This FAQ applies to Virginia Physician Insureds only.*
What does ProAd MedGuard
coverage provide?
Is there any additional cost?
Who is eligible for MedGuard?
What is included in MedGuard coverage?
Do I need to have a claim or lawsuit filed
against me before I am eligible for MedGuard coverage?
What is an administrative action?
What is the difference between an
administrative action and a malpractice lawsuit?
What should I do if an administrative action is
filed against me?
Q: What does ProAd MedGuard
coverage provide?
It pays to defend you against various
disciplinary proceedings. These include:
- Hospital, HMO/PPO Peer Review
- Local and State Society Peer Review
- State Licensure and Disciplinary Boards
- National Practitioner Data Bank
- Professional Review Organization
- OBRA (Omnibus Budget Reconciliation Act)
- Medicare**
It has an Annual
Aggregate Limit of Insurance of $25,000 for these legal
expenses.
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Q: Is there any additional cost?
NO. There is no additional cost or premium increase associated
with MedGuard coverage. Nothing will appear on your annual
billing statement. MedGuard coverage is added automatically to
all eligible individual and organizational policies.
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Q:
Who is eligible for MedGuard?
All Professionals Advocate Insureds qualify for MedGuard if
they are Physicians or Surgeons with individual policies or
who are insured on a group policy with coverage equivalent to
an individual policy.
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Q:
What is included in MedGuard coverage?
MedGuard provides defense-only coverage, which includes:
- Attorney fees
- Legal fees
Professionals Advocate has the right to select defense
counsel for this type of coverage.
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Q: Do
I need to have a claim or lawsuit filed against me before I am
eligible for MedGuard coverage?
No. While Insureds are often subject to administrative action
in conjunction with a lawsuit; a claim or lawsuit is not
required for you to be eligible for MedGuard coverage. All the
coverage requires is an administrative action.
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Q:
What is an administrative action?
An administrative action, also known as an insured event,
means an administrative or judicial proceeding instituted by a
government agency, or the formal professional review body of
any other organization, to examine allegations of:
- Improper professional conduct or competence in the practice of the Insured's health care profession; or
- The performance of health care services in violation of
recognized standards of practice or established guidelines
for the appropriate utilization of such services.
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Q: What is the difference between an
administrative action and a malpractice lawsuit?
Administrative actions differ from malpractice lawsuits in
several ways.
- No jury
- No determination of damage
- Not necessarily patient driven
- Wide range of issues
Similar to most malpractice lawsuits, administrative
actions can be time-consuming and costly.
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Q: What should I do if an administrative
action is filed against me?
You should treat any administrative action the same way that
you would treat a claim.
- Notify ProAd immediately
- Record the specifics of the event
- Send copies of any legal documents in connection with
the event to ProAd
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*As with any insurance coverage, the premiums for, and the coverages provided by, Professionals Advocate, including all terms, conditions and exclusions are set forth in your policy and related documents. The descriptions contained in this brochure are intended only as a general description of how MedGuard coverage works. These descriptions do not refer to your specific premium and are not a substitute for reading your bills and any policy provisions related to your premium. Please check with your local Professionals Advocate insurance producer or the Professionals Advocate Customer Service Department if you have any specific questions about your policy premium.
**Excludes fraud or willful non-compliance with Medicare/Medicaid or other similar statutes, regulations, or procedures.