Get the free ismie aa 1000 form

AA-1000 10/11 ATTN UNDERWRITING DIVISION Twenty North Michigan Avenue Suite 700 Chicago IL 60602 Telephone 312-782-2749 Toll Free 800-782-4767 Fax 312-782-2023 www. ismie. com Processing Number Application for Physician Professional Liability Insurance Claims-Made A claims-made policy is limited to claims which are first made while the policy is in force and arise out of professional services provided on or after the retroactive date stated in the Declarations page and as defined in the...

How to fill out ismie aa 1000 form

How to fill out the ismie aa 1000 form:

1. Obtain the ismie aa 1000 form from the appropriate source.
2. Read the instructions carefully to understand the information required to complete the form.
3. Begin by providing your basic personal information, such as your name, address, and contact details.
4. Fill in any required information regarding your medical practice, such as the name and address of your facility.
5. Provide accurate details about your insurance coverage and any previous claims made.
6. Answer all the questions on the form truthfully, ensuring you provide additional information or explanations whenever necessary.
7. Double-check your completed form for any errors or missing information before submitting it.

Who needs the ismie aa 1000 form:

1. The ismie aa 1000 form is typically required by healthcare professionals, including physicians and medical providers.
2. It may be necessary for those individuals seeking professional liability insurance from ismie, the Illinois State Medical Inter-Insurance Exchange.
3. The form helps gather important information about the healthcare professional and their practice, which is used to assess their eligibility for insurance coverage.
4. The form may also be required when renewing an existing insurance policy or making changes to coverage.
5. It is important to consult with ismie or your insurance provider directly to determine if the ismie aa 1000 form is required in your specific situation.

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What is ismie aa 1000 form?

ISMIE AA 1000 form is a document used for reporting certain information related to insurance coverage.

Who is required to file ismie aa 1000 form?

Healthcare providers and facilities that are insured by ISMIE Mutual Insurance Company are required to file the ISMIE AA 1000 form.

How to fill out ismie aa 1000 form?

To fill out the ISMIE AA 1000 form, you need to provide information such as the insured's name, policy number, claims-made date, and details of any prior acts coverage.

What is the purpose of ismie aa 1000 form?

The purpose of the ISMIE AA 1000 form is to report insurance coverage information to ISMIE Mutual Insurance Company.

What information must be reported on ismie aa 1000 form?

Information such as insured's name, policy number, effective dates of coverage, retroactive dates, limits of liability, and details of any prior acts coverage must be reported on the ISMIE AA 1000 form.