Frequently Asked Questions: Insurance
Who is eligible for primary professional liability insurance?
You are eligible for HIC primary professional liability insurance if you are a Voluntary Attending Physician at one of the following hospitals: Beth Israel Medical Center, Maimonides Medical Center, Mount Sinai Medical Center or New York Eye and Ear Infirmary. Each application is reviewed by HIC’s underwriters who make the final eligibility decision.
What coverage is available under primary professional liability insurance?
The primary layer provides $1.3 million per claimant and $3.9 million in the aggregate. This means up to $1.3 million is available per claimant and a total of $3.9 million in the aggregate is available annually. HIC offers both Occurrence and Claims Made coverage.
What is Occurrence coverage?
Occurrence policies provide coverage for claims resulting from events that took place during the policy period, regardless of when these claims are made.
For example, a claim is covered under an occurrence policy issued in 2005 if the incident occurs between January 1, 2005 and December 31, 2005, even though the claim is not filed against the physician until 2007. With occurrence coverage:
- protection is guaranteed even if the policy is not renewed;
- purchase of prior acts or a tail policy is not necessary; and
- premiums became less expensive than premiums for Claims Made coverage after the fifth year.
What is Claims Made coverage?
Claims Made policies provide coverage for claims first made against the insured during the policy period, provided the event also took place during the period of coverage (i.e. after the retroactive date). Purchase of a tail or prior acts policy may be required to avoid gaps in coverage.
For example, a claim is covered under a Claims Made policy issued in 2007 even if the incident giving rise to the claim occurred in 2005 but was not filed against the physician until 2007.
With this coverage:
- protection for claims filed in years after a Claims Made policy expires is ensured only if the policy is renewed;
- purchase of a tail or prior acts policy may be required to avoid gaps in coverage; and
- rates increase at fixed percentages until maturity (usually eight years), and are also subject to standard yearly rate modifications.
What primary insurance discount options are available?
- a physician can elect to receive a 5% discount by selecting a “no consent” endorsement.
- a 2% discount is available if the entire annual premium is paid in a lump sum.
- a 5% discount is available for completion of a New York State Insurance Department-approved risk management program (such as the HIC Risk Management course).
- new physicians can qualify for a discount of up to 50% during the first year of practice.
As a newly graduated physician, am I eligible for a discount?
Discounts are available if you qualify for HIC primary insurance within 90 days of finishing an approved residency or fellowship and are working full-time.
New doctor and part-time discounts can not be applied concurrently.
My practice is part-time. Do you offer this coverage?
For Voluntary Attending Physicians at HIC member hospitals, part-time private practice coverage is available for physicians who maintain practices limited to 20 or fewer hours per week.
Premiums are calculated with discounts of 35% or 50% based on specialty.
New doctor and part-time discounts can not be applied concurrently.
Is there a discount if I pay my annual premium in a lump sum?
If you pay your entire annual premium in a lump sum at the beginning of the policy year, you will receive a 2% discount. This amount will be deducted from the total premium, and you will receive the discount in a refund check.
What are tail and prior acts policies? When do I need one?
Tail and prior acts (sometimes called "nose") policies provide coverage for occurrences that took place during the period before a Claims Made policy was in effect or were reported after the expiration of the Claims Made policy. If you have an Occurrence policy, you do not need a tail policy. If you are terminating a Claims Made policy, HIC strongly recommends that you purchase a tail policy.
Prior acts or nose policies are recommended for physicians making a change to a HIC occurrence policy. The premium for prior acts (nose) coverage is included in the HIC Claims Made rate level, which reflects the total number of years of continuous Claims Made coverage.
The limits of the tail and/or prior acts coverage (typically $1 million per incident and $3 million in the aggregate) are for all claims reported after the expiration of a Claims Made policy, not for each year of coverage. Since any number of claims could be reported after the coverage has expired, the limits of a tail and/or prior acts policy may be inadequate.
How do I make the transition from a Claims Made to an Occurrence policy?
For those applicants who are terminating Claims Made policies, HIC strongly recommends that physicians purchase tail coverage from the carrier that issued their Claims Made policy.
I have Claims Made coverage with another carrier and wish to change to a HIC Claims Made policy. Must I purchase a tail policy?
Claims Made applicants who are currently covered on a Claims Made basis by certain insurers may avoid the expense of purchasing tail coverage with their Claims Made insurer by securing prior acts (nose) coverage with HIC.
What is the difference between a tail policy and prior acts coverage?
A tail policy is purchased from the current insurance carrier after termination of coverage; and prior acts (nose) coverage is purchased from the new insurance carrier when a Primary policy is purchased.
I am a physician in private practice. How do I find out about Primary Professional Liability Insurance?
If you are a Voluntary Attending Physician at one of HIC's five participating hospitals (list is here), then you are eligible to apply for HIC Primary Professional Liability Insurance coverage. Coverage information is available from HIC by calling 800.982.7101 or sending an e-mail. If you are a physician in New York State and you are an attending with any hospital in New York, you may be eligible for Excess (Section 18) Professional Liability Insurance at no cost. Please call HIC at 800.982.7101 to apply.
What is an endorsement?
An endorsement is additional coverage added to the existing policy for specifically defined activities.
What is a consent policy?
A consent policy provides the right to bring disputed matters (between physicians and insurance carriers) before the Medical Advisory Review Committee (MARC) for a binding decision. This committee of practicing physicians from participating hospitals conducts hearings to resolve disputes regarding the disposition of cases (trials vs. settlement) and the percentage allocated for liability.
What is a no consent policy?
The insured allows the carrier--with input from MARC--to make decisions about the outcome of a claim.
What is excess professional liability insurance?
Excess Professional Liability Insurance is a layer of excess insurance that gives you additional limits of $1 million per claimant and $3 million in the aggregate above your primary insurance, which is paid for by New York State. HIC automatically provides excess insurance enrollment applications to VAP physicians who meet the necessary eligibility requirements and HIC's underwriting standards. Excess insurance is written for the policy period from July 1 through the following June 30.
Who is eligible for excess insurance coverage? Who needs it?
HIC recommends strongly that every physician in New York carry this state-funded insurance. There is no cost to the physician for the excess coverage. To qualify for excess insurance, the physician must be licensed in New York State, have admitting privileges at a general hospital in New York, carry qualifying primary limits of at least $1.3 million per medical incident and $3.9 million in the aggregate, and complete a New York State Insurance Department-approved risk management course. Excess insurance is not required by the state, but maybe required by your hospital.
What coverage is available under excess insurance coverage?
An additional $1 million per medical incident and $3 million in the aggregate is provided under New York State’s Excess Professional Liability Insurance Program. This additional layer brings the individual physician limits to $2.3 million per medical incident and $6.9 million in the aggregate for each policy year.
What is a Statement of Insurance?
A Statement of Insurance is a certificate that confirms that an enrolled physician has professional liability insurance coverage. The information included on the certificate indicates the name of the physician, territory of principal practice, premium class, effective dates of coverage, limits and endorsements. All facilities where a physician practices will require that a Statement of Insurance be maintained on file as proof of the physician’s medical professional liability coverage. To receive a Statement of Insurance, please fax a signed letter containing your name and the name of your sponsor hospital to Physician Services at 914.328.3716.