Samaritan Insurance Application Form
We are pleased to announce that Baptist Health South Florida (BHSF) has assisted in the development of a professional liability insurance program. The program is specifically for physicians with medical staff privileges at BHSF facilities. As a staff member of Baptist Health South Florida, you may be eligible to participate in this special program, which has been established through a risk retention group. The name of the program is Samaritan Risk Retention Group, Inc. Samaritan offers coverage at $250,000 per claim with an annual aggregate of $750,000. To obtain a quote, please fill out the attached application. Details about the coverage should be directed to Carlotta Redondo of Aon Risk Services.
Carlota may be reached at 305 961-6125 or Carlota_redondo@ars.aon.com
Click here for the Member Agreement & Proxy form
Click here for the Application form
Please note if you have Adobe Acrobat you will be able to save the form.
If you only have Adobe Acrobat "Reader" you may fill in the form but you will not be able to save it.
You will be able to print the form regardless which version you have. We recommend that you print (2) copies.