Insurance for CHC - Health Choice Network

Report
Robert W. Miller, AAI, CIC
508-957-4270
rmiller@doins.com
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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Loss Scenario
A large piece of artwork fell on a patient while a physician was
administering a reflex test. The art fractured the patient’s neck.
FTCA denied coverage for one reason:
1. Not considered a medical professional loss.
Medical Professional GAP insurance company settled the claim
for $175,000 under professional liability.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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Loss Scenario
Health center contracted with a physician in optometry. Optometrist
dilates patient and then leaves the room. The dilated patient tries to
get out of chair and falls, breaking her hip and ankle.
FTCA denied coverage for two reasons:
1. Contractor worked less than 32.5 hours per week and had
no written contract.
2. Not considered a professional loss.
Medical Professional GAP insurance company settled the claim
for $225,000 after determining the proximate cause to be a
professional service.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
3
FTCA Coverage
FTCA provides medical malpractice coverage for medical, surgical,
dental, and “related activities” for acts or omissions by the deemed
health center, its qualified individual providers and/or other eligible
individuals.
FTCA does not provide protection against:
• Directors & Officers Liability
• Cyber Security
• Crime
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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FTCA Coverage
The acts or omissions must:
• Occur on or after the effective date that the CHC received deemed
status; AND
• Are within the CHC’s approved scope of project; AND
• Are provided within the CHC’s approved sites/locations; AND
• Are within the scope of employment, contractor for services, or
duties as an officer or director of the CHC; AND
• Are provided to a CHC patient.
There are some exceptions to these rules in the event of an emergency.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
5
FTCA Coverage
Dual coverage is not allowed under FTCA. Health Centers may not
purchase primary malpractice coverage using federal funds.
Gap or wrap-around coverage is encouraged* by the government and
can be purchased using federal funds.
* See page 18 of the most recent HRSA Policy & Procedures Manual
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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FTCA Coverage
The government may decide to revoke FTCA coverage if, while
investigating an adverse event, it determines that the CHC was not in
compliance with all deeming requirements.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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FTCA Coverage
Who is covered?
• The deemed Health Center
• All employees (part-time, locums, full-time, exempt or non-exempt)
with job descriptions and/or contracts
• All part-time contractors in a primary care field of Family Practice,
Pediatrics, OB/GYN or Internal Medicine
• Any specialty contractor who works 32.5 hours per week or more
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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FTCA Coverage
Services Covered:
Services Not Covered:
Primary health services defined by
Section 330 of the Public Health
Services Act so long as the
services are provided under
certain criteria (next slide)
FTCA does not provide a list. Gaps
exist based on what is not listed as
covered.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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Potential FTCA Coverage Gaps
• Adult immunizations at health fairs
• Needle exchange
• Criminal activities (sexual abuse or molestation)
• Clinical trial participation
• Community-wide event participation (if CHC does not conduct event)
• Medical students or medical residents not employed by CHC
• Newborn deliveries (if not in approved scope)
• Supervision of non-CHC employees
• Teaching activities offsite with non-CHC patients or non-CHC employees
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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Potential FTCA Coverage Gaps
These services are not required primary health services but may be
granted* coverage under FTCA:
• Behavioral and mental health and substance abuse services;
• Recuperative care services;
• Screening for and control of infectious diseases; and
• Injury prevention programs.
*These services must be part of the deemed CHC’s Scope of Project.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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Broadened Malpractice Coverage
If it is not moonlighting and not covered by FTCA,
our GAP Professional Medical Liability insurance will provide
defense and indemnification via specialized in-house counsel
and adjusters at the company level.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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Health Center Exposures
A comprehensive insurance plan can protect your health center from:
• Gaps in FTCA coverage for medical malpractice
• Cyber Security (HIPAA violations)
• Directors & Officers Liability
• Unique Property Exposures
• Crime
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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Contact Us
Robert W. Miller, AAI, CIC
508-957-4270
rmiller@doins.com
www.chcinsurance.com
Disclaimer
This presentation offers a brief description of coverages, services, and programs and we do our best to provide complete and accurate information. For exact terms,
conditions, exclusions and limitations of coverages, please refer to your insurance contract and any applicable federal, state, and local laws.
Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers.
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