Apply For Coverage
To start a new application or return to an online application, select the option below that best describes your coverage needs. If you have any questions about the application process, please call 800-681-1840.
**If you are a former MICA insured with online account credentials, log into our member portal to submit your online application.**
Application Options
Individual Physician Application
Online Application
To access a new online application or resume an application you already started, use the button below. You are able to save the online application to finish later, and will receive an email with instructions and a "resume code" to access your application.
Downloadable Application
You can also use our downloadable PDF application to fill in or print, and once you have finished, either email it to micauw@mica-insurance.com or mail in.
MICA's Mailing Address: 2602 E Thomas Rd, Phoenix, AZ 85016.
*The short form application should ONLY be used for a group submission along with a roster, loss runs, CVs, COI/Dec pages
Advanced Healthcare Professional Application
This application choice is for CNM, CRNA, NP or PA.
Online Application
To access a new online application or resume an application you already started, use the button below. You are able to save the online application to finish later, and will receive an email with instructions and a "resume code" to access your application.
Downloadable Application
You can also use our downloadable PDF application to fill-in or print, and once you have finished, either email it to micauw@mica-insurance.com or mail in.
MICA's Mailing Address: 2602 E Thomas Rd, Phoenix, AZ 85016.
Business Entity (Group) Application
Downloadable Application
You can also use our downloadable PDF application to fill in or print, and once you have finished, either email it to micauw@mica-insurance.com or mail in.
MICA's Mailing Address: 2602 E Thomas Rd, Phoenix, AZ 85016.
Facility Application
Downloadable Application
You can also use our downloadable PDF application to fill in or print, and once you have finished, either email it to micauw@mica-insurance.com or mail in.
MICA's Mailing Address: 2602 E Thomas Rd, Phoenix, AZ 85016.
Additional Insured
Downloadable Application
If you employ healthcare professionals and would like to apply for coverage under your policy with shared limits.
You can also use our downloadable PDF application to fill in or print, and once you have finished, either email it to micauw@mica-insurance.com or mail in.
MICA's Mailing Address: 2602 E Thomas Rd, Phoenix, AZ 85016.