Section 760 IAC 1-21-10 - Scope of coverageAuthority: IC 34-18-5-4
Affected: IC 16-21-2; IC 34-18-2-14; IC 34-18-2-24.5; IC 34-18-5-2; IC 34-18-5-3; IC 34-18-5-4
Sec. 10.
(a) A hospital's or psychiatric hospital's coverage with the PCF is limited to facilities identified in the hospital's or psychiatric hospital's application for licensure to operate as facilities operated under the hospital or psychiatric hospital license. Each hospital or psychiatric hospital shall identify on the surcharge calculation worksheet prescribed by the department all of the: (1) facilities operated under the license; and(2) classes of employees intended to be included in the coverage.(b) Any health care provider, including a physician or independent ancillary provider, that uses an assumed business name must state the assumed business name on the PCF certificate of insurance filed with the department for the assumed business name to be included in the health care provider's status as a qualified provider as defined by IC 34-18-2-24.5. A health care provider may amend a filing to add a d/b/a. In the event of such an amendment, the health care provider shall remit the greater of the following: (1) Additional surcharge if the d/b/a brings any additional risk to the coverage already filed.(2) A minimum surcharge payment of one hundred dollars ($100). If a proposed complaint has been filed, the d/b/a may only be added if it does not bring any additional risk that was not already considered in its surcharge payment.
(c) To become a qualified health care provider each physician and independent ancillary provider shall do the following:(1) File individual proof of financial responsibility.(2) Pay a surcharge as required by 760 IAC 1-60 or IC 34-18-5, or both.(d) No ancillary provider may include a physician or independent ancillary provider in its qualification.(e) Qualification for individual health care providers may not include employees. Including a d/b/a on a PCF certificate of insurance does not allow an individual to include employees. However, nothing in this subsection shall prevent a corporation, sole proprietorship, partnership, or any other entity organized or registered under state law from including employees in the entity's qualification.(f) A hospital, psychiatric hospital, or nursing home may include an employed physician or employed independent ancillary provider in its qualification under the following conditions:(1) The hospital, psychiatric hospital, or nursing home shall pay an appropriate surcharge for each. For a physician the appropriate surcharge is the current rate for the specialty class defined at 760 IAC 1-60.(2) For an independent ancillary provider, the appropriate surcharge is encompassed in the calculations contained in the PCF's hospital or nursing home calculation sheet.(3) The physician's or independent ancillary provider's qualification status is limited to duties performed within the scope of his or her employment as an employee of the hospital, psychiatric hospital, or nursing home.(g) A hospital, psychiatric hospital, or nursing home may include a nonemployed medical director in its qualification under the following conditions: (1) The medical director provides no direct patient care as part of the medical director duties.(2) The medical director's qualification status is limited to duties performed within the scope of his or her medical directorship. No additional surcharge is required for a nonemployed medical director who meets the conditions set forth in subdivisions (1) and (2).(h) A hospital or psychiatric hospital may include in its qualification a nonemployed resident or fellow under the following conditions:(1) The hospital or psychiatric hospital shall pay an appropriate surcharge for each resident or fellow.(2) The resident's or fellow's qualification status is limited to duties performed within the scope of his or her residency or fellowship with the hospital or psychiatric hospital.(3) In the case of a fellow, the fellowship is full time and the fellow engages in no additional medical practice except for part-time moonlighting work.(i) An institution of higher education may include in its qualification dentists and optometrists who are faculty members in its school of dentistry and school of optometry, respectively, acting within the scope of their employment as faculty members.(j) An institution of higher education may include in its qualification a fellow, resident, or student of the institution of higher education pursuing a degree as a health care provider listed in IC 34-18-2-14 (1) or as a pharmacist with respect to activities that are associated with the educational requirements of the institution of higher learning. Department of Insurance; 760 IAC 1-21-10; filed Mar 18, 2005, 10:45 a.m.: 28 IR 2376; filed Feb 2, 2007, 3:08 p.m.: 20070228-IR-760060032FRA; filed Apr 18, 2011, 11:34 a.m.: 20110518-IR-760100245FRA; readopted filed November 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFAReadopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFA