AZ-Tucson GSI Disability Insurance

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Thanks for choosing University of Arizona - Tucson for your disability insurance. Click here to contact the plan administrator directly OR complete the form below and submit for personalized plan options.

Privacy Notice:

The personal information you share below will not be sold or shared, nor used for anything else, other than to provide you with an accurate estimate of your personalized disability insurance benefit and premium options.

* I hereby confirm that I am an active resident or fellow at University of Arizona - Tucson and thus eligible to apply for this disability insurance coverage.

*Name:

*Mobile:

*Email:

*Age:

*I am a (select one)

Final year resident or fellow within 6 months from graduation

Final year resident or fellows outside 6 months from graduation

Non-final year resident or fellow

*Gender
Male Female

*Are you a tobacco user?
No Yes

*Medical specialty:

*Do you have student loans you would like paid off if disabled?
Yes No

*Anticipated month/year of graduation (mm/yyyy)

*Do you have a signed employment contract after graduation?
Yes No

*Do you have any other individual disability insurance inforce?
Yes No

*Carrier:

*Monthly benefit:

Who referred you to this GME disability insurance program?

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