NJ PURE

Apply /

Online Application

Before getting started...

When you are ready, click the Apply Now button at the bottom of this page to launch the online application. You will be asked to enter your email address or sign in with an existing Google or HelloSign account.

After you have completed the application, click "I Agree" at the bottom. Your completed application will be sent to NJ PURE. You will receive an email with your completed application attached for reference purposes.

If you need to adjust the screen size, please use your internet browser's zoom function. If you have any questions please call NJ PURE at 877-265-7873.

NJ PURE Professional Liability Insurance Options*

Claims-Made

The Claims-Made Option is designed to cover claims made against you during the policy period, so long as the medical incident that gives rise to the claim occurs on or after the retroactive date. There is no coverage for claims that may be made against you after cancellation or nonrenewal, unless you either purchase or otherwise qualify for a free extended reporting period endorsement under the terms stated in the policy.

Occurrence-Evergreen Plan

This option includes extended reporting (or "tail") coverage and affords an unlimited period of time to report covered claims that result from medical incidents that occur while your policy with NJ PURE is in effect.

* These descriptions are intended as a general guide and do not serve to modify or supersede language contained in the insurance policy in any way. Feel free to call NJ PURE for more information or to request a specimen policy form. The limits of insurance available under this program are: $1,000,000 each medical incident; $3,000,000 aggregate.

Additional Requested Documents

Page 1 of the application requests the following documents be provided as part of your application:

  • Curriculum Vitae (CV)
  • Residency and fellowship certificate(s)
  • All medical licenses
  • CDS and DEA registration certificate(s)
  • All specialty certifications
  • Educational Commission for Foreign Medical Graduates (ECFMG) certification, if applicable
  • All specialized training certificates and credentials, if applicable
  • Declarations page of most recent medical professional liability policy

After completing the online application, please email these documents to info@njpure.com. If these items are not provided with your application or are incomplete, your application may not be processed.

In order to bind your policy with NJ PURE, you must read and sign the Power of Attorney. You may complete this step now by clicking here or you may complete it with your Account Executive when your policy quote is delivered.

If the policy premium and surplus contribution will be paid for by someone other than the applicant, you must complete the Assignment of Any Returns. You may complete this step now by clicking here or you may complete it with your Account Executive when your policy quote is delivered.

Other Considerations

Please answer all questions fully and completely.

If you are beginning a new practice or changing your current practice, your application must reflect your planned practice situation as of your Requested Effective Date, unless a question requires that you provide information about previous practices.

Apply Now

When you click the signature field on page 16, 18, or 19 the “Add Digital ID” pop-up will appear. If this is your first time electronically signing a PDF form:

  • Select the second option (A new digital ID I want to create now) and click Next.
  • On the second screen, select the first option (New PKCS#12 digital ID file) and click Next.
  • Fill in the fields on the screen, leaving the three drop down selections as they appear and click Next.
  • Enter a password for this signature and click Finish.
  • A “Sign Document” pop-up will appear. Enter the password you indicated on the previous screen and click Sign.
  • Finally, you are asked to save the form to your computer. Select a location you where you will be able to easily locate it, such as your desktop.

Any signature field you click on after setting up your signature will simply ask for your password to sign.

When you click the SUMBIT button on page 19, the “Send Email” pop-up will appear.

Select whether to use your system’s default email program or use webmail for Gmail, Yahoo, etc. A draft email will open in your selected email program with the proper recipient addresses automatically inserted into the “To” field and your completed application automatically attached. Simply attach the additional requested documents (see below) and click Send.