Applications: New Policies and Renewals



To apply for coverage:



Apply for coverage by e-mail
OPTION 1
Apply for coverage by e-mail

Complete the PDF fillable application online and email the completed form (as an attachment) to your insurance agent. If you are not working with an agent, you can send the completed form directly to MMIC at This email address is being protected from spambots. You need JavaScript enabled to view it..

View PDF Fillable Form Instructions


Apply for coverage by mail or fax
OPTION 2
Apply for coverage by mail or fax

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

ATTN: Sales and Marketing
MMIC, Suite 500
7701 France Avenue South
Minneapolis, MN 55435
Fax: 952.838.6808




Application Forms:


Select Type:



Alternative Risk Financing Options

In addition to traditional insurance programs, we offer alternative risk financing options including:

  • Self-insured retentions
  • Fronting arrangements
  • Loss portfolio transfers
  • Large or small deductibles
  • Stand-alone reporting endorsements
Learn More   

Cyber Solutions® & Medefense® Plus


Add coverage to protect
your practice in the event of:

  • privacy and security breaches
  • cyber extortion
  • multi-media liability
  • cyber crime
  • defense costs
  • fines and penalties related to billing audits and investigations
Learn More