|
New Business Applications For Individual Healthcare Providers
Due to the heavy volume of new business submissions, please make certain that you provide a fully completed application. “Fully completed” means you have answered all questions, provided separate explanations where necessary, signed and dated in the appropriate places, and attached the following documents:
- A copy of your current declarations page showing the type of policy form and current retroactive date.
- Verification of or intent to obtain Reporting Coverage (tail) from your current carrier.
- Loss run from all previous professional liability insurers for not less than the prior 10 years, or since you first became licensed, whichever is greater; and a National Practitioner Data Bank Report. (www.npdb-hipdb.hrsa.gov or 1-800-767-6732)
- Copy of Curriculum Vitae (CV); and a copy of business letterhead.
Upon receipt of a fully completed application and Data Bank Report, every effort will be made to fax quotation letters to agents within 15 business days. Coverage is not bound until the JUA receives payment in full.
Classification and Rating
All responses on the application, especially the list of procedures performed and essential questions, shall be carefully reviewed. Each healthcare provider is assigned a rating classification according to his or her specialty and procedures that he or she performs. When more than one classification is applicable, the highest rate classification shall apply.
The JUA must have the premium payment before we can bind coverage. Brokers shall collect the full premium from the insured and remit a payment net of commission to the JUA. Brokers do not have binding authority.
|
