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Group
Coverage Application
| For more information about the group program, call (800) 245-3333, ext. 314 or visit our group page |
Download
the applications below (.pdf format), complete the application,
then return the application to PRMS, Inc. by faxing it to
(703) 276-0873 or mailing it to:
PRMS,
Inc.
1515 Wilson Blvd. Suite 800
Arlington, VA 22209-3985
The application
you need depends on the state in which you practice. To get
this application, call (800) 245-3333, ext. 304, or find your
application online, according to the lists below:
National
Union Group Application
Alabama,
Alaska, Arizona, Arkansas, California, Colorado, Connecticut,
Delaware, District of Columbia, Florida, Georgia, Idaho,
Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New
Hampshire, New Jersey, New York, North Carolina, North Dakota,
Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Texas, Utah, Vermont, Virginia, West Virginia,
Washington and Wyoming.
Lexington
Insurance Company
Hawaii, Louisiana, Massachusetts,
Nebraska, New Mexico, Oklahoma
and Tennessee.
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