| AMERICAN PSYCHIATRIC ASSOCIATION ENDORSED | |||||||||||||||||||||
| PSYCHIATRIST PROFESSIONAL LIABILITY PROGRAM | |||||||||||||||||||||
| INDIANA | |||||||||||||||||||||
| Territory 1 - Remainder of State | |||||||||||||||||||||
| Claims-Made | $250,000/$750,000 | $500,000/$1,500,000 | $1,000,000/1,000,000 | $1,000,000/3,000,000 | $2,000,000/4,000,000 | $2,000,000/6,000,000 | |||||||||||||||
| Year | |||||||||||||||||||||
| First | $1,294 | $1,596 | $1,630 | $1,680 | $2,100 | $2,150 | |||||||||||||||
| Second | $2,402 | $2,964 | $3,026 | $3,120 | $3,900 | $3,994 | |||||||||||||||
| Third | $3,142 | $3,876 | $3,958 | $4,080 | $5,100 | $5,222 | |||||||||||||||
| Fourth | $3,511 | $4,332 | $4,423 | $4,560 | $5,700 | $5,837 | |||||||||||||||
| Fifth | $3,696 | $4,560 | $4,656 | $4,800 | $6,000 | $6,144 | |||||||||||||||
| Occurrence | $4,103 | $5,062 | $5,168 | $5,328 | $6,660 | $6,820 | |||||||||||||||
| Territory 2 - Lake | |||||||||||||||||||||
| Claims-Made | $250,000/750,000 | $500,000/$1,500,000 | $1,000,000/1,000,000 | $1,000,000/3,000,000 | $2,000,000/4,000,000 | $2,000,000/6,000,000 | |||||||||||||||
| Year | |||||||||||||||||||||
| First | $1,617 | $1,995 | $2,037 | $2,100 | $2,625 | $2,688 | |||||||||||||||
| Second | $3,003 | $3,705 | $3,783 | $3,900 | $4,875 | $4,992 | |||||||||||||||
| Third | $3,927 | $4,845 | $4,947 | $5,100 | $6,375 | $6,528 | |||||||||||||||
| Fourth | $4,389 | $5,415 | $5,529 | $5,700 | $7,125 | $7,296 | |||||||||||||||
| Fifth | $4,620 | $5,700 | $5,820 | $6,000 | $7,500 | $7,680 | |||||||||||||||
| Occurrence | $5,128 | $6,327 | $6,460 | $6,660 | $8,325 | $8,525 | |||||||||||||||
| PREMIUM DISCOUNTS: | |||||||||||||||||||||
| Part-time discount: A 50% discount if you practice 20 hours or less a week. | |||||||||||||||||||||
| New doctor discount: A 25%-50% discount if you qualify as a new doctor. | |||||||||||||||||||||
| Member in Training discount (MIT): A 50% discount if you are classified as a MIT by the American Psychiatric Association. | |||||||||||||||||||||
| Child and Adolescent discount: A 15% discount if your practice consists of more than 50% children and adolescents. | |||||||||||||||||||||
| Claims-free discount: A 10% discount if you have been claims-free for more than 10 years. | |||||||||||||||||||||
| New business discount: A 10% discount if you are applying to the Company for the first time and have been claims-free for the last six months. | |||||||||||||||||||||
| Risk Management discount: A 5% discount for completion of risk management courses approved by the Company. | |||||||||||||||||||||
| Purchasing Group Fee: Coverage is written through the Professional Counselors Purchasing Group. There is a $5.00 administrative fee | |||||||||||||||||||||
| assessed to each policy. Please include this in your payment. | |||||||||||||||||||||
| Group policies: If you are interested in group coverage, please contact us at 1-800-421-6694 and we will be happy to assist you. | |||||||||||||||||||||
| Quarterly payments: Quarterly payments are available if the annual premium is $1,000 or more. If you wish to pay quarterly, please remit | |||||||||||||||||||||
| 35% of the premium (rounded to the nearest dollar). | |||||||||||||||||||||
| DAR-ADUL-IN(06/30/10) | |||||||||||||||||||||