Health Care Facilities

For your convenience, there are two ways to complete an application.

  1. Complete the PDF fillable application on-line and e-mail as an attachment to your insurance agent. If you are not working with an insurance agent, you can e-mail directly to MMIC: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

  2. Print the application, complete it and fax or mail it to your insurance agent. If you are not working with an insurance agent, you can fax or mail directly to MMIC :

    MMIC Group
    Attn: Sales and Marketing Department
    7701 France Avenue South, Suite 500
    Minneapolis, MN 55435
    Fax: (952) 838-6808
    Tel: (952) 838-6700

Health Care Facility Applications

Click here for PDF fillable instructions.