Grant your permission here and your insurance application will be 75% completed.
Insurance » Applications
Synernet
Because of a special partnership with Synernet, an outsourced provider of credentialing and other services for healthcare organizations, you have access to free, time-saving help in filling out your application for Medical Mutual insurance.
You see, in providing credentialing services for your current or prospective employer, Synernet gathers and verifies up to 75% of the information needed for your insurance application: degrees, previous employers, claims history etc.
All you have to do is grant your permission for Synernet to share its credentialing information with Medical Mutual. We’ll send you an email with a link to your pre-populated application and you’ll then have the option of completing the remaining 25% or so online, or printing it out to complete by hand.
It could hardly be easier. So fill out the fields below and click Submit to grant your permission today.
Release of Information
I hereby authorize Synernet to disclose to Medical Mutual Insurance Company of Maine (MMIC) or its representatives any and all information concerning my medical training, practice, competence, experience, character, conduct, judgment, ethics, ability to work with others and other matters which might be of significance for insurance underwriting purposes. I expressly release and discharge all such informants, Medical Mutual Insurance Company of Maine and their agents from any liability of any kind whatsoever in any manner arising from the disclosure of such information.
I further state that I authorize that a photocopy, facsimile or electronic version of this authorization be accepted with the same authority as the original.