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PIA Forms and Applications
Applications for Professional Liability
Health Care Provider Application (Form 7/05)
Professional Organization Application (Form 7/05)
Physicians and Surgeons Application (Form 7/05)

Supplemental Applications - Professional Liability
Supplemental Information form for Radiologists
Part-Time Coverage Form
Supplemental Information for VBAC
Supplemental Claims Form

Member Society Applications
Michigan State Medical Society
Member Rewards
Michigan Osteopathic Association

Individual Applications
Delta Dental Application
Vision Application

Group Health Enrollment/Change of Status
Group Health Enrollment/Change of Status Form

Delta Dental Open Enrollment
Dental Rates
Delta Dental Brochure

More Information

To submit an application:

You may fax to our office at 517-324-4327, scan and email to msmsagency@msms.org or mail to the following address:

MSMS Physicians Insurance Agency
120 W. Saginaw
East Lansing, MI 48823
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