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Medical Indemnity Fund

MIF Home | Enrolling in the Fund

Forms and Instructions

Unless otherwise specified, the following forms and instructions are in PDF format and available in different languages. Select the Languages link to display or hide the language link options for the document(s) desired.

Authorization for Release and Use of Medical InformationLanguages
Home Care Supplies Prior Approval (cover letter)Languages
Appeal Form – Request for Review of a Denial of Claim or Prior ApprovalLanguages


To enroll in the Fund an applicant must also submit the following:

Completed applications should be mailed to:

NYS Medical Indemnity Fund
c/o AliCare
333 Westchester Avenue
White Plains, NY 10604

Applications and supporting documentation may also be scanned and e-mailed to the Fund in PDF format to:

If you have any questions or need assistance completing the application, please contact us:


1-855-NYMIF33 (1-855-696-4333)

Updated 12/07/2017


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