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Physician Name
Retroactive Date
Liability Limits
Hours Per Week
Medical Or Surgical
1
2
3
4
5
6
7
8
9
10


Coverage Needed For:
    If yes, how many?    
    If yes, how many?    
Coverage for OSFs at shared limits is provided at no extra charge if limited to practice members.
Please indicate if required limits are:

If separate limits, please list annual number:
Ophthalmic: ; Non-Ophthalmic: ; procedures.
If shared limits give above numbers ONLY for non-practice utilizers of your facility.
Coverage for Medical Spas is provided at no extra charge if limits are shared with the owner-ophthalmologist/entity.
Please indicate if required limits are:



Physicians Perform:


* Located on policy declarations page of claims-made policy (IF POLICY IS "OCCURENCE" FORM CHECK HERE)





Six reasons OMIC is the best choice for ophthalmologists in America.

Leader in the industry.

A-rated by AM Best, OMIC is consistently ranked among the top malpractice insurance companies in America for financial stability. No other carrier has matched OMIC's consistent financial performance with regard to both combined, operating, and surplus ratios, the most relevant financial measurements for an insurance carrier.

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