Medical Indemnity Insurance and Membership. Combined Financial Services Guide and Product Disclosure Statement for Doctors.

Transcription

1 Medical Indemnity Insurance and Membership Cmbined Financial Services Guide and Prduct Disclsure Statement fr Dctrs 1 July 2015

2 Medical Defence Assciatin f Suth Australia Limited ABN Medical Insurance Australia Pty Ltd ABN General Enquiries and Client Service Free Call Facsimile Claims and Legal Services (During Office hrs and 24hr emergency legal supprt) Free Call Facsimile Imprtant Ntice This PDS is fr guidance nly, and entitlements under the Plicy are determined in accrdance with the terms and cnditins f the particular Plicy and Plicy Schedule which is issued. The terms and cnditins f the insurance prvided by Medical Insurance Australia are fully cntained in the applicable Plicy Wrding, Plicy Schedule and any applicable endrsements. This dcument des nt frm part f the Plicy Wrding. miga@miga.cm.au Pstal GPO Bx 2048 Adelaide Suth Australia 5001 Head Office Level 14, 70 Franklin Street Adelaide, Suth Australia 5000 Printed using paper with EMAS, ISO14001 Envirnment Management Certificatin, FSC certified paper; Printed by carbn neutral printer Finsbury Green miga July 2015 miga Medical Indemnity Insurance & Membership July 2015

3 Defined Terms DEFINED TERMS APRA Means the Australian Prudential Regulatin Authrity Actual Incme, Estimated Incme, Grss Incme and Grss Indemnity Csts Have the meanings set ut in Sectins 5 and 12 f Part 2 Categry Means yur practice categry, as set ut in the Categries f Insurance Guide ECS Means Exceptinal Claims Indemnity Scheme FOS Means Financial Ombudsman Service FSG Means Financial Services Guide HCCS Means High Cst Claim Indemnity Scheme MDASA Means Medical Defence Assciatin f Suth Australia Limited MDO Means medical defence rganisatin Medical Insurance Australia Means Medical Insurance Australia Pty Ltd Medical Student Means a student registered in an apprved curse f medical study in a medical schl r university in Australia miga Means Medical Insurance Grup Australia which cmprises MDASA and Medical Insurance Australia MISS Means the Medical Indemnity Subsidy Scheme MPF Means Macquarie Pacific Funding PDS Means Prduct Disclsure Statement Perid f Insurance Means the perid f insurance nted n yur Plicy Schedule Plicy Means the Medical Indemnity Insurance Plicy that is issued t yu by Medical Insurance Australia Plicy Schedule Means the dcument issued by us t yu cnfirming the details f the insurance arrangements that are specific t yu fr the Perid f Insurance PSS Means the Premium Supprt Scheme RHEP Grant Means Rural Health Enhancement Package (applies in SA nly) ROCS Means the Run-ff Cver Indemnity Scheme RRMA Means Rural, Remte and Metrplitan Area Run-ff cver Means cver fr claims made in the future which relate t yur prir practice Sessin Has the meaning set ut in Sectin 5 f Part 2 SMO Means a Salaried Medical Officer SOA Means Statement f Advice us, ur r we Means miga yu, yur r yurself Means an individual wh is a member f MDASA and has medical indemnity insurance with Medical Insurance Australia miga Medical Indemnity Insurance & Membership July 2015 i

4 CONTENTS Cntents Defined Terms i Sectin 6 Run-Off Cver PART 1 PART 2 Sectin 1 Sectin 2 Sectin 3 Financial Services Regulatin Welcme t miga Abut miga 1 Financial Services Guide a Intrductin 2 b Financial services licence 2 c What qualificatins d ur emplyees have? 2 d Selecting the right Categry 2 e Dispute reslutin 2 Prduct Disclsure Statement Membership f MDASA a Intrductin 3 b Benefits f Membership 3 Medical Indemnity Insurance Plicy a Intrductin 5 b Overview f the Plicy 5 c Limits and Sub-limits f Indemnity 5 d What yu are cvered fr 6 e Key Plicy benefits 7 f Other matters that we cver yu fr 7 g Cver fr treatment f public patients 12 h Gd Samaritan Acts and Gratuitus Advice 12 i Yur Plicy Schedule and Certificate f Insurance 13 j What the Plicy des nt cver 13 k Ntificatin f claims and circumstances 13 Claims Made Insurance and Retractive Cver a Claims made insurance 14 b Retractive cver 14 c Calculatin f premiums 15 d What will yur tax invice include? 15 e Claims made premiums Why they may increase ver time Sectin 4 Chsing yur Categry 16 Sectin 5 Declaratin f Grss Incme a Intrductin 16 b Definitin f Grss Incme 17 c Special Cases 17 d Adjustment f Grss Incme / Sessins 17 e Audit f Grss Incme / Sessins 17 iii 16 Sectin 7 Sectin 8 Sectin 9 Sectin 10 a Why yu need Run-ff cver 18 b Types f Run-ff cver 18 c ROCS 19 d ROCS Gap Cver 19 e Standard Run-Off 19 f Mre infrmatin abut Run-Off Cver 20 Renewal f yur Insurance and Membership a Renewal 20 b Yur Tax Invice 20 c Payment and steps t finalise yur renewal 21 General Administratin a Steps t jining and btaining insurance with miga 21 b Once yur applicatin has been accepted 21 c Perid f insurance and membership 22 d Paying yur invice 22 e Paying yur invice by instalments 22 f Change in Categry 22 g Changing State r Territry f practice 22 h Resignatin f membership f MDASA 22 i Cancellatin f yur insurance 23 Claims and Advice Services a Overview 23 b Our advice service 23 c Claims management philsphy 23 d Ntificatin f claims 23 e Ntificatin f circumstances 24 Risk Management a Intrductin 25 b Value f ur Risk Management Prgram 25 c CPD pints a duble benefit 25 d Risk management services 25 e Risk Resurces 25 f Sectin 11 Mre infrmatin abut ur Risk Management Prgram Cmmnwealth Arrangements a Federal Gvernment refrm 26 b Medical indemnity - nly ffered by licensed insurers c Summary f key legislatin 26 d Medical indemnity legislatin key facts ii miga Medical Indemnity Insurance & Membership July 2015

5 Financial Services Regulatin FINANCIAL SERVICES REGULATION Sectin 12 Premium Supprt Scheme PART 1 SCHEME DETAILS a Intrductin 28 b The nature f the PSS 28 c Eligibility 28 d Electing int the PSS 28 e PSS subsidy calculatin 28 f Definitin f Actual and Estimated Incme 29 g Definitin f Grss Indemnity Csts 29 PART 2 TERMS AND CONDITIONS OF PSS h Payment f Grss Indemnity Csts 30 i Prvisin f infrmatin 30 j k Prvisin f infrmatin by thse dctrs eligible fr MISS Participatin in infrmatin sharing and cnfidentiality l Participatin in audits 30 m Factrs affecting a dctr s eligibility 30 n Medical practice utside Australia 31 Change f insurance details r Estimated Incme 31 p The administratin fee 31 q GST and Stamp Duty 31 r Dispute reslutin 31 s Alternative PSS calculatins MISS 32 t Imprtant Ntices in relatin t the Premium Supprt Scheme (PSS) Sectin 13 Imprtant Ntices Sectin 14 a Ntice t the Prpsed Insured 34 b Claims made insurance 34 c Retractive date 35 d Privacy 35 e Third Party Authrity fr Privacy reasns 35 Other Infrmatin a Cling-ff perid 36 b Dispute reslutin 36 c Cntacting us 37 d Privacy 37 e Other Infrmatin The Financial Services Regulatin (FSR) prvisins (Chapter 7 f the Crpratins Act) is legislatin designed t prtect cnsumers f financial services. Medical indemnity insurance is a type f general insurance which is a financial prduct under the FSR prvisins. It came int full effect n 11 March Fr ur clients this means that: When we prvide yu with persnal advice in relatin t yur insurance bjectives, financial circumstances r needs we must prvide yu with a Statement f Advice (SOA) that sets ut, amngst ther things, the advice and the basis n which it is given We are required t prvide yu with an FSG and PDS befre prviding yu with a financial service, such as prviding yu with advice r issuing r renewing yur insurance. The FSG and PDS are designed t: Prvide a wide range f infrmatin n the prducts and services we ffer including their features and benefits Help yu make infrmed decisins abut ur prducts and services. The intentin f these dcuments is that cnsumers are prvided with the same type f infrmatin abut services and prducts frm different prviders, which will make it easier fr them t make cmparisns. Financial Claims Scheme The Plicy may be prtected by the financial claims scheme administered by the Australian Prudential Regulatin Authrity (APRA), which nly applies in the unlikely event f an insurer becming inslvent. A persn wh is entitled t make an insurance claim under a prtected plicy may be entitled t payment under the financial claims scheme, if they satisfy the eligibility criteria. Mre infrmatin may be btained frm APRA at r Medical Practitiners Practising in New Suth Wales When making a decisin cncerning cver prvided t a practitiner wh practises in New Suth Wales, the Insurance Regulatin Order made under the Health Care Liability Act 2001 requires us t: prvide a claims histry n request t the practitiner; and cmply with certain cnditins when refusing cver t the practitiner (the cnditins vary depending n whether the practitiner is an existing plicyhlder r a new applicant). A cpy f the Order is set ut at: pubs/2006/ins_reg_rderjul2006.html miga Medical Indemnity Insurance & Membership July 2015 iii

6 ABOUT MIGA Welcme t miga Abut miga Abut the Grup We are a natinal prvider f indemnity insurance prducts and assciated services t the health care prfessin acrss Australia. We have wrked with and supprted the medical prfessin fr ver 110 years and ur experience with and knwledge f medical issues and the legal system is extensive. Our Head Office is in Adelaide. Medical Insurance Australia, ur insurance subsidiary, is a well funded, natinal, licensed, regulated insurance cmpany. Our visin Our visin is t empwer health care prfessinals t practise with cnfidence and achieve safer, better health care fr all Australians. Abut this dcument This dcument will be given t yu when we prvide yu with a qutatin fr insurance and membership with miga r when the ffer t renew yur insurance and membership is made. It applies t ur Plicy which is available fr dctrs in Australia, including thse wh are retired and thse wh require Run-ff cver. It cntains ur: FSG in PART 1 PDS in PART 2. It is imprtant that yu keep this Cmbined FSG and PDS as it prvides cmprehensive infrmatin n the benefits f yur insurance and membership arrangements with us. It als prvides yu with imprtant infrmatin abut ur claims handling prcesses and ur Risk Management Prgram. A separate Plicy wrding and Cmbined FSG and PDS are available fr Medical Students. Grup structure The Grup cmprises the fllwing tw perating cmpanies, which are cllectively referred t as miga. Operating Cmpany Medical Defence Assciatin f Suth Australia Limited (MDASA) A dctr-wned, mutual, nn-prfit rganisatin Frmed in 1899 It has n sharehlders, nly dctr members Medical Insurance Australia Pty Ltd (Medical Insurance Australia) A whlly wned subsidiary f MDASA A licensed general insurer Regulated by APRA Key functin Prvides a range f membership services Prvides medical indemnity insurance 1 miga Medical Indemnity Insurance & Membership July 2015

7 Part 1 Financial Services Guide PART 1 a) Intrductin This FSG is prvided t assist yu in making an infrmed decisin abut whether t acquire ur financial services. It cntains infrmatin abut wh we are, hw we can be cntacted, what services we are authrised t prvide t yu, hw we and ther relevant persns are remunerated and details f hw yu can make a cmplaint against us. It cntains nly general infrmatin n the financial services we ffer. When we give yu advice that takes int accunt ne r mre f yur bjectives, financial situatin and needs, we will give yu an SOA. The SOA will set ut the advice that yu have been given and explain the basis fr that advice. We have summarised within this FSG sme very imprtant infrmatin which must be read befre yu finalise yur insurance and membership arrangements with us. The terms and cnditins f the insurance prvided by Medical Insurance Australia, including all applicable exclusins, are fully cntained in the Plicy wrding, Plicy Schedule and any applicable endrsements. This FSG des nt frm part f the Plicy wrding. b) Financial services licence Medical Insurance Australia is licensed as an Australian Financial Services Licensee pursuant t sectin 913B f the Crpratins Act. Medical Insurance Australia s financial services licence number is Medical Insurance Australia is licensed t advise and deal in its wn medical indemnity general insurance prducts. Medical Insurance Australia is a whlly-wned subsidiary f MDASA and MDASA is an authrised representative (rep number ) f Medical Insurance Australia under Medical Insurance Australia s licence. MDASA is authrised t prvide these services under a binder arrangement, which means that it acts n behalf f and as the agent f Medical Insurance Australia. In prviding these services neither MDASA nr Medical Insurance Australia act n yur behalf. MDASA receives a management fee frm Medical Insurance Australia t act n behalf f Medical Insurance Australia in giving financial prduct advice, prviding services and issuing prducts. The management fee is calculated annually n an activity basis t reflect the cst f services prvided by MDASA t Medical Insurance Australia. Medical Insurance Australia has granted MDASA the authrity t distribute this FSG n its behalf. Medical Insurance Australia is liable fr the FSG and the infrmatin cntained within it. We fllw a strict plicy f recrding in file nte frm all financial prduct advice given ver the phne. A cpy f the dcumentatin in relatin t such advice given ver the phne will be prvided, upn written request, within 5 wrking days f receipt f the request. d) Selecting the right Categry This Cmbined FSG and PDS prvides infrmatin n: The services and prducts we ffer Sme issues yu shuld cnsider in selecting yur Categry The insurance cver prvided in each Categry. Details f all Categries are in ur Categries f Insurance Guide which is available frm ur website at It is very imprtant all f this infrmatin is read befre submitting an Applicatin r Change f Details Frm t ensure yu select the right Categry and that it prvides yu with what yu require in terms f medical indemnity insurance and membership. Cver under yur medical indemnity insurance is dependent n the Categry selected. It is imprtant yu select the Categry that mst accurately describes yur specific area f practice and the wrk yu actually undertake (r have undertaken). Yur Categry is determined by the fllwing: Whether r nt yu are practising The nature f wrk yu undertake (r have undertaken) Yur qualificatins as registered with the Medical Bard f Australia Whether yu are indemnified by yur emplyer fr yur wrk (i.e. Emplyer Indemnified) Whether yu require cver fr prescriptin writing, referrals, rdering pathlgy, Gd Samaritan Acts and/r Gratuitus Advice (if yu are n lnger practising). If yu are a Medical Student, yu need t refer t ur separate Cmbined FSG and PDS and Student Plicy fr Medical Students. e) Dispute reslutin We have in place a frmal dispute reslutin prcess, encmpassing bth internal and external dispute reslutin. Full details are prvided in the Sectin titled Dispute Reslutin n page 31. It is very imprtant that yu read the infrmatin in this Sectin t ensure yu are fully aware f yur rights and ur bligatins. c) What qualificatins d ur emplyees have? We understand that medical indemnity is a cmplex area and nt smething that dctrs deal with every day. That is why ur emplyees wh are invlved in the sale f insurance prducts and services are Tier 2 qualified based n FSR requirements. This enables them t prvide yu with meaningful advice and assistance when yu need it. miga Medical Indemnity Insurance & Membership July

8 Part 2 Prduct Disclsure Statement Sectin 1: Membership f MDASA a) Intrductin Yu must be a member f MDASA in rder t btain and renew medical indemnity insurance with Medical Insurance Australia. If medical indemnity insurance is nt required yu can still be a member f MDASA prvided yu are a registered dctr r a Medical Student. Yu must maintain registratin in rder t retain yur membership f MDASA. b) Benefits f Membership Membership f MDASA is gverned by the terms and cnditins f its Cnstitutin and brings with it the fllwing valuable benefits. Many f ur services and benefits are nly available via the Client Area f ur website. In the fllwing we have utlined the services and benefits that are available t thse wh are members f and/r are insured with miga. Services and benefits Bulletins Published bi-mnthly and als available via the website Feature articles n risk management, claims management, case studies, key insurance and membership issues, infrmatin abut us and imprtant medic-legal develpments Lng-term membership benefit After 40 years f cntinuus financial membership f MDASA, members are entitled t apply fr Cmpund Life Membership (CLM) This benefit rewards the lyalty f members t MDASA CLM prvides annual membership f MDASA at n cst If still practising, dctrs need t arrange and pay fr medical indemnity insurance thrugh Medical Insurance Australia Risk Resurces Prvides easy access t a wide range f risk management materials, infrmatin and tls t assist dctrs in their day t day medical practice (Sme Case studies are nly available t insured members) Persnal advice Available frm dedicated service persnnel Dctr s Wellbeing Prgram Prvides a range f ways t supprt, encurage and prmte the imprtance f dctrs lking after their wn health Includes infrmatin and tls t help identify and manage persnal health risks iphne App Technlgy Supprts a free iphne App ffering access t the latest Australian Medicare Benefits Schedule. The MBS Search Applicatin enables dctrs and their practices t btain the latest Australian Medicare Benefits Schedule free n their iphne Access t ur Risk Management Prgram Offers a maximum 10% discunt ff the next year s insurance premium upn full cmpletin Access t 24-hur emergency claims and legal advice Dctrs Supprt Services Catering fr emergency situatins where claims and legal advice is required Prvided t all insured members acrss Australia Dctrs wh are invlved in a claim can access the fllwing services: Medical Supprt Service prvided by ne f a grup f psychiatrists r psychlgists ffering prfessinal clinical supprt Peer Supprt Service prvided by ne f a grup f dctrs ffering supprt and understanding 3 miga Medical Indemnity Insurance & Membership July 2015

9 Sectin 1: Membership f MDASA (cntinued) Services and benefits Client nly internet access Risk management services Prvides a range f n-line resurces, including: Insurance On-line cmpletin and ldgement f Change f Details Frm, payment and access t Certificates f Insurance Medic-legal Services - On-line ldgement f claims and circumstance ntificatins Risk Management Prgram On-line bkings fr Wrkshps Access t status f Pints accumulated thrughut the year and activities cmpleted On-line access t Practice Self Assessments, Questinnaires and Speciality Quizzes prviding immediate feedback and benchmarking against ther participants Services available n an as needs basis include: Risk management advice Member presentatins Practice reviews fr members/practices with a higher than average risk prfile Starting Private Practice Package An attractive insurance Package which recgnises the significant cst and time it takes t establish a private practice fr the first time and reflects ur supprt f dctrs transitining t private practice Access t benefits f cntinuus membership/insurance Free r lw-cst Run-ff cver fr dwngrades in Categry and fr ROCS Gap Cver, n cmpletin f qualifying perids Premium funding A range f payment ptins via a third party funding arrangement Dctrs in Training - Grants Prgram Prvides funding t assist dctrs in training whilst pursuing specialist training pprtunities in Australia and abrad miga Medical Indemnity Insurance & Membership July

10 Part 2 Prduct Disclsure Statement Sectin 2: Medical Indemnity Insurance Plicy a) Intrductin Our Medical Indemnity Insurance Plicy has been develped t meet the needs and requirements f mdern medical practice and the unique requirements f ur dctr members. A cpy f the Plicy will be prvided t yu with yur qutatin r renewal. It is very imprtant that yu read the Plicy and familiarise yurself with the scpe f cver, terms, cnditins and exclusins. If yu are a Medical Student the Plicy details prvided in this Sectin d nt apply t yu. Cntact us fr details f ur medical indemnity insurance fr Medical Students. The infrmatin in this Sectin is fr guidance nly. Entitlements under the Plicy are determined in accrdance with the terms and cnditins f the particular Plicy and the Plicy Schedule that is issued t yu. b) Overview f the Plicy The Plicy prvides cver fr: Claims and Claim Csts A range f Expenses including in relatin t prceedings, inquests, inquiries, investigatins r cmplaints; and Advice and advisry assistance arising ut f the practice f medicine. The Plicy has been develped recgnising that nt all members need the full range f cver. The cver prvided is in accrdance with the Categry yu select and as utlined in yur Qutatin and Plicy Schedule. c) Limits and Sub-limits f Indemnity The aggregate Limit f Indemnity and Sub-limits f Indemnity prvided by us are as fllws: Sectin Claims and Claim Csts Expenses Other matters that we cver yu fr Limit (any ne claim and in the aggregate in the Perid f Insurance) $20,000,000 fr Claims and Claim Csts (assciated legal expenses) $1,000,000 fr Expenses Sub-Limit fr In relatin t threats t the persnal safety f the dctr, Emplyees r their immediate family (Refer clause 1.4(f) f the Plicy) Fr cmplaints under an emplyment r cntract r cntract fr services (Refer clause 1.4(b) and 1.4(c) f the Plicy). Subject t a Deductible f $1,000 each claim, inclusive f csts and expenses Fr disputes under a visiting medical fficer cntract f the dctr (Refer clause 1.4(d) f the Plicy) Fr cmplaints in relatin t the by-laws f a prfessinal cllege r assciatin. (Refer clause 1.4 (e) f the Plicy Sub-Limits (any ne claim and in the aggregate in the Perid f Insurance) Nne $175,000 ($5,000 in the case f Interns) $150,000 (Cmbined) $50,000 Lss f Dcuments (Refer clause 2.8 f the Plicy) $100,000 Out f pcket expenses (Refer clause 2.14 f the Plicy) $10,000 Inncent partner cver (Refer clause 2.18 f the Plicy) Prtectin f reputatin (Refer clause 2.19 f the Plicy). Subject t a Deductible f $2,500 each claim, inclusive f csts and expenses Limited by reference t the number f partners in the partnership $50,000 Public relatins expenses (Refer clause 2.21 f the Plicy) $25,000 Cmmunicable disease cver (Refer clause 2.23 f the Plicy) $100,000 The abve limits are nt cumulative which means that cver fr Claims and Claim Csts and Expenses are subject t an verall aggregate limit f $20,000,000 in any ne Perid f Insurance. Cver fr Expenses is sub-limited t $1,000,000 in any ne Perid f Insurance. The aggregate limit and each sub-limit f cver is exclusive f GST t the extent that we are entitled t a GST credit. Lwer Sub-Limits may apply in ther situatins and if applicable t yu they are detailed in yur Qutatin and Plicy Schedule. 5 miga Medical Indemnity Insurance & Membership July 2015

11 Sectin 2: Medical Indemnity Insurance Plicy (cntinued) The cver under the Plicy is divided int the fllwing areas, as fllws: Sectin Claims and Claim Csts cver fr claims arising ut f the practice f medicine within the Categry Expenses Prvides cver fr: Damages and claims fr cmpensatin Legal csts incurred in defending claims Cver Prvides cver fr legal csts in defending r respnding t varius matters in cnnectin with practice; Includes cver fr defending a prsecutin r respnding t inquests, inquiries, investigatins r cmplaints r cmplying with a requirement t prduce medical recrds arising frm the practice f medicine within the Categry selected Als cvers legal csts in defending r pursuing cmplaints r prceedings invlving emplyment and visiting medical fficer matters and allegatins f discriminatin, harassment and breach f equal pprtunity law Yu are nly entitled t cver as per yur Categry and as utlined in yur Qutatin and Plicy Schedule if yu: Are a member f MDASA Are registered by the Medical Bard f Australia Have declared yur crrect practice infrmatin, including Grss Incme r Sessins (as defined in Sectin 5) and paid the full amunt f any premium, adjustments and charges due t us Prvide a declaratin f actual Grss Incme/Sessins upn request Have been issued a Plicy Schedule reflecting the cver prvided. d) What yu are cvered fr The cver we prvide is limited t the wrk yu undertake as per the Categry selected, as fllws: Categry Cver fr Claims and Claim Csts Cver fr Expenses Specialists All Specialist categries Yes Yes General Practitiners All GP categries Yes Yes Csmetic Dctrs All Csmetic Dctr categries Yes Yes Staff Specialists With limited Private Practice Yes Yes With n Private Practice Medical Bard and Tribunal cver nly N* Yes Salaried Medical Officers SMO in Training includes Private Practice Yes Yes SMO >PGY5 with limited Private Practice Yes Yes With n Private Practice Medical Bard and Tribunal cver nly N* Yes Interns N* Yes Other Practice All Other Categries (Refer pages f the Categries f Insurance Guide) Yes Yes * Other than in relatin t Gd Samaritan Acts and Gratuitus Advice. Fr full details f all Categries including retired and temprarily nt practising please refer t the Categries f Insurance Guide which is available frm ur website at miga Medical Indemnity Insurance & Membership July

12 Part 2 Prduct Disclsure Statement Sectin 2: Medical Indemnity Insurance Plicy (cntinued) e ) Key Plicy benefits Our Plicy wrding incrprates a range f very imprtant benefits fr ur members. These include the fllwing: Benefit Wh is insured Scpe f cver fr Expenses Detail Our Plicy is structured t respnd t the changing nature f dctrs medical practice depending n yur Categry and Plicy Schedule. It includes as an insured: The Dctr named in the Plicy Schedule A cmpany r trust wned and cntrlled by the dctr and which prvides services fr the purpse f the Practice by the dctr Persns wh are Emplyees fr matters that arise ut f their emplyment whilst they are wrking in the cnduct f the Practice (sme emplyees are nt included, as utlined belw) Medical Students: Prvided they are assigned t the Practice by their university In relatin t matters that arise whilst wrking in the Practice. Emplyees wh are nt included as an insured are: Dctrs, as they must arrange their wn insurance Any persn wh is registered as an eligible midwife by the Nursing and Midwifery Bard f Australia whse registratin has an eligible midwife ntatin Any ther persn wh prvides health care treatment, advice r service charged fr and billed in their wn name. Our Plicy prvides cver fr Expenses incurred in relatin t investigatins, prceedings r cmplaints. These include: Medical bard, medical tribunal r ther disciplinary investigatins and prceedings Hspital, health service r health authrity, private health insurer r Medicare Australia Prfessinal cllege r assciatin, health service and health care mbudsman inquiries and cmplaints investigatins and prceedings by the Office f the Australian Infrmatin Cmmissiner (and ther such gvernment/statutry authrity r ther bdy perfrming similar functins r exercising similar pwers t the abve bdies) Crnial inquiries, ryal cmmissins Criminal investigatins and prceedings Health Insurance Act 1973 inquiries Cmpetitin and Cnsumer Act 2010 r equivalent State r Territry legislatin Threats t yur persnal safety r that f yur emplyees In defending cmplaints and prceedings by persns (including emplyees) wh prvide services t the practice In defending r pursuing matters in relatin t yur cntract as a visiting medical fficer In defending r pursuing matters in relatin t yur emplyment cntract Cmplaints r prceedings in relatin t the by-laws f a prfessinal cllege r assciatin in respect t yur participatin in a training prgram. In terms f allegatins re inapprpriate practice, transmissin f disease, intxicatin etc, cver is prvided t assist with the defence f these matters, i.e. we take an inncent until prven guilty apprach. This prvides very imprtant prtectin in the event f such allegatins. f) Other matters that we cver yu fr Our Plicy prvides sme imprtant extensins t cver, as shwn in yur Plicy Schedule. Sme extensins are mre imprtant fr sme practices than thers s refer t yur Categries Guide and cnsider their applicatin t yur situatin. Fr example, sme extensins t cver may nly apply if yur Categry includes cver fr claims fr cmpensatin. Other extensins t cver may nly be relevant t yu if yur Categry includes cver fr private practice. 7 miga Medical Indemnity Insurance & Membership July 2015

13 Sectin 2: Medical Indemnity Insurance Plicy (cntinued) Benefit Detail Intern Public Patients Gd Samaritan Acts Wrldwide Gd Samaritan Acts fr Emplyees in Australia and verseas Vicarius liability Cvers yu fr the treatment f public patients prvided yu are nt therwise entitled t indemnity fr medical services prvided t Public Patients. Salaried Medical Officer in Training Other Dctrs Cvers yu fr Gd Samaritan Acts anywhere in the wrld including USA. Emplyees are autmatically cvered fr Gd Samaritan Acts which ccur in Australia in the curse f emplyment. Emplyees are als cvered fr Gd Samaritan Acts verseas (excluding the USA and jurisdictins t which the laws f the USA apply) which ccur in the curse f their emplyment by yu r a Practice Entity, where yu and the Practice Entity are cvered fr Practice verseas (as defined in the Plicy). Cvers yu and the Practice Entity fr vicarius liability in respect f acts, errrs r missins cmmitted r alleged t have been cmmitted by: (a) Anther insured in the curse f Practice (b) An emplyed dctr, cntractr (including a lcum) (N cver is prvided in relatin t these parties unless they held a valid plicy f insurance at the time f the act, errr r missin that cvered claims arising frm health care.) Cver is subject t: Wrk that he r she is emplyed r cntracted by yu r a Practice Entity t undertake; and Where he r she is registered if required by law t be registered; and The wrk is within yur Categry r a lwer risk Categry as determined by us. (c) A nn-emplyed health care prfessinal under direct supervisin, training r mentring by yu in the curse f prviding health care treatment, advice r service within the same Categry as yu. A nn-emplyed health care prfessinal means a persn wh, at the time f the act, errr r missin: was a registered dctr, a registered nurse, a registered nurse practitiner r a registered midwife, respectively, wh was nt emplyed by yu r a Practice Entity r in partnership with yu; and was required by a cllege, training institutin, medical bard r nursing and midwifery bard t be directly supervised, trained r mentred by yu fr the purpse f btaining, retaining r regaining a recgnised prfessinal medical r nursing r midwifery qualificatin, award r registratin. miga Medical Indemnity Insurance & Membership July

14 Part 2 Prduct Disclsure Statement Sectin 2: Medical Indemnity Insurance Plicy (cntinued) Benefit Detail Intern Practice utside the Cmmnwealth f Australia Vlunteer Practice Cmpetitin and Cnsumer Cmplaints Liability fr restricting ability t practise Medical research and clinical trials Lss f Dcuments Advice and advisry assistance Cvers yu fr practice verseas, excluding the USA and jurisdictins t which the laws f the USA apply, prvided the ttal perid f verseas practice des nt exceed 120 days during the Plicy Perid. Cver is prvided fr yu and an Emplyee accmpanying yu, as a team dctr fr an Australian sprting team r cultural grup that is travelling, cmpeting r perfrming in the USA fr n mre than 120 days during the Plicy Perid. Cvers yu fr claims arising ut f wrk as an unpaid vlunteer in the curse f vlunteer activities, including any amateur sprting activity, schl r cmmunity based event, charity wrk, aid prgram r disaster respnse wrk. Cvers yu fr any actin by a gvernment r statutry authrity alleging a cntraventin f r seeking relief under a prvisin f the Cmpetitin and Cnsumer Act 2010 r any equivalent State r Territry legislatin. Cvers yu fr claims arising in the curse f supervising, training r mentring a registered dctr: Wh was required t be directly supervised, trained r mentred fr the purpse f btaining, retaining r regaining a recgnised prfessinal medical qualificatin, award r registratin Where the allegatin is that yu have restricted the ability f the registered dctr t prvide health care treatment advice r service in the future. Cvers yu and any Emplyee under yur direct cntrl and supervisin fr any claim arising slely ut f yur rle in any medical research r clinical trial as an investigatr r c-investigatr, if the medical research r clinical trial is: apprved by a prperly cnstituted human research ethics cmmittee apprved and registered by the NHMRC; cnducted in accrdance with the requirements f that ethics cmmittee; and within the Categry fr which yu are insured. Cvers yu and a Practice Entity fr the reasnable cst f replacing r restring dcuments (as defined) in yur pssessin if they are destryed, damaged, lst r mislaid. Is prvided t yu in respect f any cver prvided t yu under the Plicy and where yu are in Australia and require emergency claims and legal advice, it will be available 24 hurs a day. Salaried Medical Officer in Training Other Dctrs 9 miga Medical Indemnity Insurance & Membership July 2015

15 Sectin 2: Medical Indemnity Insurance Plicy (cntinued) Benefit Detail Intern Salaried Medical Officer in Training Other Dctrs ROCS Gap Cver ROCS Gap Cver prvides cver fr yu if yu: permanently cease private practice; and are nt yet eligible fr ROCS, i.e. yu have nt yet reached age 65; and have 5 years f cntinuus insurance/ membership with us (excluding insurance as a Medical Student). Threat t persnal safety Out f pcket expenses Run-ff cver Liability fr Cmplaints abut thers We prvide Run-ff cver t eligible dctrs fr up t 3 years n an annually renewable basis until they are eligible fr ROCS. Any additinal premium is capped at $50 per annum exclusive f statutry charges. Cvers yu fr Expenses in relatin t any threat t the persnal safety f yu, an emplyee, r yur r their immediate family that arises in relatin t yur Practice. Cvers yu fr reasnable ut f pcket expenses incurred by yu in respnding t a Claim r a matter that has given rise t Expenses, subject t ur prir apprval. This is intended t cver csts such as travel, meals and accmmdatin expenses. Cvers yu at n additinal cst fr wrk undertaken under a prir Categry if that wrk is nt cvered under yur current Categry where we have cvered yu cntinuusly fr a perid f at least: (i) 2 years, if the Categry is fr nging practice (ther than an emplyer indemnified, nn-clinical, retired, cmpund life r suspended Categry); r (ii) 5 years, if the Categry is an emplyer indemnified Categry. We may therwise require an additinal premium, including fr where cver is n lnger required fr Public Patients and based n Yur claims and practice histry. Cvers yu fr Claims arising frm yu: having reprted an incident and/r a health care prfessinal t a Medical Bard r ther bdy respnsible fr the prfessinal discipline f health care prfessinals; r assisting in an investigatin in relatin t the incident r the reprting f an incident t any ne r mre bdies respnsible fr the prfessinal discipline f health care prfessinals. miga Medical Indemnity Insurance & Membership July

16 Part 2 Prduct Disclsure Statement Sectin 2: Medical Indemnity Insurance Plicy (cntinued) Benefit Detail Intern Inncent partner cver Prtectin f reputatin Pursuit f indemnity Public relatins expenses Unintentinal intellectual prperty rights infringements Cver fr prir practice Cmmunicable Diseases Cver Cvers yu fr Claims arising ut f yur jint and several liability in partnership if: yu have btained written evidence f current insurance cvering yur partner(s) each year; and yur partner(s) wrk within the Categry fr which yu are insured, r a lwer risk Categry as determined by us. Cver under this extensin is limited t yur ttal liability divided by the number f partners in the partnership, r the aggregate limit f indemnity, whichever is lesser. Cvers yu against Expenses incurred in relatin t cmplaints and prceedings pursued by yu alleging defamatin in cnnectin with Practice, prvided the cmplaint r prceeding is nt pursued against persns insured by us. Cvers yu fr Expenses incurred in pursuing a third party (e.g. insurer, hspital etc) fr indemnity in respect f any Claim where yu are entitled t indemnity frm the third party. Cvers yu fr Expenses incurred in engaging a public relatins cnsultant fr the purpse f prtecting yur reputatin as a result f a Claim. Salaried Medical Officer in Training Other Dctrs Cvers yu fr any Claims, Claim Csts r Expenses frm an unintentinal infringement f a third party s intellectual prperty rights in the curse f Practice. Cvers yu at n additinal cst fr claims which are nt cvered by the plicy because they arise frm health care treatment, advice r service that was undertaken by yu and determined by us t be a lwer risk categry, prvided we have insured yu cntinuusly. This includes fr claims arising in relatin t when yu were a medical student r intern. Cvers yu if yu first test psitive fr a Cmmunicable Disease during the Perid f Insurance prvided that the plicy cnditins are met, including a 3 mnth waiting perid after the start f the Perid f Insurance. The abve is a brief summary f the cver prvided and yu must refer t ur Plicy fr full details f the cver prvided under these extensins. 11 miga Medical Indemnity Insurance & Membership July 2015

17 Sectin 2: Medical Indemnity Insurance Plicy (cntinued) g) Cver fr treatment f public patients Cver fr treatment f public patients is autmatically prvided (refer clause 2.16 f the Plicy), subject t the terms and cnditins f the Plicy, except where yu are: therwise indemnified fr such claims; r insured in a Categry that excludes r des nt extend t cver claims arising ut f the treatment f public patients (see fllwing). If yur practice invlves the treatment f public patients, it is imprtant that yu clarify whether yu are entitled t be indemnified by any ther surce (including but nt limited t a State Gvernment r yur emplyer) fr claims that arise ut f such wrk. If yu are indemnified, r entitled t be indemnified, by any ther surce (including but nt limited t a State Gvernment r yur emplyer) fr the treatment f public patients, yu will nt be insured under ur Plicy fr any claims that arise ut f such treatment (Refer Plicy exclusin 5.25). Where cver fr the treatment f public patients is required, it is imprtant that yu: check yur Categry t make sure it des nt exclude cver fr the treatment f public patients (refer belw). If yur Categry excludes cver fr the treatment f public patients, call us t change yur Categry t ne that meets yur specific requirements include yur Grss Incme/Sessins frm public wrk in yur declaratin f Grss Incme/Sessins t us. Categries that specifically exclude cver fr treatment f public patients Please nte sme Categries specifically exclude cver fr treatment f public patients and they are: GP - Rural Private nly in SA and GP Obstetrics - Rural Private nly in SA refer Sectin 3 f ur Categries f Insurance Guide Interns refer Sectin 6 f ur Categries f Insurance Guide Emplyer Indemnified refer Sectin 5 f ur Categries f Insurance Guide. Fr infrmatin abut the Categries f Insurance we ffer please refer t ur website at If yu select any f the abve Categries: n cver is prvided fr Claims and Claim Csts under the Plicy fr claims fr cmpensatin arising frm the treatment f public patients cver is prvided fr Expenses under the Plicy fr csts incurred in relatin t cmplaints, inquiries, investigatins etc in relatin t the treatment f public patients: t the extent yu are nt therwise entitled t indemnity subject t specific limitatins in sme Categries and as detailed in yur Qutatin and Plicy Schedule. Fr example, fr the Categry f Emplyer Indemnified Staff Specialist Medical Bard and Tribunal cver nly cver fr Expenses under the Plicy is restricted slely t inquiries etc by a Medical Bard, Medical Tribunal r crner. In ther Categries, the scpe f cver fr treatment f public patients is determined by the specific activities cvered within that Categry e.g. if yu select Medical Academic yu are nt insured fr any claims that arise frm clinical patient cntact f any kind, whether public r private. If yu prvide treatment t public patients and yu are nt clear n the cver prvided by us, please cntact ur Client Services Department t clarify yur entitlements. Infrmatin n cver fr public patients Yu are required t prvide an accurate estimate f yur Grss Incme / Sessins fr the treatment f public patients fr which yu require cver frm us. This is because we require data n the prprtin f ur insured dctrs wh need this cver. It is imprtant t nte that yu will still be entitled t indemnity fr claims arising frm the treatment f public patients, prvided: yu are nt therwise entitled t indemnity fr such wrk yu advise us f yur incme/sessins fr such wrk in yur declaratin f Grss Incme/Sessins; and it is nt excluded by the Categry that yu have selected. h) Gd Samaritan Acts and Gratuitus Advice Cver fr Gd Samaritan Acts and Gratuitus Advice is autmatically included, prvided yu have current insurance when the claim is made and the incident ccurred after any relevant retractive date in yur Plicy. Gd Samaritan Acts These are defined as acts where a dctr prvides medical treatment r advice in an emergency situatin (e.g. at the scene f an accident) subject t the fllwing: it must be fr an unfreseen emergency situatin there is n ther indemnity r immunity that applies (e.g. via legislatin, frm the State Gvernment, yur emplyer r any ther party) there is n request by yu fr payment r reward fr the service and n nging care is prvided. miga Medical Indemnity Insurance & Membership July

18 Part 2 Prduct Disclsure Statement Sectin 2: Medical Indemnity Insurance Plicy (cntinued) Gratuitus Advice Gratuitus Advice is defined as advice prvided frtuitusly and utside f cmmercial medical practice, subject t the fllwing: yu are registered with the Medical Bard f Australia at the time the advice is given there is n request by yu fr payment r reward fr the advice n cver is prvided fr prescriptins, unless yu have insurance fr prescriptin writing with Medical Insurance Australia. If yu are nly insured fr Gd Samaritan Acts and Gratuitus Advice n cver is prvided in circumstances where yu undertake vluntary medical wrk r yu wrk n a pr-bn basis. If yu wrk n a vluntary r a pr-bn basis yu must select a Categry fr practising dctrs as utlined in the Categries f Insurance Guide. i) Yur Plicy Schedule and Certificate f Insurance On receipt f full payment fr renewal, r nce an Applicatin Frm has been accepted and full payment is received, we will frward a Plicy Schedule and Certificate f Insurance t yu. If yur insurance Plicy with Medical Insurance Australia is subject t any Special Cnditins r Endrsements, they will cntinue t apply when yur Plicy is renewed, unless we agree that they are n lnger relevant. Full details f all such Special Cnditins r Endrsements will be recrded n yur Qutatin and Plicy Schedule. j) What the Plicy des nt cver The Plicy des nt prvide cver in certain instances. These are set ut in Sectin 5 f the Plicy wrding (Claims and Expenses that we d nt cver yu fr) but may als be cntained within cnditins r endrsements r where specifically excluded under the Categry. It is very imprtant yu familiarise yurself with yur Categry by reference t the Categries f Insurance Guide (available via ur website) and read these exclusins, cnditins and additinal endrsements and cntact us if yu have any questins abut them. k) Ntificatin f claims and circumstances The Plicy requires that yu prvide written ntice f any Claim made against yu during the Perid f Insurance, which is the perid f insurance nted n yur Plicy Schedule. This invlves yu advising us f the full details f an alleged incident and any subsequent claim, investigatin r ther cvered matter as sn as yu becme aware f it and in any event prir t the expiry f the Plicy. If yu d nt prvide the required ntice during the Perid f Insurance then yu may nt be cvered in respect f that claim. It is very imprtant yu ensure we are advised as sn as yu becme aware f a claim and that yu ensure this ntificatin is made t us befre the Plicy expires. In additin t this, it is imprtant that yu nte the fllwing in relatin t the ntificatin f circumstances during the Perid f Insurance. The Insurance Cntracts Act 1984 prvides that if, after the end f the Perid f Insurance, a claim is made against yu which arises frm facts that yu ntified t us: in writing; as sn as reasnably practicable after yu became aware f them; and befre the end f the Perid f Insurance then we will prvide cver in accrdance with the terms and cnditins f the Plicy in respect f the claim against yu, even if the claim was made against yu after the end f the Perid f Insurance. We therefre encurage yu t ntify us as sn as yu becme aware f any circumstance r incident which has the ptential t lead t a claim, whether r nt a frmal claim is made against yu. Nte: The Plicy des nt prvide cver fr any claims f which yu were aware prir t effecting medical indemnity insurance with us. In additin n cver is prvided in relatin t any circumstances f which yu were aware prir t effecting medical indemnity insurance with us with the ptential t give rise t a claim in the future. If yu are effecting medical indemnity insurance with us fr the first time we recmmend yu ensure that yu reprt any claims r circumstances t yur current insurer prir t expiry f yur current insurance. 13 miga Medical Indemnity Insurance & Membership July 2015

19 Sectin 3: Claims Made Insurance and Retractive Cver a) Claims made insurance The Plicy we ffer is n a claims made basis. This means the Plicy will respnd t Claims made against yu and ntified t us in writing during the Perid f Insurance, subject t the Plicy terms and cnditins. The Plicy will nt prvide cver in relatin t: events that ccurred prir t the retractive date specified in the Plicy Schedule claims first made against yu r claims first ntified t us after the expiry f the Perid f Insurance even thugh the event giving rise t the claim may have ccurred during the Perid f Insurance claims ntified r arising ut f facts r circumstances ntified (r which ught reasnably t have been ntified) under any previus plicy r indemnity arrangement claims made, threatened r intimated against yu prir t the cmmencement f the Perid f Insurance claims arising ut f facts r circumstances f which: yu first became aware prir t the Perid f Insurance, yu failed t ntify us; and which yu knew (r ught reasnably t have knwn) had the ptential t give rise t a claim under the Plicy claims arising ut f circumstances nted n any Change f Details Frm r n any previus Applicatin r Renewal Frm any matter referred t in Sectin 5 f the Plicy. Hwever, where yu give ntice in writing t us f any facts that might give rise t a claim against yu as sn as reasnably practicable after yu becme aware f thse facts but befre the expiry f the Perid f Insurance, the Plicy will, subject t the terms and cnditins, cver yu ntwithstanding that a claim is nly made after the expiry f the Perid f Insurance. b) Retractive cver Retractive cver and yur retractive date Our medical indemnity insurance cvers claims made during the Perid f Insurance fr incidents that ccur after yur retractive date and befre the end f the Perid f Insurance. It is imprtant yu nte the fllwing: yur retractive date is recrded in yur Qutatin and Plicy Schedule yu are nt cvered fr any claim made against yu during the currency f yur medical indemnity insurance relating t an incident r circumstance that ccurred prir t the agreed retractive date if yu were a member f MDASA prir t 1 July 2000 the retractive date n yur insurance Plicy will be 1 July This means the insurance will cver claims made during the Perid f Insurance fr incidents that ccurred n r after this date, subject t the Plicy terms and cnditins if yu were a member f MDASA prir t 1 July 2000, yur current insurance and membership arrangements d nt affect any prir claims incurred entitlements yu have with MDASA different retractive dates may apply in relatin t Categry upgrades and ther changes t cver. Please refer t any Special Cnditins in yur Qutatin and Plicy Schedule. D yu require a change t yur retractive date? It is imprtant t cnsider whether yu require any changes t yur retractive cver. The Medical Indemnity (Prudential Supervisin and Prduct Standards) Act 2003 requires that we make an ffer t yu: befre yu enter int the Plicy; whenever yu renew the Plicy; and befre the Plicy cmes int effect fr retractive cver fr claims that are made against yu during the Perid f Insurance in relatin t yur therwise uncvered prir incidents. As a guide, yu may require retractive cver if any f the fllwing circumstances apply: Yur claims incurred membership with an MDO was nt cntinuus (i.e. yu had gaps in yur membership) Yu had claims incurred membership with an MDO but yu were nt a financial member f the MDO at the time yu resigned r left. Yu may nt have been a financial member fr example, if yu did nt pay a call, had utstanding subscriptins r yu did nt resign in accrdance with yur bligatins under the Cnstitutin f the MDO Yu had claims made membership with yur prir MDO and did nt purchase Run-ff cver at the time yu resigned r left Yu purchased Run-ff cver at the time yu resigned r left yur prir MDO n an annually renewable basis, which yu have nt maintained Yu had a prir perid f claims made insurance with an insurer fr which yu did nt effect and maintain Run-ff cver miga Medical Indemnity Insurance & Membership July

20 Part 2 Prduct Disclsure Statement Sectin 3: Claims Made Insurance and Retractive Cver (cntinued) Yu practised withut membership f an MDO and/r withut insurance (i.e. yu were self-insured) The nature f yur practice has changed in the past but yu did nt infrm yur prir MDO r insurer f all relevant changes. In making yu an ffer fr retractive cver we will rely n yu t advise us: if yu require retractive cver; the perid(s) fr which yu believe yu were uncvered; and the nature f yur practice during the perid(s) yu believe yu were uncvered. If at any time yu believe yur claims made retractive date may nt be apprpriate (because yu have becme aware that yu may have an uncvered prir perid that yu did nt take int accunt at the time f effecting r renewing yur medical indemnity insurance) please cntact us s that we can review yur requirements fr retractive cver. If yu advise us f an uncvered prir perid during the currency f the Plicy we will prvide yu with an ffer t amend yur retractive cver mid-term. c) Calculatin f premiums The insurance premium yu pay is determined by a number f factrs including the fllwing: The nature f yur practice The State(s) in which yu practise Yur declared Grss Incme and/r Sessins Any discunt yu are entitled t fr participatin in the Risk Management Prgram The perid f retractive cver yu require Yur claims r lss histry; and Any extensins yu require t yur cver. Premiums are determined taking int accunt independent actuarial advice which includes an assessment f histrical and expected future claims csts fr us. An extensive range f infrmatin is taken int accunt t determine bth ur verall premium pl and premiums at Categry level, including the fllwing: Our claims experience Industry experience Our understanding f differences in risk between each Categry Feedback frm reinsurers n their experience f relativity f risk between Categries; and Industry benchmarking. In additin, the fllwing csts are incrprated in ur premium pl: Expected claims csts Expected perating csts The cst f buying reinsurance in rder t prtect us; and The capital (surplus) required t meet Medical Insurance Australia s prudential and regulatry requirements. d) What will yur tax invice include? Yur tax invice is made up f the fllwing parts: Membership Fee Base Premium Risk Management discunt (if applicable) Run-ff premium (if applicable) Run-Off Cver Scheme levy GST Stamp Duty Premium Supprt Scheme (PSS) (if applicable) RHEP Grant (if applicable fr SA Dctrs nly) SA Gvernment GP Indemnity Supprt Grant (if applicable fr SA Dctrs nly). 15 miga Medical Indemnity Insurance & Membership July 2015