This Online Application is the same length and requires the same information as the Application Kit that can be mailed to you or printed from our web site.
Some of the required information you will need to gather for the application: claims made policy retroactive date, license number, certifications and education information, previous carrier information from last three years, work history and claim information.

Please Note:

• Applicant must be employed and supervised by a TMLT insured physician.

• Complete and sign the Application for Coverage.

• Complete the Claim/Suit Information Addendum if a professional liability claim or suit has ever been brought against you.

• IMPORTANT ! Attach a copy of your Declarations Page and all other pages relative to the retroactive or prior acts date of your current insurance.

• Provide copy of your license (if applicable).

• If payment is included make your check payable to Texas Medical Insurance Company or TMIC.

• Return all applicable forms to:
  
  P.O. Box 160140
  Austin, TX 78716-0140
  
  We encourage the return of multiple applications for one company in the same envelope.

• Include a listing of all applicants for one company in the same envelope.

• Instructions regarding premium payment:
  Quarterly and annual payment options will be billed by invoice and mailed to the Named Insured. If you choose the monthly payment option, you must complete, sign and return the Authorization for Direct Bank Debit along with a voided check on the account to be debited.
  
  If you have any questions, we will be happy to assist you. Call your toll free number listed below and ask for Sales.
  
  TMIC Address:
  901 S. Mopac Expwy., Barton Oaks Plaza V, Ste. 500, Austin, TX 78746-5942
  TMIC Mail: P.O. Box 160140, Austin TX 78716-0140
  TMIC Phone: 800/580-8658
  Sales Fax number: 512/425-5998
  Email: sales@tmic.biz
  Website: www.tmic.biz
  Receipt by TMIC of application(s) and/or premium payment does not constitute a binder of acceptance of coverage.