Common Moonlighting Scenarios – What’s Covered By Your Malpractice Insurance?

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Common Moonlighting Scenarios – What’s Covered By Your Malpractice Insurance?

By Jensen Peck, Business and Professional Insurance Executive

As the insurance agency for the Wisconsin Medical Society, we receive calls often from members and client physicians who are considering supplemental employment (side gigs) outside of their regular scope of practice. They’re often told to “not to worry about” the liability because it’s either covered by the employer or “minimal exposure.” Fortunately, most physicians recognize this may not be true and it’s best to receive input from an insurance agency that specializes in health care liability. Let’s review a few of the more common scenarios and important questions that need to be answered to confirm potential malpractice exposures are covered.

Physicians serving in medical director or other supervisory roles in medispas, EMS services, nursing homes, and other new health care ventures have become common in recent years. While these positions can offer professional growth and financial reward, they also can present new and unprecedented risks. As a medical director, you are responsible for the overall medical practices within the facility, even if you are not directly performing the procedures. While the staff—typically non-physicians such as estheticians, nurses, and nurse practitioners—administers treatments, the medical director is accountable for ensuring that all procedures are performed according to the highest medical standards. If a patient suffers harm from a procedure such as a Botox injection requiring revision or an adverse reaction to treatment or medication, the medical director can be named in a lawsuit, regardless of whether they administered the procedure or were even on site at the time.

Another scenario is physicians who volunteer for Federally Qualified Healthcare Centers (FQHC) and free clinics. FQHCs are typically nonprofit organizations that provide primary care services to underserved populations, often funded by federal grants. Physicians who practice part-time at an FQHC are often covered for malpractice insurance through the Federal Tort Claims Act (FTCA). If a malpractice claim is filed, the FQHC will typically provide legal defense under the FTCA, meaning the FQHC will arrange and pay for legal representation in case of a lawsuit. If a claim results in a settlement or judgment, the FTCA ensures that the U.S. government will cover the financial responsibility up to the applicable limits. A free clinic is a community-based health care facility that provides medical services at either low or no cost to individuals who are uninsured, underinsured, or otherwise unable to pay for care. Physicians who volunteer at free clinics are not given coverage from the FTCA. Regardless of compensation, physicians are required to get traditional malpractice insurance to cover their work done at these clinics – whether it’s part-time or full-time. So, it’s very important to be aware if the clinic is a FQHC or not. A free clinic isn’t always an FQHC.  

There are many other questions you should ask yourself, your employer, and your malpractice insurance experts at WisMed Assure that are unique to your scenario. It’s important to have a clear understanding of your role and a written description of your responsibilities. These duties will likely fall in the category of either administrative or direct patient care. You must confirm if your or your employer’s insurance policies will cover all of your responsibilities. We urge you to reach out to us! Contact the WisMed Assure team at insurance@wismedassure.org or call 608.442.3810. We are here to serve the health care professionals who serve our communities. We will explore the application of Good Samaritan laws in a future issue of the Antidote.

Please note: Wisconsin Medical Society members have access to our legal assistance hotline for additional discussion about these topics.

Picture of Jensen Peck

Jensen Peck

Business and Professional Insurance Executive

Reach out to me to learn more. You can contact me at jensen.peck@wismedassure.org or 608.442.3731.

Send me an email!
Picture of Jensen Peck

Jensen Peck

Business and Professional Insurance Executive

Reach out to me to learn more. You can contact me at jensen.peck@wismedassure.org or 608.442.3731.

Send me an email!

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Dental Benefits with Medicare Advantage

By Martin Hurst, Insurance Service Representative

Medicare provides essential health care coverage for individuals over 65, but it does not cover routine dental services such as cleanings, exams, fillings, or dentures. For those in need of dental care, there are a couple options to enhance your Medicare coverage. You can consider Medicare Advantage plans that include dental benefits or opt for a standalone dental insurance plan.

While Medicare Advantage plans can be beneficial, they aren’t the best choice for everyone. These plans often face criticism due to having limited provider networks, higher out-of-pocket costs, and a lack of transparency. These issues can restrict access to care and may provide fewer benefits than expected. It’s important to note that enrolling in a Medicare Advantage plan typically means losing your Medicare supplement plan.

When considering dental plans, we recommend assessing your individual needs and determining the total cost, (including premiums, deductibles, and potential copayments) as well as any waiting periods for certain procedures. Waiting periods for major dental procedures, like crowns or dentures, may apply, and it’s essential to understand these requirements when choosing a plan. For example, treatments like wisdom teeth removal may have waiting periods before coverage kicks in. For individuals with Medicare Supplement plans (Medigap), dental coverage can be added, or separate dental insurance can be purchased. However, it’s important to check whether your preferred dentists are included in a Medicare Advantage plan’s network, because some plans may limit which provider you can visit. As your dental needs increase, it’s vital to carefully consider all available options to ensure both immediate and long-term coverage.

I recently worked with a client who had been enrolled in a Medicare Supplement plan for several years. His dental needs had changed, and he needed his wisdom teeth removed in the near future, which is considered major dental surgery not typically covered by basic dental plans. After reviewing a variety of dental coverage options based on his specific needs, we found several plans that provided coverage for surgical extractions, each with different waiting periods and premiums. One plan had a 12-month waiting period before covering such procedures, while another had no waiting period, but came with a higher premium. By carefully weighing his options, we helped him find a plan that balanced cost with timely coverage, ensuring he was prepared for his dental needs.

To learn more about Medicare and dental insurance options, please contact Martin Hurst at martin.hurst@wismedassure.org or call 608.442.3728.

 

Picture of Martin Hurst

Martin Hurst

Insurance Service Representative

Reach out to me to learn more. You can contact me at martin.hurst@wismedassure.org or 608.442.3728.

Send me an email!
Picture of Martin Hurst

Martin Hurst

Insurance Service Representative

Reach out to me to learn more. You can contact me at martin.hurst@wismedassure.org or 608.442.3728.

Send me an email!

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

PAYE & ICR Plans Reopening for Student Loan Borrowers

By Mark Ziety, CFP®, AIF®, Financial Advisor, WisMed Financial

The Pay As You Earn (PAYE) and Income Contingent Repayment (ICR) plans will reopen in mid-December under an Interim Final Rule. For borrowers forced into forbearance under the Saving on a Valuable Education (SAVE) repayment plan, should you switch plans? Let’s find out.

Focusing on SAVE vs. PAYE only

ICR is typically only used by parent borrowers with Parent Plus loans or consolidated Parent Plus loans. Income Based Repayment (IBR) is also available for borrowers, but the payment amount and treatment of interest are equal to or substandard to PAYE and SAVE plans. Therefore, this article will focus on SAVE vs. PAYE.

Problems with SAVE

As of this writing, borrowers in the SAVE plan have been placed in forbearance with no interest, no payment, and no progress toward loan forgiveness. It’s anticipated this forbearance will last well into 2025.

Making progress toward loan forgiveness

There are two options currently.

  • Switch from SAVE to a different payment plan, like PAYE, with required payments and progress toward loan forgiveness.
  • Anticipate using the PSLF Buyback program later to complete the 120 payments needed for forgiveness (assuming this program can be used to buyback months for the current forbearance.)

Comparing SAVE vs PAYE

  • Payment: Monthly payment under SAVE is typically lower than PAYE. The exception is at high income levels. The PAYE payment rises with higher income, but it is capped at the 10-year standard payment. The SAVE payment rises with higher income uncapped.
  • Interest: For those with relatively low income compared to their debt, the SAVE plan is often better than PAYE. The SAVE plan prevents interest from accruing when the monthly payment does not cover the interest. In contrast, unpaid interest accrues under the PAYE plan until it accumulates to 10% of the loan amount.
  • Length of Repayment: Loan forgiveness for borrowers that don’t qualify for Public Service Loan Forgiveness (PSLF) takes 20 years under PAYE. Under SAVE, forgiveness takes 20 years for undergrad loans, 25 years for graduate loans, or 10 years if the original amount borrowed was $12,000 or less.

Should you switch?

Everyone needs to run their own calculation to see what makes sense for their situation. Many borrowers will benefit by sticking with the SAVE plan if they are working for a government or 501(c)3 non-profit organization, assuming the PSLF Buyback program can be used to gain credit for the current forbearance later. For those with high income and/or their employer doesn’t qualify them for PSLF, switching to PAYE might be worthwhile.

For personalized help eliminating debt, investing smart and securing retirement, please contact Mark Ziety, CFP®, AIF® 608.442.3750.

Mark Ziety, CFP®, AIF®

WisMed Financial, Inc. part of the Wisconsin Medical Society

Picture of Mark Ziety, CFP®, AIF®

Mark Ziety, CFP®, AIF®

Executive Director of WisMed Financial
Certified Financial Planner™ Professional

Reach out to me to learn more. You can contact me at mark.ziety@wismedfinancial.org or 608.442.3750.

Book an appointment with me!
Picture of Mark Ziety, CFP®, AIF®

Mark Ziety, CFP®, AIF®

Executive Director of WisMed Financial
Certified Financial Planner™ Professional

Reach out to me to learn more. You can contact me at mark.ziety@wismedfinancial.org or 608.442.3750.

Book an appointment with me!

Note: This article is for informational purposes only and should not be considered as financial or tax advice. Please consult with a qualified financial advisor or tax professional before making any financial decisions. Full disclosures.

Don’t Wait for Disability Protection: A True Story

By Tom Strangstalien, Insurance Advisor

When you’re in your twenties and thirties, you can feel invincible. Despite the extraordinary odds of a disability, you might think, “why not wait until later in my career when my income increases?” After all, disability insurance can be expensive and impact your budget. Avoid the mistake of taking your health for granted – as resident and fellow physicians, you witness this every single day. To put it simply, life happens!

Did you know that you can get disability protection with an increasing benefit for as little as $25 to $50 per month? Put disability protection in place as early on in residency or fellowship as you can at as much as your budget allows. Also include a “future increase benefit” that allows you to increase your coverage as your income increases with no medical underwriting to protect your income throughout your entire career. Doing so protects you from the risk of financial ruin.

At WisMed Assure we are experts at designing these plans and work with physicians every single day to place this valuable protection for them. With permission, I’m sharing a story from one of our resident physicians verbatim.

“Hi Tom – this is quite a delay in my response, but I’ve unfortunately had some medical issues pop up in the past few months. I’m still very interested in disability insurance, but these medical things might have changed my situation, and I’ll let you be the judge. I’ll outline the events below. Please feel free to use my story as an example of why residents should do this as soon as possible during residency.

I woke up on a Sunday in mid-April with significant hearing loss in my right ear. I was diagnosed by an ENT provider with sudden-onset sensorineural hearing loss due to a viral infection. I took steroids for two weeks, and my hearing has returned to normal. From a long-term standpoint, there isn’t any increased risk of long-term hearing loss as a result of the condition, and I’m doing well!

As a part of the medical work-up, however, we obtained a brain MRI to ensure that an acoustic neuroma wasn’t causing my symptoms. Thankfully, that wasn’t seen. However, the MRI did find two incidental white matter lesions in my deep right parietal lobe. I don’t have any neurological symptoms and am feeling fine. I just saw a neuroimmunologist at Froedtert in late July, and thankfully, it isn’t likely to be anything clinically significant. These types of spots are typically associated with dementia in elderly patients, but they’re being found in younger patients (as MRI scans are being used more frequently in younger populations) and aren’t associated with any long-term issues. We will get a repeat MRI in one year to make sure it’s stable, and then I won’t require any additional monitoring.

So, QUITE a change in my health status. I’m feeling fine, and I’m not taking any medications at the moment. I also didn’t miss any time with these conditions. Otherwise, my answers to your initial list of questions haven’t changed. It wouldn’t take a genius to guess this would increase my monthly cost for disability insurance. Do you have any other insights or recommendations? Could you get some quotes again?”

Life truly does happen, and we don’t know what our future holds. I encourage all of you to obtain individual disability protection as soon as possible. Do not wait until it’s too late. My team and I are here to help and will passionately search for you and design a plan that is suitable for you. We exist for your benefit and it’s what we do.

For help with your insurance planning, contact Tom Strangstalien at 608.442.3730 or the WisMed Assure team at insurance@wismedassure.org, or call 608.442.3810.

Picture of Tom Strangstalien

Tom Strangstalien

Insurance Advisor

Reach out to me to learn more. You can contact me at tom.strangstalien@wismedassure.org or 608.442.3730.

Send me an email!
Picture of Tom Strangstalien

Tom Strangstalien

Insurance Advisor

Reach out to me to learn more. You can contact me at tom.strangstalien@wismedassure.org or 608.442.3730.

Send me an email!

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

2024 Volume 4

Don’t Wait for Disability Protection: A True Story

By Tom Strangstalien, Insurance Advisor

MRI Brain Scan of head

When you’re in your twenties and thirties, you can feel invincible. Despite the extraordinary odds of a disability, you might think, “why not wait until later in my career when my income increases?” After all, disability insurance can be expensive and impact your budget. Avoid the mistake of taking your health for granted – as resident and fellow physicians, you witness this every single day. To put it simply, life happens!

Read more…

PAYE & ICR Plans Reopening for Student Loan Borrowers

Pay As You Earn Repayment PAYE Plan paperwork

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

The Pay As You Earn (PAYE) and Income Contingent Repayment (ICR) plans will reopen in mid-December under an Interim Final Rule. For borrowers forced into forbearance under the Saving on a Valuable Education (SAVE) repayment plan, should you switch plans? Let’s find out.

Read more…

Common Moonlighting Scenarios – What’s Covered by Your Malpractice Insurance?

Free Medical Clinic sign

By Jensen Peck, Business and Professional Insurance Executive

As the insurance agency for the Wisconsin Medical Society, we receive calls often from members and client physicians who are considering supplemental employment (side gigs) outside of their regular scope of practice. They are often told to “not to worry about” the liability because it’s either covered by the employer or “minimal exposure.” Fortunately, most physicians recognize this may not be true and it’s best to receive input from an insurance agency that specializes in health care liability. Let’s review a few of the more common scenarios and important questions that need to be answered to confirm potential malpractice exposures are covered.

Read more…

Dental Benefits with Medicare Advantage

Dentist or dental hygienist in operation with patient.

By Martin Hurst, Insurance Service Representative

Medicare provides essential health care coverage for individuals over 65, but it does not cover routine dental services such as cleanings, exams, fillings, or dentures. For those in need of dental care, there are a couple options to enhance your Medicare coverage. You can consider Medicare Advantage plans that include dental benefits or opt for a standalone dental insurance plan.

Read more…

Lifetime Term Life Insurance. Does It Exist?

By Tom Strangstalien, Insurance Advisor

Last month was life insurance awareness month, but we should be aware of the value of life insurance and the opportunities it offers all year round. A relatively new concept in life insurance is guaranteed no-lapse universal life. So, what exactly is this new form of life insurance, and does it potentially serve a purpose in your life?

Term insurance is the least expensive and most common form of life insurance. You choose a term period of one year (annual renewable term), ten years, twenty years, thirty years, or in rare instances even 40 years. If you pay your premiums on time, the coverage is guaranteed to be in place if needed. At the end of the term period, you are now older and while you can potentially renew the coverage for another term, because you are older, the cost will be substantially higher. Alternatively, you could pay the current premium for our attained age each year until it reaches the point where it simply isn’t affordable anymore. Lastly, depending on the product that you purchased, you may not have the option to renew the coverage, and the policy simply lapses, so the coverage goes away.

The major question with term insurance is, “What if I need the coverage after the end of the term period?” As outlined above, it can create a situation that is not ideal. Life happens and there are numerous scenarios where you might want life insurance coverage for a lifetime and not just a specified number of years. A no-lapse universal life insurance policy can address these concerns. With universal life insurance, you pay more into the policy than you would with term insurance. It has a cash value component where excess funds are deposited in the earlier years of the contract. Those funds then assist in paying premiums in later years when you are older and premiums are more expensive. You can “cash out” your account at anytime if the coverage is no longer needed. If funded properly, the premiums will not change, however it must be carefully reviewed each year if anticipated interest rates (or the performance of the cash account) do not perform to the expected standards. If it’s not earning sufficient interest, premiums and/or the amount of coverage may need to be adjusted, or the policy can be in jeopardy of lapsing in the future since it’s not properly funded. It simply can run out of money.

With guaranteed no-lapse universal life, you pay more at your attained age [EW1] than you would with term insurance. However, like traditional universal life, it does have a cash value account. Yet, as long as you pay the no-lapse premium, the coverage is guaranteed to be there for life! Unlike traditional universal life, the contract is never in jeopardy. The cash account may or may not perform as anticipated, however this has no bearing on the life insurance coverage. It will always be there! It’s essentially a pseudo lifetime term insurance program!

What will your future hold? How will your health be? Will you want to create a legacy, a charitable endeavor, or a scholarship fund? Will you want to create wealth for your future generations? As you consider term life insurance, what term limit will you choose? Or maybe you should explore coverage for your lifetime in the form of guaranteed no-lapse universal life.

The WisMed Assure team would be happy to provide you with quotes from several companies. Our allegiance is always to you, and as always thank you for all that you do!

For help with your insurance planning, contact Tom Strangstalien at 608.442.3730 or the WisMed Assure team at insurance@wismedassure.org, complete this quick online form or call 608.442.3810.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Residual Disability Rider Provides Financial Protection

By Martin Hurst, Insurance Service Representative

Martin Hurst

The Residual Disability Rider is an essential addition to a physician’s disability insurance policy. It provides financial protection in the event of a disability that limits your ability to work at full capacity. Unlike standard policies that only pay out when the policyholder is completely unable to work, this rider ensures partial benefits if a physician can still perform some duties but earns less due to reduced hours, fewer patients, or other limitations. By covering the income gap during partial disability, it offers crucial financial stability and flexibility throughout a physician’s career, even during recovery periods.

I worked with a physician who injured his wrist while playing tennis. Although he could still see patients for office visits, his ability to perform procedures – which was critical to his practice – was significantly impacted. Thankfully, he had chosen a Residual Disability Rider as part of his disability insurance policy. This rider provided partial benefits, helping to offset the income lost due to his reduced capacity to work. With this coverage, he was able to stay financially stable, cover his expenses, and focus on his recovery.

For physicians, whose income often depends heavily on their ability to perform specific tasks or maintain a certain patient load, the Residual Disability Rider provides a critical safety net. It offers peace of mind, ensuring that a partial loss of ability won’t lead to a total loss of income and helps maintain financial stability during challenging times.

To learn more about your disability insurance options, please contact Martin Hurst at martin.hurst@wismedassure.org or call 608.442.3728.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

New Rules Regarding Overtime Pay

By Fine Point Consulting HR Professional

The Department of Labor announced a final overtime rule, Defining and Delimiting the Exemptions for Executive, Administrative, Professional, Outside Sales, and Computer Employees, on April 23, 2024. The rule revised the regulations issued under the Fair Labor Standards Act (FLSA) that implement the exemptions from minimum wage and overtime pay requirements.

The first phase of the rule became effective July 1, 2024, while the second phase becomes effective January 1, 2025. This final rule increases the salary exemption threshold to $58,656 per year and has the potential to impact a significant number of currently overtime-exempt employees. So, what should you do to get started?

The first step is to find out if any of your current employees will be impacted by this change. If none will be, no changes are necessary. However, if you realize you will have impacted employees, here is a quick guide on how to get started.

Steps to Take if Employees Are Affected:

Analyze Current Salaries

The first step is to evaluate the current salaries and estimate the amount of overtime worked. To help with this, feel free to use the 2024-2025 Salary Increase Impact Calculator for assistance.

Budget Adjustments

This is where it’s time to think ahead. As 2025 budgets begin to happen, be sure to allocate funds for potential increases in salaries and overtime expenses affected by this change.

Develop a Detailed Rollout Plan

Exemption Status and Role Classification – Determine whether currently exempt employees will remain exempt or be reclassified as non-exempt.

  • ‍Helpful Tip: You cannot have two employees in the exact same role, and one be exempt and one be non-exempt. You will need to reclassify one of the roles, and this doesn’t just mean a job title. To be compliant you will need well-documented differences in responsibilities along with an updated and clearly differentiated job description. Because of this, you should consider implementing salaried, non-exempt roles.

Operational Adjustments

  1. ‍Time-Keeping Changes: This is the time you should begin to prepare for any changes in time-keeping processes due to the new overtime requirements.‍
  2. Employee Communication: Address potential employee concerns through clear communication and manage employee relations.‍
  3. Policy Review: Ensure company policies, such as “Unlimited PTO,” comply with the new regulations.

‍Staged Implementation

Before you do this, we recommend that you review potential salary compression issues and adjust market rates for various positions accordingly.

Support and Resources

We know this is a lot to take in, but don’t worry our FPC HR Team is here to help. If you are a current HR client, don’t worry we are already evaluating your business and will reach out to you if changes are needed. However, if you don’t have HR services with us and would like assistance, reach out to us today. These changes can create a lot of questions and what-ifs. Our team is happy to work closely with those affected providing guidance and advice on how to navigate these adjustments- let us be the experts.

If you have any questions or would like to schedule time with our HR team, click here.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Investing in Private Equity: A Pre-IPO Opportunity

By Mark Ziety, CFP®, AIF®, Financial Advisor, WisMed Financial

Private equity offers a unique opportunity to invest in promising companies before they go public. Unlike publicly traded stocks, which are bought and sold on stock exchanges, private equity investments are made in privately held companies.

How Does Private Equity Work?

Private equity firms raise capital from investors, including individuals, institutions, and pension funds. They use this capital to invest in privately held companies through strategies such as:

  • Acquiring existing businesses
  • Funding expansion
  • Restructuring underperforming companies

Why Invest in Private Equity Before an IPO?

  • Potential for Higher Returns: Private equity firms often target high-growth companies. If these companies succeed, their value can increase significantly before an IPO, potentially yielding substantial returns for early investors.
  • Reduced Market Volatility: Unlike publicly traded stocks, private equity investments are not subject to daily market fluctuations, providing a more stable investment environment.
  • Exclusive Investment Opportunities: Private equity firms often have access to investment opportunities that are not available to the general public.

How to Invest in Private Equity

  • Direct Investment: Some private equity firms accept direct investments from individuals. However, this typically requires a substantial minimum investment and may not be accessible to all investors.
  • Private Equity Funds: Many investment firms offer private equity funds that pool capital from multiple investors. These funds provide diversification and are managed by professionals, making them a more accessible option for many investors.
  • Venture Capital Funds: Venture capital funds are a subset of private equity that focuses on investing in early-stage companies. While they often involve higher risk, they can also offer significant growth potential.

Important Considerations

  • Liquidity: Private equity investments can be illiquid, meaning it may be difficult to sell your investment before the company goes public or has another liquidity event.
  • Risk: Private equity investments carry higher risk compared to publicly traded stocks. There is no guarantee of success, and the potential for loss is greater.
  • Fees: Private equity firms typically charge management fees and performance fees, which can impact your overall returns. It’s important to understand these fees before investing.
  • Tax Implications: Consult with a tax advisor to understand the potential tax implications of private equity investments.

Investing in private equity before an IPO can offer significant rewards, but it’s essential to be aware of the associated risks and benefits. Conduct thorough due diligence on private equity firms and their investment strategies. Consider diversifying your portfolio by investing in multiple funds. And always consult with a qualified financial advisor to make informed decisions. Want more investing tips? See the 7 ways to improve investment performance.

For personalized help eliminating debt, investing smart and securing retirement, please contact Mark Ziety, CFP®, AIF® 608.442.3750.

Mark Ziety, CFP®, AIF®

WisMed Financial, Inc. part of the Wisconsin Medical Society

Note: This article is for informational purposes only and should not be considered as financial or tax advice. Please consult with a qualified financial advisor or tax professional before making any financial decisions. Full disclosures.