 Y s 0 N s COMPANION BILLS: (SB 604) GOVERNOR S ACTION:

More information

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis)

APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICATION FOR SPECIFIED MEDICAL PROFESSIONS FOR PROFESSIONAL LIABILITY INSURANCE (Claims Made Basis) APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a

More information

for Landlords and Tenants Negotiating Insurance, Indemnity and Mutual Waiver of Subrogation Provisions

for Landlords and Tenants Negotiating Insurance, Indemnity and Mutual Waiver of Subrogation Provisions Presenting a live 90 minute webinar with interactive Q&A Commercial Leases: Risk Mitigation Strategies for Landlords and Tenants Negotiating Insurance, Indemnity and Mutual Waiver of Subrogation Provisions

More information

Insurance Coverage: The Commercial General Liability Policy

Insurance Coverage: The Commercial General Liability Policy Insurance Coverage: The Commercial General Liability Policy An overview of the backbone of avionics business protection. What is available and how you can control the cost of it. Please understand what

More information