Legal 1

Legal-1.doc

Medicare Advantage Applications

Legal 1

OMB: 0938-0935

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Legal-1 INSURANCE COVERAGE





Type




Carrier



Entity

Covered


Description: Deductibles,

Co-insurance, Minimum & Maximum Benefits




Premiums


Period

Policies are

in Effect


Other Arrangements

to Cover

These Risks


Reinsurance















Risk of insolvency















Out-of-area emergency














Malpractice

1. Plan














2. Affiliated Providers














General

Liability














Casualty















Fire















Theft















Fidelity bond

















legal-1.doc

File Typeapplication/msword
File TitleLegal-1 INSURANCE COVERAGE
AuthorCMS
Last Modified ByCMS
File Modified2006-03-24
File Created2006-03-24

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