2019 Affidavits

2019 affidavits will be emailed to all email address on file and posted to our site during the second week of October 2018.

Please contact us at insurancesubsidy@ohsu.edu if you want to update your email address.

Step A: Determine your eligibility

1. Are you covered by a malpractice insurance policy that specifically names you and separately calculates your premium?
   
   If yes, continue to 3. If no, you are not eligible.
   
   
2. On your malpractice insurance policy, do you share limits with a physician?
   
   If no, continue to 4. If yes, you are not eligible.
   
   
3. Do you fully reimburse the health care facility for your premium?
   
   If yes, continue to 5. If no, you are not eligible.
   
   
4. Are you a nurse practitioner certified by the Oregon State Board of Nursing?
   
   If yes, continue to 6. If no, you are not eligible.
   
   
5. Is 60 percent or more of your practice time spent in an eligible area?
   
   If yes, continue to 7. If no, continue to 6a.
   
   
   1. Is 60 percent or more of your practice time spent in Ashland?
      
      If yes, continue to 6b. If no, you are not eligible.
      
      
   2. Are you certified in obstetrical care?
      
      If yes, continue to 7. If no, you are not eligible.
      
      
6. Do you have an in-force policy of liability insurance with an authorized insurer participating in the program with minimum limits of coverage of $1 million per occurrence and $1 million aggregate?
   
   If yes, continue to 8. If no, you are not eligible.
   
   
7. If you are NOT employed by a licensed physician, are you willing to serve patients with Medicare or Medicaid in at least the same proportion to your total number of patients as the Medicare and Medicaid populations represent to the total number of people in the eligible areas of your county? A map that represents these percentages.
   
   If yes, continue to Step B. If no, you are not eligible.

Step B: Apply to participate in the program

1. Complete the affidavit.
   
2. Save the completed affidavit on your computer and send as an attachment to insurancesubsidy@ohsu.edu.

View a list of liability carriers currently participating in the program.