MIEC Logo
Login

Group Premium Estimate Request

Please provide us with information so that we can give you a group quote.
Be sure to fill in all the required fields.

These fields are required*

GENERAL INFORMATION - part 1 of 3

hard rule
Office Manager Name*:  
E-mail Address*:  
Website Address:  
Hard Rule

Mailing Address

Street Address*:  
City*:  
State / Region*:    
Zip*:  
Phone*:  
Current Carrier:  
If other, please specify:
How did you hear about MIEC insurance?
If other, please specify:
Hard Rule

GROUP INFORMATION - part 2 of 3

Group Name*:  
Practice Location*:  
City*:  
State / Region*:    
Effective Date*:  
Limits of Insurance*:    
  Comments/questions:  
Hard Rule

PHYSICIAN INFORMATION - part 3 of 3

In this section, fill in information for up to 10 physicians. If you would like a premium estimate for more than 10 physicians in your group practice, please contact MIEC’S Underwriting Department at: 800.227.4527 or underwriting@miec.com.

Physician 1

Name*:    

Medical License #*:    

Limits of Insurance*:    

Medical Specialty*:          

Secondary Specialty (if applicable)


Retroactive Date:  

If this physician completed his/her training program within the last 3 years,
please tell us the date he/she started seeing patients:
Practice Start Date:  

 

Hard Rule

Hard Rule

         

 

INFORMATION

  800.227.4527

Join Us / Apply Here

Premium Calculator

Get a quote online now.

MIEC's Revised Business Associate Agreement

Get a Certificate of Insurance

Login Required

Get a Claims History

Login Required

Access your Recent Invoice

Login Required

PRESS ROOM

 

ELM Exchange, Inc.

MIEC has partnered with ELM Exchange, Inc., to provide case-based, online CME programs.

Special Report Claims Alert 47

Opioid Pain Medications: Regulatory Update

Educational webinars

View live and on-demand programs.

DataGuard Coverage

This additional insurance coverage protects your practice in the event of a privacy breach.

CRICO Strategies for Patient Safety

Evidence-based risk management from the Harvard medical community

2016 Five Year Financial Review