Get Plico, Inc

Filling out the PLICO, Inc application for professional liability insurance is an important step for healthcare professionals seeking coverage. This guide provides clear, detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the PLICO, Inc application with ease.

1. Click ‘Get Form’ button to obtain the application. This will open the form in an accessible digital format for you to complete.
2. Begin with Section 1, General Information. Fill in your name, social security number, and any other names you have been known by. Ensure all information is accurate.
3. Proceed to Section 2, Coverage Information. Provide details about your previous insurance coverage, including the companies and types of policies held over the past five years.
4. In Section 3, Professional Education and Training, list your educational background and any continuing education credits earned in the last three years.
5. Complete Section 4, Licensure – Certification – Association. Provide your medical license number and any additional state licenses, along with certification details.
6. Fill out Section 5, Institutional Practice. Indicate where you have staff privileges and provide any relevant history with hospitals.
7. In Section 6, Classification – Practice, select the appropriate boxes that describe your practice type and note any changes in the last five years.
8. For Section 7, Medical Specialty, specify your primary specialty and any sub-specialties you practice.
9. In Section 8, Medical and Surgical Procedures, indicate the procedures you perform along with their frequency and any anticipated changes.
10. Complete Section 9, Underwriting, by answering questions about your health status and any legal issues. Ensure clarity and honesty.
11. In Section 10, Professional Partnership, Corporation, or Association, specify your practice structure and coverage preferences.
12. For Section 11, Employees, detail any healthcare professionals you employ and their roles.
13. In Section 12, Claims History/Report, disclose any professional liability claims you've faced in the past ten years.
14. Review Section 13, Waiver of Liability & Consent for Release of Information, and sign to confirm your understanding and agreement to the terms.
15. Attach all required documents listed in Section 14 with your application to complete your submission.
16. Finally, save your changes and opt to download, print, or share the form as needed.

Complete your PLICO, Inc application online today for professional liability insurance coverage.