Request a Quote

To request an insurance quote via email, please complete the census form by clicking on the appropriate link below:

Health
Business Owners Package/Property and General Liability
Group Disability and Life
Individual Life and Disability
Long-Term Care

By clicking on the appropriate link below, you may also print the census form and mail or fax to:

Pennsylvania Medical Society Insurance Agency
P.O. Box 69067
Harrisburg, PA 17106-9067
Phone: (866) 441-2392 (Toll-Free)
Fax: (717) 561-6077 (Confidential/HIPAA Compliant)

Health (PDF)
Business Owners Package/Property and General Liability (PDF)
Group Disability and Life (PDF)
Individual Life and Disability (PDF)
Long-Term Care (PDF)

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