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APPLICATIONS

⚠️ Our customer portal and CME site are currently unavailable. Service will be restored as soon as possible. We apologize for the inconvenience and we greatly appreciate your patience. ⚠️

For quote requests or to apply for coverage, please contact Sales at 800-580-8658.

For a faster turnaround, complete the application online. 

• Individual application for coverage This link will take you to myPortal. To apply, please create an account under "New User Registration – Individual."
• Ancillary application
• Entity application

QUESTIONNAIRES

If you perform any of these procedures, please submit the appropriate questionnaires with your application.

• Bariatric
• Chiropractic
• Cosmetic
• Infusion Therapy
• Nurse Midwife
• Pain Management
• Podiatry
• Prenatal
• Telemedicine

FORMS

HIPAA-HITECH Business Associate Agreement
An agreement required by federal law concerning policies and procedures to assure the confidentiality of patient health information.