The Psychiatrists' Program: Group Coverage Information

The Psychiatrists' Program specializes in professional liability insurance coverage for psychiatrists and mental health professionals.

Unlike most professional liability insurance programs, we have only one focus: psychiatry. We tailor our policy and services to meet your needs. Our staff of psychiatric professional liability specialists provides personal service and expertise...you will not have to explain psychiatric terminology to us.

Please complete the form below if you would like The Psychiatrists' Program to contact you regarding coverage for your group practice. All practitioners -- psychiatrists, psychologists, social workers and other behavioral healthcare providers practicing in a group -- can be covered under one policy, along with the group practice itself.

You can also obtain information about group coverage by calling (800) 245-3333, ext. 310 or emailing Group@prms.com.

Contact Name:

Practice Name:

Address:

City:

State:

Zip Code:

Telephone Number:

Fax Number:

E-mail Address:

Practice Manager:

Preferred method of contact:

Phone Email

Renewal Effective Date:

Current policy type of coverage:

Occurrence Claims Made

Current retroactive date:

Person responsible for insurance administration:

How do you pay for your group policy?:

Annual Monthly Quarterly

ABOUT YOUR GROUP

How many of the following are in your practice?:

# full-time

# part-time
(up to 20 hours per week)

MDs (Psychiatrists)

MDs (Other)

Physician Assistants

Nurse Practitioners

Other

Type of coverage requested?:

Claims Made

Occurrence

Corporate coverage?:

Yes

If Yes:

Shared Limit Separate Limit

Limits of liability?:

$1M/$3M $2M/$6M $500K/$1.5M $1.3M/$3.9M other

Other Information: