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Please note that in addition to the Group Applications listed below, each individual physician group member must complete an individual application to apply for coverage with MICA. Click here to go to the Individual Application Checklist.

__ Underwriting Requirements for Business Enterprise Applicants

__ Business Enterprise New Business Application for Reporting Policy

__ Application for Prior Acts Coverage, if applying for Prior Acts

__ Payment Plan Selection

__ Experience Verification Letter - please complete and send this letter to both your present and your previous medical malpractice insurance carriers from the past ten years.    Experience verification instructions.

__ Additional Insured Applications, if you employ any of the following extended role providers, and would like to apply for coverage under your policy.

     Additional Insured - Acupuncturist
     Additional Insured - Certified Registered Nurse Anesthetist
     Additional Insured - Dentist
     Additional Insured - First Assist
     Additional Insured - Nurse Practitioner
     Additional Insured - Certified Nurse Midwife
     Additional Insured - Occupational/Physical Therapist
     Additional Insured - Optometrist
     Additional Insured - Perfusionist
     Additional Insured - Physician
     Additional Insured - Physician's Assistant
     Additional Insured - Psychologist