Policyholder Services

General Information about the BRP and e-MD® Benefits Included in OMIC’s Professional Liability Policy

OMIC was one of the first malpractice carriers in the United States to cover its policyholders for proceedings related to Medicare billing errors and other regulatory exposures. Over the years the coverage has been continually expanded and enhanced to meet the changing exposures of OMIC’s insureds’ medical practice. These benefits can be found in the OMIC Professional and Limited Office Premises Liability Insurance policy under Section VII. Additional Benefits. The following coverage summary is current as of September 2016.

The Broad Regulatory Protection (“BRP”) provided in Section VII.B. of the policy, reimburses insureds for legal expenses relating to regulatory proceedings, which include billing errors proceedings, DEA proceedings, EMTALA proceedings, HIPAA proceedings, covered licensing proceedings, STARK proceedings, and peer review. BRP also covers audit expenses related to billing errors proceedings and fines or penalties (where allowed by state law) related to billing errors, EMTALA, HIPAA, and STARK proceedings.

In 2012, OMIC added a comprehensive coverage benefit for electronic media exposures and breaches. This coverage is referred to as “cyber liability” and included under the name “e-MD®” in Section VII.C. of the OMIC policy. Learn more about Cyber/e-MD® coverage here: OMIC Coverage Benefit for Cyber Liability and Network Vulnerabilities.

The benefit limit for BRP exposures is $100,000 per proceeding and in the aggregate per policy period. OMIC professional liability policyholders are automatically provided with this coverage.

Is there any exclusion of coverage if the event upon which a regulatory proceeding is based occurs prior to the policy effective date?

So long as the proceeding is first instituted during your policy period or within the first two years of an extended reporting period, there is no coverage restriction as to when the alleged billing error or event occurred. Coverage for regulatory proceedings are excluded, though, if the Insured or its supervisory level employees knew or should have known, prior to the Insured’s original effective date, the events might result in such a proceeding.

However, for stand-alone BRP/e-MD® coverage, underwriting considerations may require certain policyholders to carry a retroactive date, whereby coverage is restricted to claims based on alleged billing errors or events occurring after the retroactive date.

Can non-OMIC insureds obtain BRP/e-MD® stand-alone coverage?

Individual American Academy of Ophthalmology (Academy) members and their employed optometrists may obtain stand-alone BRP/e-MD® policies. Also, business entities with two or more physician members, all of whose physician members are individual BRP/e-MD® insureds, may obtain coverage.

What are the costs of higher limits and the stand-alone BRP/e-MD® Policy?

Policyholders interested in purchasing higher limits or Academy members interested in the stand-alone policy should contact NAS Insurance Services for pricing.

What are the policy limits?

Tokio Marine HCC, through Tokio Marine HCC Insurance Agency, offers several liability limits for the Broad Regulatory Protection coverage. OMIC professional liability policyholders are provided with a $100,000 limit under the standard professional liability policy at no additional charge. These insureds may purchase higher limits, up to $1 million. Insureds interested in purchasing higher limits can obtain upgrade forms from NAS Insurance Services.

Members of the Academy who are not covered by OMIC for professional liability may purchase BRP/e-MD® coverage directly from Tokio Marine HCC Insurance Agency, at limits up to $1 million.

Is this policy available to optometrists who are insured under an OMIC policy?

Yes. This policy is available to OMIC-insured optometrists; however, they must purchase this coverage. OMIC provides BRPP coverage free of charge to OMIC physician and entity policyholders only. Contact OMIC’s plan administrator, Tokio Marine HCC Insurance Agency, for rates and information.

Is this policy available to retirees?

OMIC provides a free lifetime professional liability extended reporting period endorsement (“tail” policy) to insureds who fully retire and have been insured for professional liability with OMIC continuously for at least five years prior to retirement. The BRP and e-MD® benefits include a two year extended reporting period if the insured acquires tail coverage for his or her professional liability policy. Therefore, retirees who receive a free PL tail will receive along with it a free two-year BRP/e-MD® tail.

For higher limits or stand-alone coverage purchased through Lloyds of London, coverage past the policy expiration date can be purchased for an additional premium. Contact NAS Insurance Services for more details.

Who can I contact for more information about the BRP/e-MD® coverage, pricing, limits, or to report a claim?

Insureds who have questions about the BRP/e-MD® benefits provided within their professional liability policy should call OMIC at (800) 562-6642 ext. 654.

Insureds who need to report a proceeding or claim should contact OMIC’s Claims Department at (800) 562-6642 ext. 672.

All other underwriting and claims services are administered by Tokio Marine HCC. Policyholders interested in purchasing higher limits or Academy members interested in stand-alone coverage can contact Tokio Marine HCC through our program representative, Dana Pollard Carulli, at Tokio Marine HCC Insurance Agency, at (877) 808-6277.