Professional Liability Insurance
Your session will expire in one minute. If your session expires, any information you enter for this application will not be transferred to any subsequent application you fill out.
Transferring information from one application to another is a service GEBA offers, but only if applications are submitted within 30 minutes of each other.
By providing your email address to us, you expressly consent to receive emails from us. We may use email to communicate with you, to send information that you have requested or to send information about other products or services developed or provided by us, provided that, we will not give your email address to another party to promote their products or services directly to you.
Plan year is January 1 – December 31.
Coverage can begin at the first of any month. Premium will be prorated based on the effective date (date the policy starts, which you can select below). Effective date is the first day of the following month from the date of application submission. The policy automatically renews in January of the next year. Annual automatic debits are collected on the first business day of January for $280 for the year (January 1 – December 31).
The policy provides an Accidental Death Benefit for a death directly related to the scope of your employment. Please provide a Beneficiary Designation.
I hereby authorize Government Employees’ Benefit Association, Inc. (GEBA) to debit my checking/savings account according to the published schedule. I understand that GEBA reserves the right, upon written notification, to terminate my participation in this payment option. If an automatic debit is returned for any reason including insufficient funds, closed or unauthorized account, GEBA will not be able to process payment. I understand that I may be subject to a $20 charge if payment is rejected, reversed, or refused by my financial institution. I may cancel participation in the GEBA Automatic Debit service with written notice 10 days prior to the premium due date.
You must include your ABA (Routing) Number for your bank. Use this image to see where your routing number is listed, if you don't already know. An ABA/Routing number is always 9 digits, no letters or punctuation.
By signing and dating this application, I request the insurance indicated, attest to having read the Fraud Notice above, and that to the best of my knowledge and belief, the answers to the questions are true and complete.
THE FOLLOWING TERMS AND CONDITIONS GOVERN YOUR USE OF THE ONLINE ENROLLMENT.
IF YOU AGREE WITH THESE TERMS AND CONDITIONS, PLEASE CLICK THE ACCEPT BUTTON BELOW.
By clicking the accept button below, I acknowledge that I read, understand and agree with all the following statements:
BY CLICKING THE “ACCEPT”, YOU ACKNOWLEDGE THAT YOU AGREE TO THE ELECTRONIC DELIVERY OF THE AGREEMENT AND TO BE LEGALLY BOUND WITH RESPECT TO THIS AGREEMENT AS IF YOU HAD SIGNED THIS AGREEMENT WITH A HAND WRITTEN SIGNATURE. YOU MAY PRINT AND RETAIN A COPY OF THIS AGREEMENT FOR YOUR RECORDS.