Ext: 5158

Transcription

1 Acupuncture Plus Malpractice Policy To be considered for coverage complete the attached application and forward to: William H. Scott III, CIC Scott Danahy Naylon Co., Inc 300 Spindrift Drive Amherst, New York Ext: 5158 Fax (716)

2 SCOTT DANAHY NAYLON COMPANY, INC. Thank you for your interest in our Professional Liability Program. The coverage is underwritten by Allied Professional Insurance Company, A Risk Retention Group, Inc. better known as the American Acupuncture Council (AAC). We are offering a Claims Made or Occurrence policy. The policy limits are $1,000,000 per claim/$3,000,000 total policy limit at annual premiums as follows: BASE RATES CLAIMS MADE FORM OCCURRENCE FORM First year Practitioner $550 $592 Second year Practitioner $760 $827 All others $900 $984 Part time Practitioner $550 $592 Please complete the application in its entirety. It is very important to have an exact effective date for your policy to start, and note that we must receive your application in our office prior to the desired effective date. When returning your completed application, please also include: 1. A check payable to the American Acupuncture Council for the full annual premium OR if paying by credit card, the appropriate information completed on the application. 2. A copy of your current policy's Declaration Page (if applicable). If you have any questions or need additional information, please don't hesitate to give our office a call. Sincerely, William H. Scott III, CIC Acupuncture Program Manager 300 Spindrift Drive, Amherst, New York phone fax web

3 SCOTT DANAHY NAYLON COMPANY, INC. Acupuncture Professional Liability Insurance Program Coverage Benefits Professional, fast & friendly service. Both Claims-Made and Occurrence policies are available. $1,000,000 per claim and $3,000,000 annual aggregate coverage limits. No deductibles. Prior Acts coverage available with proof of current insurance. Entity Coverage available. No Arbitration Agreements necessary. Special rates for new licensees aimed to help you get your practice started. Part-time coverage available for individuals working 20 hours or less per week. Coverage includes Oriental & Herbal Medicine. Coverage available for students/internship. Massage & Physical Therapy coverage available. Injection Therapy coverage available. College faculty credits. Premium waiver for medical-leave period. Access to our exclusive Acu-Pac Program for your Business Owners Liability policy. Competitive rates. Claim-Made Policy First Year Practitioner: $550 Second Year: $760 All Other: $900 Part Time: $550 Occurrence Policy First Year Practitioner: $592 Second Year: $827 All Other: $984 Part Time: $592 Scott Danahy Naylon Program Department 1 (800) Spindrift Drive, Amherst, New York phone fax web

4 SCOTT DANAHY NAYLON LLC Visa MasterCard American Express

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7 SCOTT DANAHY NAYLON COMPANY, INC. Coverage Comparison An occurrence policy provides coverage for any incident that occurs during the policy period regardless of whether or not the policy is still in effect at the time the claim is made. An advantage of the occurrence coverage form is the certainty that a claim will be covered if the incident from which the claim arose occurred during a time when insurance was in place. Also, there is no need to obtain additional coverage upon termination of coverage as would be necessary with a claims-made policy. A claims-made policy provides coverage for claims that occur subsequent to the retroactive date and reported to the insurer while the policy is still in force. The retroactive date is the first date on which an incident may occur and be covered by the policy; usually the date the policy was initially purchased (1 st policy effective date). It is important to understand the concept of claims-made insurance coverage, in order to prevent potential gaps in coverage. The major difference between occurrence and claims-made coverage forms is that with the occurrence form, claims do not have to be reported before the termination of the insurer-insured relationship, under the claims-made form, they do; unfortunately, it may not be possible to do so. Therefore, to ensure coverage of incidents that occurred prior to termination but were reported after expiration of the last policy period, the insured must purchase either an extending reporting endorsement, commonly known as tail coverage, from the former insurer, or prior acts coverage with the new insurer. This endorsement in effect converts a claims-made policy to an occurrence policy by extending coverage to include those claims that occurred previously, no matter when they are reported. Initially, occurrence coverage may appear to be more costly than claims-made. The cost of a claims-made policy changed during the first few years of coverage as the policy matures, with the cost of the first year being the lowest and increasing each year until the 5 th year, when it is considered mature. The price of a claims-made policy is initially more attractive, due to the discounts in the first 4 years, but keep in mind that there is a cost involved if tail coverage needs to be purchased. After a number of years under either program the premium differences tend to be immaterial. I have read the description of the two forms and elect to purchase: An Occurrence Form Policy A Claims Made Form Policy If your current coverage is a Claims Made Form and you are now requesting an Occurrence Form policy, you need to purchase tail coverage from your current carrier. If tail coverage is not purchased and a claim is filed from the period you were covered by a Claims Made policy, the claim will not be covered by either policy. (Signature) (Date)

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9 A U T O P A Y A U T H O R I Z A T I O N PROFESSIONAL LIABILITY INSTALLMENT PAYMENT Installment Option (Select one): Name of Insured: Installment Type: Annual Quarterly Installment Amount: (From Renewal Application) Auto Pay Option (Select one): Bank Auto Pay (Attach Voided Check) Account Type: Checking Savings (select one) Account #: Bank Name: Bank Routing #: Branch City / State: Credit Card Auto Pay Credit Card #: (Visa, MasterCard, AMEX) Expiration Date: Authorization and Continuing Effect: Based on the Auto Pay Option I have selected, I hereby authorize the above account to be debited, or credit card to be charged, for the installment type selected; and I grant authority to initiate future debit entries as indicated until I have cancelled such authority in writing. Changes in Amounts and Accounts: I understand that the above installment amount may change upon renewal of my coverage or as a result of other changes I may request be made to my coverage. This authorization is intended to extend to modified installment amounts, which may result from any future coverage renewal submitted by me, and to any other coverage change requested by me. In addition, I may, from time to time, approve updates to the accounts or credit cards to which this Auto Pay Option applies, by contacting your office via phone, , customer service portal, or by mail. This authorization is intended to apply to any such updates. Sign Here: Date: Allied Professionals Insurance Services, Inc. All Rights Reserved, Rev. 2/25/16 Page 1 of 1 G3112

10 Scott Danahy Naylon, Co. Inc. ACUPUNCTURE Scott Danahy Naylon, Co., Inc. proudly presents an Insurance Program underwritten with The Hartford, designed specifically for Acupuncture Offices. The Hartford s small business insurance package, called Spectrum, has core business coverages that is top of the line. When your business is covered by Spectrum, you ll be covered for a wide range of liability and property risks tailored to businesses like yours. Here are some examples: Property Coverages Building and/or contents Liability Limits $2 Million/$4Million (Excludes professional/malpractice liability) Equipment Breakdown covers the cost to repair or replace equipment Business Income Interruption Competitive Rates Special Optional Coverages Valuable Papers Backup of Sewers and Drains Money and Securities Tenants Improvements Employee Dishonesty Computers and Data Other Coverages Available Workers Compensation Umbrella Liability Employment Practice Liability For More Information or to Obtain a Quote Inquiries about the program should be directed to the Customer Service Center at , ext or visit our web site at: This document outlines in general terms the coverages that may be afforded under a Hartford policy. All policies must be examined carefully to determine suitability for your needs and to identify any exclusions, limitations or any other terms and conditions that may specifically affect coverage. In the event of a conflict, the terms and conditions of the policy prevail. All Hartford coverages described in this document may be offered by one or more of the property and casualty insurance company subsidiaries of The Hartford Financial Services Group, Inc. Possession of these materials by a licensed insurance producer does not mean that such producer is an authorized agent of The Hartford. To ascertain whether a producer is a Hartford agent, please contact your state s Department of Insurance or The Hartford at (Option 1). Nov The Hartford Financial Services Group, Inc., Hartford, CT All Rights Reserved All information and representations herein are as of 11/2009