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Why Gallagher:

• Clients who switch to us save 20-50% on average.
• Benefit from real quotes by our expert advisors (and not a software program).
• Proud to have worked with over 60,000 physicians across the United States with a 98% Renewal Rate.
• A large network of major carriers, which ensures Gallagher Healthcare can find the best option for you by reviewing all coverage solutions.
• Specializing in unique coverage needs, such as gap insurance or multi-state coverage.
• Professionals who can help guide you through every step of the process, ensuring you are fully covered and compliant when selecting coverage.

Insured's Information

Last Name  

First Name  

Designation Degree M.D. D.O. D.P.M. D.D.S. CRNA NP PA PT Other

Contact Information

Email

Phone

Contact Person

Practice Information

Zip  

Practice State AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

Practice County

Current type of coverage

Claims MadeOccurrenceTailGroup

Effective Date (MM/DD/YYYY)

Retroactive Date (MM/DD/YYYY)

Insured Specialty Abdominal Surgery Acupuncture Administrative Medicine Aerospace Medicine Allergy and Immunology Allergy Minor Surgery Allergy No Surgery Anesthesiology Bariatric Surgery Broncho-Esophology Cardiology Minor Surgery Cardiology Minor Surgery With Angioplasty Cardiology Minor Surgery With Catheter Cardiology No Surgery Cardiovascular Minor Surgery Cardiovascular Surgery Certified Registered Nurse Anesthetist Certified Registered Nurse Anesthetist - Assistant Child Neurology No Surgery Child Psychiatry Chiropractor Colon and Rectal Surgery Dentistry Dentistry With Oral Surgery Dermatology Minor Surgery Dermatology No Surgery Diabetes Minor Surgery Diabetes No Surgery Emergency Medicine Emergency Medicine Major Surgery Endocrinology Major Surgery Endocrinology No Surgery Family Practice Major Surgery Family Practice Minor Surgery Family Practice No Surgery Family Practice With Obstetrics Forensic Medicine Gastroenterology Major Surgery Gastroenterology Minor Surgery Gastroenterology No Surgery General Dentistry General Practice Major Surgery General Practice Minor Surgery General Practice No Surgery General Practice With Obstetrics General Surgery Geriatrics Major Surgery Geriatrics Minor Surgery Geriatrics No Surgery Gynecology Major Surgery Gynecology Minor Surgery Gynecology No Surgery Hand Surgery Head and Neck Surgery Hematology Minor Surgery Hematology No Surgery Hematology-Oncology Minor Surgery Hematology-Oncology No Surgery Home Health Hospitalist Hospitalist - Pediatric Hyperbaric Medicine Immunology Infectious Diseases Minor Surgery Infectious Diseases No Surgery Intensive Care Medicine Internal Medicine Minor Surgery Internal Medicine No Surgery Manipulation Medical Case Manager Medical Spa Neonatology No Surgery Nephrology Minor Surgery Nephrology No Surgery Neurological Surgery Neurology Minor Surgery Neurology No Surgery Nuclear Medicine Nurse Midwife - Births Nurse Midwife - No Births Nurse Practitioner Nutrition Obstetrics and Gynecology Major Surgery Obstetrics and Gynecology No Surgery Occupational Medicine Oncology Minor Surgery Oncology No Surgery Ophthalmology Major Surgery Ophthalmology Minor Surgery Ophthalmology No Surgery Optometry Oral and Maxillofacial Surgery Orthopedic Minor Surgery No Spine Orthopedic No Surgery Orthopedic No Surgery No Spine Orthopedic Surgery No Spine Orthopedic Surgery With Spine Other Otorhinolaryngology Major Surgery Otorhinolaryngology Minor Surgery Otorhinolaryngology No Surgery Otorhinolaryngology With Plastic Pain Management Minor Surgery Pain Management No Surgery Pathology Minor Surgery Pathology No Surgery Pediatrics Minor Surgery Pediatrics No Surgery Pharmacology Physiatry Physical Medicine Physician Assistant Plastic Surgery Plastic Surgery (No Elective Cosmetic) Podiatry - Surgery Podiatry No Surgery Preventive Psychiatry Psychiatry (Shock Therapy) Public Health Pulmonary Disease Minor Surgery Pulmonary Disease No Surgery Radiation Oncology Radiology - Diagnostic Radiology - Interventional Radiology - Technician Radiology Minor Surgery Registered Nurse Respiratory Therapist Respiratory Therapist Rheumatology Minor Surgery Rheumatology No Surgery Therapeutic Radiology Thoracic Surgery Traumatic Surgery Urgent Care Urology Major Surgery Urology Minor Surgery Urology No Surgery Vascular Surgery Wound Care

Current Insurance Carrier

Desired Limits 100,000/300,000 200,000/600,000 250,000/750,000 300,000/900,000 500,000/1,000,000 500,000/1,500,000 1,000,000/3,000,000 1,300,000/3,900,000 1,500,000/3,000,000 2,000,000/6,000,000 Comp Fund 400,000

Comments

Comments

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