Owned and Managed by Professional Risk Management Services, Inc.Professional Risk Management Services, Inc.

PRMS Renewal Application

To meet insurance company requirements for periodic account reviews, we are asking you to update your practice information through a renewal application. This ensures that we have your complete and accurate information on file for coverage purposes.

Please select the application that matches your primary state of practice below.

If your practice is incorporated (e.g., LLC, PLLC, PC, PA or s-corporation), or unincorporated (e.g. DBA), then please also complete and submit the Practice Structure/Vicarious Liability supplemental application. This application is included in the .pdf document.

Additionally, if your business has healthcare providers who are co-owners, employees or independent contractors, please include a copy of their current malpractice insurance (e.g. Certificate of Insurance, COI) if they are not a PRMS active client.

Primary State of Practice

Link to Renewal Application

AK, AL, CA, CO, DE, DC, GA, HI, IA, IN, KY, LA, ME, MI, MN, MO, MS, NC, ND, NM, NV, OK, OR, PA, RI, SC, TN, UT, WA, WY

Individual Practice Application (.pdf)

 

AZ, CT, ID, NE, NH, NJ, OH, VA, WV

Individual Practice Application (.pdf)

 

MD

Individual Practice Application (.pdf)

 

AR

Individual Practice Application (.pdf)

 

KS, FL, IL, MA, MT, NY, SD, TX, VT, WI

Please contact ClientServices@prms.com to receive your renewal application.

 


Download, complete, sign your renewal application. Return your completed application by the date provided on your notification letter via:

Email:

Renewal@prms.com

Fax:

(703) 276-0873

Mail:

PRMS
Attn: Renewal
1401 Wilson Boulevard, Suite 700
Arlington, VA 22209

 

Once we receive your completed application, an account advisor will review. Upon acceptance within 15 business days, your renewal proposal, invoice and/or finance agreement will be mailed to you. Payment will then be due 30 days prior to your renewal date as indicated on the invoice.

If you have any questions, you may reach us at (800) 245-3333 or ClientServices@prms.com.

Thank you for being our valued client. We look forward to continuing to meet, and exceed, your needs for medical professional liability insurance.

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