Q. Is coverage available for my surgery center?
A. Subject to review and approval of a special questionnaire, coverage
may be extended to ophthalmologist-owned surgery centers, refractive centers,
and in-office surgical suites used by outside physicians. Generally, the limits of liability are shared with the owner ophthalmologist/entity, but separate limits may be purchased. Depending upon your facility's ownership, usage, and limits, an additional premium may apply. Please contact your underwriter for details.
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Q. Can OMIC insure my corporation or partnership?
A. In most states, sole shareholder corporations are insured at shared limits for no additional charge. A separate set of limits for your sole shareholder corporation can usually be provided for an additional premium. Physicians who participate in their state's Patient Compensation or Excess Liability Fund generally must purchase
separate limits if they wish to insure their corporation.
If you are in a multi-shareholder corporation or partnership, entity coverage may be available. Generally, all partners or shareholders should be insured by OMIC for the entity to qualify for coverage, but exceptions may be granted on a case-by-case basis. If approved, the entity will be insured at separate liability limits and an additional premium will apply.
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Q. Do I need entity coverage for my limited liability corporation or partnership?
A. Regardless of the form of the business organization, physicians would be well advised to maintain adequate professional and general liability insurance. A limited liabilitycorporation or partnership is not a substitute for insurance. Entities can be, and frequently are, named in suits. Even though the entity may ultimately be dismissed from a claim, legal expenses can be costly.
In addition, entity coverage offers protection to corporations and partnerships and to their members for their vicarious liability exposure arising from services rendered by other members of the practice. Entity coverage also protects the entity’s non-physician employees for their direct liability exposure. For example, if a physician, her two partners, their business entity, and the entity’s employed technician are all named in a lawsuit based on the physician’s and technician’s actions, the entity coverage would provide vicarious liability coverage to the entity, direct liability coverage to the employed technician, and coverage to the partners for any liability they incur due to their status as partners in the business. (The physician’s direct liability would be covered under her individual coverage.)
Entity coverage also covers members of the entity for their professional committee activities, such as credentialing, accreditation, and quality assurance performed for the entity.
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Q. Can OMIC include my Management Services Organization as an additional insured?
A. Yes. Except as prohibited by state law, OMIC will insure your approved MSO for vicarious liability as an additional insured at shared limits under your policy. An additional premium applies.
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Q. What coverage exists for my ancillary personnel?
A. All employed ancillary personnel, except for optometrists and nurse anesthetists, are automatically covered under your policy as additional insureds for services rendered within the scope of their training, licensure (if any), and employment by you and for your direct benefit. This coverage is included at no additional charge, and you and your personnel share your single limit of liability. In Kansas, Nebraska, and Pennsylvania, all ancillary personnel share a limit of liability separate from but equal to your personal limits. Since such personnel are automatically insured under your policy for services they render on your behalf, they do not need to maintain their own professional liability insurance policies. And you are covered for your vicarious liability arising from services your staff (including employed optometrists and nurse anesthetists) render.
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Q. Does my optometrist or nurse anesthetist have to be insured?
A. Yes. So that you do not become financially responsible for full liability exposure arising from their actions, OMIC requires not only that employed optometrists and nurse anesthetists be insured with a reputable carrier, but also that they maintain the same "per claim" liability limit that you carry. Although this requirement does not apply to independent contractors, we strongly recommend that contract optometrists and CRNAs also carry equal limits.
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Q. Can I purchase coverage from OMIC for my optometrist or nurse anesthetist?
A. OMIC can insure your employed optometrist as an additional insured under your policy following review and approval of an Application for Additional Insured. In Kansas, Nebraska, and Pennsylvania, your employed optometrist will share a single limit of liability with your other employed ancillary personnel. In all other states, your optometrist will share your liability limits. An additional premium equivalent to 3.6% of the non-discounted Surgery Class 3 premium will apply to cover your optometrist at shared limits. If separate limits are desired, a premium equivalent to 6.5% of the Surgery Class 3 premium will apply.
Coverage of employed nurse anesthetists (CRNAs) is available in all states except Nebraska. As with employed optometrists, coverage is subject to approval of an Application for Additional Insured, and the CRNA will generally share your limits of liability. (In Pennsylvania, your CRNA will share limits with your other employed ancillary personnel.) Nurse anesthetists in Kansas must maintain a separate limit of liability. Separate liability limits are available in other states for an additional premium. If liability limits are shared, the CRNA’s premium will be equivalent to 40% of the non-discounted Surgery Class 3 premium. At separate limits, the premium will be approximately 80% of the Surgery Class 3 rate.
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Q.Does OMIC provide Locum Tenens coverage?
A. Yes. In all states except Kansas, Nebraska, and Pennsylvania, OMIC provides locum tenens coverage for up to 90 days per year, free of charge, for physicians who temporarily substitute for you in your absence. Each locum tenens will be endorsed to your policy as an additional insured at shared limits following review and approval of an Application for Locum Tenens. Due to legislation prohibiting the sharing of limits between health care providers, OMIC is unable to offer locum tenens coverage in Kansas, Nebraska, or Pennsylvania.
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Q. Is coverage available to me before I complete my residency?
A. You may be covered by OMIC through a “slot” position under your residency program’s insurance policy. However, for individual coverage, while you may submit your application at any time, your coverage will not become effective until you have completed your residency. Because most residency programs prohibit moonlighting, coverage is generally not available for moonlighting activities but may be provided if you have received written approval from your residency program.
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Q.Are refractive surgery procedures covered?
A. Although the standard policy excludes coverage for refractive surgery procedures, your policy can be endorsed to include coverage for specified procedures following review and approval of a supplemental refractive surgery questionnaire. A questionnaire is required for each type of procedure performed. If approved, coverage will apply at full policy limits. OMIC currently offers coverage for RK/AK, ALK, PRK, LASIK, CK, intrastromal corneal ring segments ("Intacs"), phakic implants for refractive purposes and refractive lens exchange.
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Q. Will I be charged extra for this coverage?
A. No. OMIC prefers to carefully underwrite this procedure rather than assess a surcharge.
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Q. Does OMIC cover skin resurfacing or rejuvenation procedures?
A. Yes. Coverage is extended under the standard policy for a variety of skin care services. Depending upon your coverage classification, you may qualify for coverage of hair removal, chemical peels, blue light acne treatment, cellulite reduction, skin tightening/rejuvenation, skin resurfacing, or treatment of spider and varicose veins.
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Q. Can I administer Botox injections?
A. OMIC’s policy covers not only physicians who perform therapeutic Botox injections but also qualified physicians who perform cosmetic Botox procedures as a portion of their overall practice activities.
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Q. Does OMIC cover full facelifts for cosmetic purposes?
A. Yes. Although the standard policy excludes coverage for full facelifts (i.e. those performed on the lower 1/3 of the face) performed for cosmetic purposes, coverage can be added by endorsement following review and approval of a supplemental questionnaire. Due
to the higher risk of these procedures, a premium surcharge of 50% applies.
Full facelifts for functional purposes are automatically covered under the standard Surgery Class 3 coverage.
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Q. Does OMIC cover liposuction?
A. As with full cosmetic facelifts, the standard policy excludes coverage for liposuction, but your policy can be endorsed to include such coverage. Approval of a supplemental questionnaire is required, and a premium surcharge of 50% applies.
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Q. Is coverage for rhinoplasty also available?
A.Following review and approval of a supplemental questionnaire and subject to a 50% premium surcharge, your policy may be endorsed to include coverage for rhinoplasty.
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Q. What will my premium be if I perform liposuction, facelifts, and rhinoplasty?
A. Only a single 50% surcharge will apply. Your total premium will be approximately 150% of the Surgery Class 3 premium.
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Q. How does OMIC view newly developed clinical procedures?
A. Because OMIC is in the business of insuring ophthalmologists and we take our responsibility to meet their needs seriously, we will not automatically exclude coverage for "experimental" or "investigational" procedures. Instead, it is our intention to cover our insureds for their participation in any clinical trial that is conducted under, and in accordance with, an American IRB-approved protocol. Once a newly developed clinical procedure is generally accepted by a responsible minority of the profession, OMIC will develop guidelines, whenever possible, to facilitate that procedure's insurability.
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Q. Can OMIC provide coverage for services I render while under contract?
A. Yes. If you are an independent contractor and the contracting entity does not provide insurance coverage for you, OMIC will insure you for these activities.
Some contracts contain "hold harmless" or "indemnification" clauses under which you could assume the liability of these third parties. We strongly recommend that you have all hold harmless, indemnification, or similar clauses deleted from your contracts. If they cannot be removed, we recommend they be modified to include a similar clause applying to the contracting entity in your favor. If you have a contract and are not sure whether it contains such a clause, please forward it to our Risk Management Department for review.
Although the OMIC policy generally excludes coverage for liability assumed under contract, OMIC will insure you for damages and reasonable defense costs you become legally obligated to pay pursuant to a “hold harmless” or indemnification agreement in a written contract between you and a hospital, HMO, private or governmental health insurer, PPO, or similar managed care or health care provider organization. This coverage applies only for damages arising solely from direct patient treatment by you and solely for professional services incidents otherwise covered by the policy. Unlike standard defense costs, which are paid in addition to the limits of liability, contractual liability coverage is included within your limits of liability, and all payments made under this coverage are considered payment of damages and reduce your limits of liability.
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Q. Is premises coverage included?
A. Yes. Subject to a maximum of $50,000 per claim/$150,000 aggregate, your OMIC policy will insure you for claims arising from your ownership, maintenance, or use of the office premises you use for direct patient treatment, including the traditional "slip and fall" cases. Premises coverage does not extend to parking lots, sidewalks, elevators, escalators, stairways, or public hallways. Due to legislation prohibiting the sharing of limits, premises coverage is excluded from Kansas and Nebraska policies.
This coverage is limited in nature and doesn't constitute or replace commercial general liability coverage or fire and property coverage. Such coverage can be obtained by purchasing a Business Owners Policy ("BOP") offered on OMIC's behalf through Medical Risk Management Insurance Services (MRMI).
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Q. Will OMIC defend me for regulatory investigations and actions?
A. Yes. Under Section VII, Additional Benefits, Part A, Disciplinary Proceeding Protection, OMIC will defend you for any disciplinary proceeding or action for review of your practice by any federal, state, or local regulatory agency arising from a complaint or report by a patient to that agency alleging an injury they sustained from direct patient treatment you provided. OMIC will pay defense costs up to $25,000 per incident/$75,000 aggregate. Coverage for fines, sanctions, penalties, or other awards is not included.
Under Part B, Broad Regulatory Protection, your policy provides the additional benefit of reimbursement of up to $35,000 for certain legal expenses and audit expenses for the following actions:
Fraud and abuse actions related to civil investigations or proceedings instituted by a government agency, a qui tam plaintiff (whistleblower), or a commercial payor alleging the presentation of erroneous billings by the insured to the government health benefit payor or commercial payor;
Governmental proceedings based on alleged violations of the HIPAA (Health Insurance Portability and Accountability Act) Privacy rules; and
Claims related to alleged violations of the Emergency Medical Treatment and Active Labor Act (EMTALA), Stark Act I and II, and DEA regulations.
When allowed by law, fines and penalties assessed due to billing errors, EMTALA, HIPAA, and STARK proceedings are also covered within these sub-limits.
These additional benefits are included within the standard policy at no additional cost.
Higher Broad Regulatory Protection Policy limits and expanded coverage are available for purchase from Lloyds of London through our program representative, Dana Pollard, at NAS Insurance Services (877) 808-6277 or dpollard@nasinsurance.com.
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Q. Will OMIC cover my peer review and utilization review activities?
A. Yes – if they are conducted on behalf of a state licensed health care facility, such as a hospital or surgery center, on behalf of a professional society, or on behalf of an OMIC-insured entity with which you are affiliated. Health insurance companies and managed care companies that you contract with or are employed by generally should include you as an additional insured under their own policies for peer review and utilization review services you render for them. Or, you may purchase errors and omissions coverage from OMIC to cover those activities.
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Q. What happens if my practice changes after I am insured with OMIC?
A. Because any change in your practice could change your liability exposure and your insurance needs, notifying us promptly will help us serve you better and continue to provide you with uninterrupted coverage. Your policy provides 30 days in which to report such changes after they occur.
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Q. What changes in my practice should I contact you about?
A. Examples of the kinds of changes you should advise us of include:
- Changes in practice locations or mailing address
- Changes in practice organization (such as the addition or deletion of a physician, incorporation of your practice, or a change in practice name or affiliation)
- Changes in hospital privileges
- Modifications in practice activities, including significant changes in your hours worked per week or coverage classification, and intent to perform refractive procedures or other new procedures not previously performed
Changes in your status or response to other questions asked on your application form also should be reported promptly to OMIC.
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Q. Do I need to notify you of changes in my staff during the policy period?
A. Since your policy automatically includes coverage for your ancillary personnel, you do not need to notify us of changes in these staff unless your hospital requires that any of your ancillary personnel be included by name under your policy or your hospital requires verification of their coverage.
In addition, you need to notify us of changes in employed or contract optometrists and nurse anesthetists. If OMIC insures your employed optometrist or CRNA as an additional insured, we will need to endorse your policy accordingly. If OMIC insures only your vicarious liability for services rendered by an employed or contract optometrist or CRNA, we will need proof of their individual coverage.
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