ENCLOSED ARE THE FORMS NECESSARY FOR
THE ALLIED HEALTHCARE PROFESSIONALS APPLICATION
Thank you for choosing to apply with LONE STAR ALLIANCE, INC., A RISK RETENTION GROUP (LSA).
We know that you have choices when purchasing liability insurance to protect your reputation and your medical practice. We appreciate the opportunity to earn your business.
When submitting your application, please:
- Complete and sign the application.
- Complete the Claim/Suit Information Addendum if a professional liability claim or suit has ever been brought against you.
- Enclose the following:
|A copy of your current declarations page |
|Current loss run(s) for a five-year period |
|A copy of active training certificates or licensures |
Any additional documentation requested in the application
|Which billing and payment option is right for you?|
There are no finance charges or transaction fees associated with LSA payment plans. You can set up recurring automatic payments once your policy is issued by contacting Customer Service at 1-844-595-8866 ext. 5050 for assistance.