Get Application For Hospitals Professional And/or General Liability Insurance

Filling out the Application for Hospitals Professional and/or General Liability Insurance online can be a straightforward process when approached step-by-step. This guide is designed to assist users of all backgrounds in completing the application accurately and efficiently.

Follow the steps to fill out the application with ease.

1. Click ‘Get Form’ button to access the application and open it in your editor.
2. Begin with Part I, which includes providing the applicant's basic information. Ensure to fill in the full name, business address, and check appropriate boxes for the type of hospital and ownership. If applicable, attach a list of additional insured entities.
3. In the Operations section, answer each question regarding Medicare approval, Joint Commission accreditation, and relevant associations such as the American Hospital Association. Attach explanations for any 'no' responses.
4. Complete the financial summary for the past three years, providing revenue, profit/loss data, and percentages related to Medicare, Medicaid, and other payers. Attach audited financial statements as required.
5. Estimate the average daily occupied beds, emergency department visits, and surgical procedures for the upcoming year in the designated fields.
6. State whether the hospital advertises its services and attach copies of advertisements, indicating the total annual expenses for advertising.
7. Indicate if the applicant is a 'Covered Entity' under HIPAA and provide details about compliance and the Privacy Officer.
8. In Part II, if professional liability coverage is desired, complete the administrative procedures, including verifying physician orders and maintaining patient records.
9. Complete all requested services and personnel sections in detail, ensuring to accurately count and report the numbers of employed and contracted staff.
10. For Part III, complete the premises and safety section thoroughly, outlining fire safety measures and emergency evacuation plans in place.
11. Lastly, review all completed sections for accuracy, save your changes, and prepare the application for submission. Users can then download, print, or share the form as needed.

Start filling out your application for hospitals professional and/or general liability insurance online today!