Help -
Help for Webmasters
« back to results for ""
Below is a cache of http://www.hpso.com/pdfs/HPSO_CSE_request_NB.pdf. It's a snapshot of the page taken as our search engine crawled the Web.
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. Consulting Services Liability Endorsement 159 East County Line Road Hatboro, PA 19040-1218 1-800-982-9491 Fax 1-800-739-8818 www.hpso.com
Consulting Services Liability Endorsement Complete your Protection Today for Just $25 a Year. If youre interested in adding the Consulting Services Liability Endorsement to your coverage,
simply complete the request form and return it to HPSO within 30 days of your application, along
with your payment of $25.00.
If you have any questions about the endorsement or want to know if it is right for you, please call
our Customer Service Center at 1-800-982-9491, Monday-Friday 8AM-6PM Eastern Time.
Please note: This additional coverage is not available to healthcare aides, technicians or technologists. Dedicated To Serving The Insurance Needs of Healthcare Professionals This program is underwritten by American Casualty Company of Reading, P ennsylvania a CNA company and is offered through the Healthcare Providers Service Organization Risk Purchasing Group. Coverages, rates and limits may differ in some states. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a service mark and trade
name registered with the U.S. Patent and Trademark Office.
Healthcare Providers Service Organization is a division of Affinity Insurance Services, Inc.; in CA (License #0795465), MN & OK, AIS Affinity nsurance Agency, Inc.; and in NY, AIS Affinity Insurance Agency. 159 East County Line Road Hatboro, PA 19040-1218 1-800-982-9491 Fax 1-800-739-8818 www.hpso.com This form must be completed if you would like to add the Consulting Services Liability
Endorsement to your Professional Liability Insurance policy. This endorsement is for healthcare professionals who use their knowledge as a licensed professional to provide
non-medical services such as medical administration, training, legal consultation, speaking at seminars, teaching
or acting as an expert witness. (If you are a Case Manager, or otherwise provide case management services,
please call 1-800-982-9491 for the appropriate application.)
Please note: This additional coverage is not available to healthcare aides, technicians or technologists. For those healthcare professionals who are paying a part-time premium: This important coverage is available to
you, however you must pay the full time premium, plus $25.00. Please call 1-800-982-9491 to speak to a Service
Associate about adding this important coverage to your policy. First Name: Last Name: Address: City: State: Zip: Phone: Fax: Email: Professional Liability Insurance Policy Requested Effective Date: YES, I would like to add the Consulting Services Liability Endorsement to my Professional Liability insurance policy as of the Policy Effective Date listed above. I understand that I must submit this form, along
with full payment, within 30 days of my application date. Enclosed is my check for $_____________ (Payable to HPSO) Charge my credit card in the amount of $___________. AMEX Discover MasterCard Visa
Credit Card # ___________________________________ Expires: _____/_____
Cardholders signature:___________________________________ Date:_____/_____/_____
PLEASE RETURN THIS FORM TO: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 Or if paying by credit card, you can fax to:
1-800-739-8818 Dedicated To Serving The Insurance Needs of Healthcare Professionals This program is underwritten by American Casualty Company of Reading, P ennsylvania a CNA company and is offered through the Healthcare Providers Service Organization Risk Purchasing Group. Coverages, rates and limits may differ in some states. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a service mark and trade
name registered with the U.S. Patent and Trademark Office.
Healthcare Providers Service Organization is a division of Affinity Insurance Services, Inc.; in CA (License #0795465), MN & OK, AIS Affinity nsurance Agency, Inc.; and in NY, AIS Affinity Insurance Agency.
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. Consulting Services Liability Endorsement 159 East County Line Road Hatboro, PA 19040-1218 1-800-982-9491 Fax 1-800-739-8818 www.hpso.com
Consulting Services Liability Endorsement Complete your Protection Today for Just $25 a Year. If youre interested in adding the Consulting Services Liability Endorsement to your coverage,
simply complete the request form and return it to HPSO within 30 days of your application, along
with your payment of $25.00.
If you have any questions about the endorsement or want to know if it is right for you, please call
our Customer Service Center at 1-800-982-9491, Monday-Friday 8AM-6PM Eastern Time.
Please note: This additional coverage is not available to healthcare aides, technicians or technologists. Dedicated To Serving The Insurance Needs of Healthcare Professionals This program is underwritten by American Casualty Company of Reading, P ennsylvania a CNA company and is offered through the Healthcare Providers Service Organization Risk Purchasing Group. Coverages, rates and limits may differ in some states. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a service mark and trade
name registered with the U.S. Patent and Trademark Office.
Healthcare Providers Service Organization is a division of Affinity Insurance Services, Inc.; in CA (License #0795465), MN & OK, AIS Affinity nsurance Agency, Inc.; and in NY, AIS Affinity Insurance Agency. 159 East County Line Road Hatboro, PA 19040-1218 1-800-982-9491 Fax 1-800-739-8818 www.hpso.com This form must be completed if you would like to add the Consulting Services Liability
Endorsement to your Professional Liability Insurance policy. This endorsement is for healthcare professionals who use their knowledge as a licensed professional to provide
non-medical services such as medical administration, training, legal consultation, speaking at seminars, teaching
or acting as an expert witness. (If you are a Case Manager, or otherwise provide case management services,
please call 1-800-982-9491 for the appropriate application.)
Please note: This additional coverage is not available to healthcare aides, technicians or technologists. For those healthcare professionals who are paying a part-time premium: This important coverage is available to
you, however you must pay the full time premium, plus $25.00. Please call 1-800-982-9491 to speak to a Service
Associate about adding this important coverage to your policy. First Name: Last Name: Address: City: State: Zip: Phone: Fax: Email: Professional Liability Insurance Policy Requested Effective Date: YES, I would like to add the Consulting Services Liability Endorsement to my Professional Liability insurance policy as of the Policy Effective Date listed above. I understand that I must submit this form, along
with full payment, within 30 days of my application date. Enclosed is my check for $_____________ (Payable to HPSO) Charge my credit card in the amount of $___________. AMEX Discover MasterCard Visa
Credit Card # ___________________________________ Expires: _____/_____
Cardholders signature:___________________________________ Date:_____/_____/_____
PLEASE RETURN THIS FORM TO: Healthcare Providers Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 Or if paying by credit card, you can fax to:
1-800-739-8818 Dedicated To Serving The Insurance Needs of Healthcare Professionals This program is underwritten by American Casualty Company of Reading, P ennsylvania a CNA company and is offered through the Healthcare Providers Service Organization Risk Purchasing Group. Coverages, rates and limits may differ in some states. This material is for illustrative purposes only and is not a contract. It is intended to provide a general overview of the products and services offered. Only the policy can provide the actual terms, coverages, amounts, conditions and exclusions. CNA is a service mark and trade
name registered with the U.S. Patent and Trademark Office.
Healthcare Providers Service Organization is a division of Affinity Insurance Services, Inc.; in CA (License #0795465), MN & OK, AIS Affinity nsurance Agency, Inc.; and in NY, AIS Affinity Insurance Agency.
