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§ 1303.711. Medical professional liability insurance

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: March 20, 2002

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 P.S. Insurance (Refs & Annos)
Chapter 5C. Medical Care Availability and Reduction of Error (Mcare) Act (Refs & Annos)
Chapter 7. Insurance (Refs & Annos)
Subchapter B. Fund (Refs & Annos)
Effective: March 20, 2002
40 P.S. § 1303.711
§ 1303.711. Medical professional liability insurance
Currentness
(a) Requirement.--A health care provider providing health care services in this Commonwealth shall:
(1) purchase medical professional liability insurance from an insurer which is licensed or approved by the department; or
(2) provide self-insurance.
(b) Proof of insurance.--A health care provider required by subsection (a) to purchase medical professional liability insurance or provide self-insurance shall submit proof of insurance or self-insurance to the department within 60 days of the policy being issued.
(c) Failure to provide proof of insurance.--If a health care provider fails to submit the proof of insurance or self-insurance required by subsection (b), the department shall, after providing the health care provider with notice, notify the health care provider's licensing authority. A health care provider's license shall be suspended or revoked by its licensure board or agency if the health care provider fails to comply with any of the provisions of this chapter.
(d) Basic coverage limits.--A health care provider shall insure or self-insure medical professional liability in accordance with the following:
(1) For policies issued or renewed in the calendar year 2002, the basic insurance coverage shall be:
(i) $500,000 per occurrence or claim and $1,500,000 per annual aggregate for a health care provider who conducts more than 50% of its health care business or practice within this Commonwealth and that is not a hospital.
(ii) $500,000 per occurrence or claim and $1,500,000 per annual aggregate for a health care provider who conducts 50% or less of its health care business or practice within this Commonwealth.
(iii) $500,000 per occurrence or claim and $2,500,000 per annual aggregate for a hospital.
(2) For policies issued or renewed in the calendar years 2003, 2004 and 2005, the basic insurance coverage shall be:
(i) $500,000 per occurrence or claim and $1,500,000 per annual aggregate for a participating health care provider that is not a hospital.
(ii) $1,000,000 per occurrence or claim and $3,000,000 per annual aggregate for a nonparticipating health care provider.
(iii) $500,000 per occurrence or claim and $2,500,000 per annual aggregate for a hospital.
(3) Unless the commissioner finds pursuant to section 745(a)1 that additional basic insurance coverage capacity is not available, for policies issued or renewed in calendar year 2006 and each year thereafter subject to paragraph (4), the basic insurance coverage shall be:
(i) $750,000 per occurrence or claim and $2,250,000 per annual aggregate for a participating health care provider that is not a hospital.
(ii) $1,000,000 per occurrence or claim and $3,000,000 per annual aggregate for a nonparticipating health care provider.
(iii) $750,000 per occurrence or claim and $3,750,000 per annual aggregate for a hospital.
If the commissioner finds pursuant to section 745(a) that additional basic insurance coverage capacity is not available, the basic insurance coverage requirements shall remain at the level required by paragraph (2); and the commissioner shall conduct a study every two years until the commissioner finds that additional basic insurance coverage capacity is available, at which time the commissioner shall increase the required basic insurance coverage in accordance with this paragraph.
(4) Unless the commissioner finds pursuant to section 745(b) that additional basic insurance coverage capacity is not available, for policies issued or renewed three years after the increase in coverage limits required by paragraph (3) and for each year thereafter, the basic insurance coverage shall be:
(i) $1,000,000 per occurrence or claim and $3,000,000 per annual aggregate for a participating health care provider that is not a hospital.
(ii) $1,000,000 per occurrence or claim and $3,000,000 per annual aggregate for a nonparticipating health care provider.
(iii) $1,000,000 per occurrence or claim and $4,500,000 per annual aggregate for a hospital.
If the commissioner finds pursuant to section 745(b) that additional basic insurance coverage capacity is not available, the basic insurance coverage requirements shall remain at the level required by paragraph (3); and the commissioner shall conduct a study every two years until the commissioner finds that additional basic insurance coverage capacity is available, at which time the commissioner shall increase the required basic insurance coverage in accordance with this paragraph.
(e) Fund participation.--A participating health care provider shall be required to participate in the fund.
(f) Self-insurance.--
(1) If a health care provider self-insures its medical professional liability, the health care provider shall submit its self-insurance plan, such additional information as the department may require and the examination fee to the department for approval.
(2) The department shall approve the plan if it determines that the plan constitutes protection equivalent to the insurance required of a health care provider under subsection (d).
(g) Basic insurance liability.--
(1) An insurer providing medical professional liability insurance shall not be liable for payment of a claim against a health care provider for any loss or damages awarded in a medical professional liability action in excess of the basic insurance coverage required by subsection (d) unless the health care provider's medical professional liability insurance policy or self-insurance plan provides for a higher limit.
(2) If a claim exceeds the limits of a participating health care provider's basic insurance coverage or self-insurance plan, the fund shall be responsible for payment of the claim against the participating health care provider up to the fund liability limits.
(h) Excess insurance.--
(1) No insurer providing medical professional liability insurance with liability limits in excess of the fund's liability limits to a participating health care provider shall be liable for payment of a claim against the participating health care provider for a loss or damages in a medical professional liability action except the losses and damages in excess of the fund coverage limits.
(2) No insurer providing medical professional liability insurance with liability limits in excess of the fund's liability limits to a participating health care provider shall be liable for any loss resulting from the insolvency or dissolution of the fund.
(i) Governmental entities.--A governmental entity may satisfy its obligations under this chapter, as well as the obligations of its employees to the extent of their employment, by either purchasing medical professional liability insurance or assuming an obligation as a self-insurer, and paying the assessments under this chapter.
(j) Exemptions.--The following participating health care providers shall be exempt from this chapter:
(1) A physician who exclusively practices the specialty of forensic pathology.
(2) A participating health care provider who is a member of the Pennsylvania military forces while in the performance of the member's assigned duty in the Pennsylvania military forces under orders.
(3) A retired licensed participating health care provider who provides care only to the provider or the provider's immediate family members.

Credits

2002, March 20, P.L. 154, No. 13, § 711, imd. effective.

Footnotes

1
40 P.S. § 1303.745.
40 P.S. § 1303.711, PA ST 40 P.S. § 1303.711
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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