Miscellaneous Healthcare Facilities Insurance

To report a claim, please contact us at:

Fax: 866-260-0104
Mail:  Attn: CID
         101 Hudson Street, 31st Floor
         Jersey City, NJ 07302

To check the status of a claim, please contact us at 866-473-0756

Patient Safety & Risk Management Consulting – For Hospitals and Healthcare Organizations

The applications below are for the exclusive use of licensed surplus lines insurance brokers. As a surplus lines insurer, Lexington Insurance Company does not accept applications from or provide quotes to individuals.

Miscellaneous Healthcare Facilities Application (.pdf)
Application form for Miscellaneous Healthcare Facilities, Professional and General Liability insurance.

Abortion Clinic Application (.pdf)
Application form for Miscellaneous Healthcare Facilities, Professional and General Liability insurance for abortion clinics

ASC Application (.pdf)
Application form for ASC, Professional and General Liability insurance.

Birthing Centers Supplemental Application (.pdf)
Supplemental application form for birthing centers for the Miscellaneous Healthcare Facilities product.

Blood Banks Supplemental Application (.pdf)
Supplemental application form for blood banks centers for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Diagnostic Radiology Facility Application (.pdf)
Supplemental application form for diagnostic radiology facilities for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Dialysis Centers Supplemental Application (.pdf)
Supplemental application form for dialysis centers for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Emergency Medical Services Supplemental Application (.pdf)
Supplemental application form for emergency medical services for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Healthcare Clinic Supplemental Application - Lexington (.pdf)    
Supplemental application form for heathcare clinics for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Healthcare Clinic Supplemental Application - Landmark (.pdf)                         
Supplemental application form for healthcare clinics for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Hospice Supplemental Application (.pdf)
Supplemental application form for hospice services for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Laboratory Application (.pdf)
Application form for the Miscellaneous Healthcare Facilities, Professional and General Liability laboratories insurance product.

Lasik Supplemental Application (.pdf)
Supplemental application form for lasik providers for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Medical Spa Supplemental Application - Lexington (.pdf)
Supplemental application form for medical spas for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Medical Spa Supplemental Application - Landmark (.pdf)                                                           
Supplemental application form for medical spas for the Miscellaneous Healthcare Facilities, Professional and  General Liability insurance product.

Mental Health Facilities Supplemental Application (.pdf)
Supplemental application form for mental health facilities providers for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Organ Procurement Organization and Tissue Bank Supplemental Application (.pdf)
Supplemental application form for organ procurement organizations and tissue banks facilities for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

PBM Pharmacy Benefit Managers Application (.pdf)
Application form for the Miscellaneous Healthcare Facilities, Professional and General Liability Pharmacy Benefit Managers insurance product.

Pharmacy Supplemental Application - Lexington (.pdf)                                                  
Supplemental application form for pharmacies for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Pharmacy Supplemental Application - Landmark (.pdf)                                                         
Supplemental application form for pharmacies for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Physicians and Surgeons Professional Liability Application (.pdf)
Application form for the Miscellaneous Healthcare Facilities, Professional and General Liability Physicians and Surgeons insurance product.

Schools Supplemental Application (.pdf)
Supplemental application form for schools for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Weight Loss Center Supplemental Application (.pdf)
Supplemental application form for weight centers for the Miscellaneous Healthcare Facilities, Professional and General Liability insurance product.

Healthcare netAdvantage Application

Security & Privacy Supplemental Application

Security & Privacy IT Assessment 

Healthcare Clinic Supplemental Application (.pdf)

Medical Spa Supplemental Application (.pdf)

Pharmacy Supplemental Application (.pdf) 

Healthcare Clinic Supplemental Application - Landmark (.pdf)

Medical Spa Supplemental Application - Landmark (.pdf)

Pharmacy Supplemental Application - Landmark (.pdf)

Healthcare organizations of all types - from hospitals, to managed care companies, to physician groups - are vulnerable to security breaches, both malicious and accidental. Even the best internal processes and data security measures cannot guarantee that private data will be kept safe. And while the potential liability is formidable, the exposure is typically not addressed by conventional insurance policies - including professional liability, commercial general liability or even media liability insurance policies. Security & Privacy Insurance with Crisis management Insurance Coverage  covers the multiple facets of a healthcare organization's data breach exposure.

Features and Benefits

- Failure of their network security
- Failure to protect or wrongful disclosure of private or confidential information
- Failure to protect personally identifiable information from misappropriation
- Violation of federal, state, or local privacy statute alleged in connection with failure to protect private information, including HPIAA-related information