Only practitioners and healthcare providers, covered by medical malpractice liability insurance in 2006, whose primary practice area was in one of the specialties and subspecialties listed in Order A07-118 (PDF, 60K) were eligible to apply for the subsidy. Those specialties/subspecialties were:

• Obstetrics/Gynecology - Practices otherwise limited to gynecology were excluded.
• Neurosurgery
• Diagnostic Radiology - Limited to radiologists who read mammograms. The radiologist must have been a New Jersey Board Certified or Board eligible radiologist and was certified as meeting the requirements under the Federal Mammography Quality Standards Act and regulations.

Please Note:

• Only applications containing all the required information will be processed.
  
  
• This application could not be updated once it was filed. Contact our staff at 609-292-3100.

PLEASE NOTE:

Detailed Medical Malpractice Liability Insurance Premium policy information for all insurance policies issued or renewed in 2006, that included: 

1. Insurer name
2. Policyholder or insured's name and address (for the Applicant, Group Practice, Hospital or other named insured)
3. Complete Policy Number
4. Policy Dates (inception and expiration dates, ie: 01/01/2006 to 01/01/2007)
5. Type of Policy (Claims Made, Occurrence, Tail, etc.)
6. Limits of Liability

Note: If you were insured by more than one insurer in 2006, the application provided for additional insurer information.

If you were not the named insured on the policy or policies, you needed to obtain the above information from the named policyholder (ie: your employer, group practice, hospital, etc.) before proceeding with the application process.

If you were not the named policyholder and another party or entity was paying the premium, you had the option of having the subsidy payment sent directly to a Designated Payee other than yourself. You needed to provide the Designated Payee's name, address, contact person, telephone number and FEIN or Tax ID Number. Designated Payees include Group Practices, Hospitals or other such employers. If you chose this option, it was very important to notify the Designated Payee that they need to complete the W-9 questionnaire and fax it to 609-777-0508, with a cover sheet containing your name and complete BME License number, for proper identification. The W-9 Questionnaire form should be submitted no later than Friday, August 24, 2007.

Note: The State Treasurer cannot issue payment to the Designated Payee if there is no W-9 on file with their office. If you or your designated payee previously received a premium subsidy paid in either 2005 and/or 2006, another W-9 is not necessary for the 2006 premium subsidy paid in 2007. The New Jersey State Treasury office already has your payee information on file.