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|2006 Application Instructions||Medical Malpractice Liability Insurance Premium Assistance Fund|
|IMPORTANT: The 2006 Online Application Period ended August 24, 2007.|
|Who Could Apply?|
Only practitioners and healthcare providers, covered by medical malpractice liability insurance in 2006, whose primary practice area was in one of the specialties and subspecialties listed in Order A07-118 (PDF, 60K) were eligible to apply for the subsidy. Those specialties/subspecialties were:
|IMPORTANT:||You must have also submitted a State of New Jersey W-9 Questionaire Form at the time that you filed your online application. This questionaire must have been completed, signed and returned to the New Jersey Department of Banking and Insurance BEFORE you or your designated payee can receive the subsidy. Please complete the W-9 questionnaire, and fax the form to 609-777-0508. The W-9 form cannot be filed online. The person who will receive the subsidy payment (either you or your designated payee) should submit the W-9 Questionnaire form as soon as possible.|
|Even if the Department of Banking and Insurance determines that you are eligible
for this subsidy, the State Treasurer will not process our
request for a payment to you (or your designated payee) without a
W-9 on file with their office.
If you or your designated payee previously received a premium subsidy paid in either 2005 and/or 2006, another W-9 is not necessary for the 2006 premium subsidy paid in 2007. The New Jersey State Treasury office already has your payee information on file.
The W-9 form is NOT the 2006 Online Application.
Applications are no longer being accepted.
|To complete the Medical Malpractice Liability Insurance Premium Assistance Fund Application, you needed the following required information:|
|1.||Your Complete 12-digit BME License Number that begins with either 25MA or 25MB and is followed by 8 numbers.|
Detailed Medical Malpractice Liability Insurance Premium policy information for all insurance policies issued or renewed in 2006, that included:
Note: If you were insured by more than one insurer in
2006, the application provided for additional insurer information.
you were not the named policyholder and another party or entity
was paying the premium, you had the option of having the subsidy
payment sent directly to a Designated Payee other
than yourself. You needed to provide the Designated Payee's
name, address, contact person, telephone number and FEIN or Tax
ID Number. Designated Payees include Group Practices, Hospitals
or other such employers. If you chose this option, it was very
important to notify the Designated Payee that they need to complete the W-9 questionnaire and fax it to 609-777-0508,
with a cover sheet containing your name and complete BME License
number, for proper identification. The W-9 Questionnaire form
should be submitted no later than Friday, August 24, 2007.
|4.||ALL information on the application is required (including social security number) except your e-mail address.|
|More Information||View our Frequently Asked Questions|
NJ Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325
|OPRA is a state law that was enacted to give the public greater access to government records maintained by public agencies in New Jersey.||You will need to download the latest version of Adobe Acrobat Reader in order to correctly view and print PDF (Portable Document Format) files from this web site.|
| Copyright © 2007,
State of New Jersey
New Jersey Department of Banking and Insurance