This Online Application is the same length and requires the same information as the Application Kit that can be mailed to you or printed from our web site.

Some of the required information you will need to gather for the application: claims made policy retroactive date, license number, board certifications, education information, previous carrier information from last three years, work history and claim information.

If you are requesting a quote and do not want to apply at this time, please return to the Quote page. Or go back to the TMLT homepage.

This is not the Moonlighting Application for Residents. Click here for the moonlighting application

Instructions:

• THIS IS NOT A BINDER OR ACCEPTANCE OF INSURANCE
  
  Coverage will not be considered until this application is completed, signed and dated. Failure to provide complete information/attachments as requested will cause delay.
  
  

• PROCESSING TIME FOR MOST APPLICATIONS IS 10-15 BUSINESS DAYS
  
  

• YOU MUST BE A MEMBER OF TEXAS MEDICAL ASSOCIATION or HAVE MEMBERSHIP APPLICATION PENDING IN ORDER TO APPLY FOR COVERAGE. TMA PHONE (800/880-1300, 512/370-1300) URL: http://www.texmed.org
  
  

• COVERAGE WILL NOT BE BOUND WITHOUT THE PARTIAL SURPLUS PAYMENT
  
  The $250 surplus deposit payment must be submitted with the application before coverage can be effected. If you have not received a premium/surplus indication a TMLT sales representative will be contacting you with this information.The surplus deposit can be made by check or credit card. Please submit your check or money order for the $250 surplus payment with the required mail-in forms, or, to make a credit card payment , you will need to contact our office at 1-800-580-8658 and ask for the Sales Department.
  
  

• TO COMPLETE THE APPLICATION PROCESS, YOU MUST SIGN AND DATE THE ATTACHED FORMS BEING SENT TO YOUR EMAIL ADDRESS.
  
  

• TMLT ADDRESS:
  
  TMLT Address: 901 S. Mopac Expwy., Barton Oaks Plaza V, Ste. 500, Austin, TX 78746-5942
  TMLT Mail: P.O. Box 160140, Austin TX 78716-0140
  TMLT Phone: 800/580-8658
  Sales Fax number: 512/425-5998