Applications and Forms
Instructions for Completed Applications
- Send completed applications to email@example.com or by fax at 1.785.232.4704.
- If you work with a KAMMCO agent, please submit applications directly to your agent.
MPLI New Business Applications
For physicians and surgeons interested in individual MPLI coverage.
For physicians and surgeons interested in MPLI coverage above the limits included in the basic coverage policy.
For non-physician health care professionals interested in individual coverage.
For physician-owned practices, groups, corporations, or entities.
For hospitals, long-term care facilities, community mental health clinics, urgent care facilities, etc.
For facilities interested in umbrella coverage.
For dentists interested in individual MPLI coverage.
Optional Higher Limits Coverage
Embedded cyber coverage is included in every KAMMCO policy.
Use this application if you're interested in increasing your cyber limits. More information is available on our Cyber Security Coverage page.
License defense coverage is included in individual KAMMCO policies. But for only $250 per provider, purchase an endorsement that covers defense costs up to five times higher than the embedded license defense coverage.
More information is available on our License Defense Coverage page.
MPLI Renewal Applications
Renewal application for all individual health care providers, including physicians, surgeons, non-physician providers, and dentists.
Renewal application for hospitals, long-term care facilities, mental health clinics, urgent care facilities, etc.
Renewal application is for physician-owned practices, groups, corporations, and entities.
♦ Important ♦ Submit an "All Health Care Provider" renewal application for each health care provider with individual coverage with this entity.
Renewal application is for ambulatory surgery centers providing same-day surgical care.