insurance

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.

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.

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.

Worker’s Compensation rates drop

By Brian Fowler, WisMed Assure Account Director

On October 1, 2024, for the ninth consecutive year, Worker’s Compensation (Work Comp) rates in Wisconsin dropped. Overall, there will be a decrease of 10.5% across all employee classifications. Physician rates remain low and competitive. Rates have decreased for physicians within hospital systems and hospital employees other than professional employees.

WisMed Assure also works with dentists and non-physician owned medical professional offices, like chiropractors, therapists, etc.; many of which share this same classification (8832) (see the chart below).  

The following chart shows the current and new rates for the listed class codes (rates are per $100 of payroll):

CodeDescriptionCurrent RatesNew Rates 10/1/2024Change
8832Physician & Clerical0.280.25-11%
8833Hospital Professional Employees0.760.70– 8%
9040Hospital All Other Than Professional3.613.22– 11%

This year there is a very small change to minimum premiums for experience rating. There is an increase of $2,548 in annual remuneration to calculate premiums for sole proprietors and partners and a $3,796 increase in the maximum annual remuneration used for executive officers.

Another difference in how Worker’s Compensation is governed in Wisconsin is there is not a set fee schedule for medical services provided. The Wisconsin Medical Society has long advocated to keep Wisconsin from adopting a Work Comp fee schedule.

Mark Grapentine, Wisconsin Medical Society Chief Policy and Advocacy Officer and a medical liaison to the Worker’s Compensation Advisory Council, told Wisconsin Health News that the current system gets workers back on the job faster and more satisfied with their health care than in other states.

“The news of yet another significant decrease in rates is good news across the board,” he said.

He called the state’s current worker’s compensation system a “national model” that provides injured workers easy access to high quality care. Though he noted that Wisconsin can do better when it comes to its workplace injury rate, and getting that below the national average would be a win-win for everyone.

If you have questions about Worker’s Compensation coverage rates and dividend programs for your practice, please contact Brian Fowler, WisMed Assure Account Director, at brian.fowler@wismedassure.org 608.442.3718.

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.

Practice managers: join us for virtual discussions!

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Chris Noffke

In the constantly changing field of health care management, it is crucial to collaborate and share insights to achieve success. With this in mind, we are pleased to announce that we will be hosting virtual discussions for practice managers.

These teleconferences will serve as a platform for us to delve into various critical issues and exchange valuable perspectives with fellow health care professionals. Some of the topics we plan to explore include:

Staffing Solutions: Best practices for recruiting, retaining, and nurturing talent amidst evolving workforce dynamics.

Efficiency Maximization: Strategies to accomplish more with limited resources and enhance productivity.

Culture Development: Methods for cultivating a positive work culture that prioritizes employee satisfaction and patient-centric care.

While these topics provide a starting point, we welcome suggestions for additional discussion themes from anyone interested in attending. To participate, please contact Martin Hurst.

Our primary goal with these calls is to create a supportive network where we can learn from each other’s experiences, share valuable insights, and collectively address challenges facing health care practices. Whether you are seeking guidance, eager to contribute your expertise, or simply interested in connecting with peers in the field, these discussions offer a valuable opportunity for growth and collaboration.

Together, we can navigate the complexities of health care management and strive for excellence in patient care.

WisMed Assure and WisMed Financial are focused on building and maintaining relationships with clients, and always keeping the best interest of the client at the center of all we do. Contact us at chris.noffke@wismedassure.org, 608.442.7374, insurance@wismedassure.org or 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.

Med Mal 101 Refresher for All Physicians

By Shawna Bertalot, CIC, ACI, WisMed Assure President

The WisMed Assure team spends a lot of time the first half of the year doing Medical Student and Resident education on topics especially important to those who are completing their education and heading off to their first jobs. Part of that education is Medical Professional Liability (Med Mal) 101. While most physicians are now employed by large groups, hospitals or health systems that purchase their Med Mal insurance for them, there are a few key elements and responsibilities that every physician should know.

Med Mal insurance requirements vary by state. Wisconsin has strong tort reform laws* and requires all physicians and CRNAs who are licensed and practice in the state to carry insurance limits of $1M per medical incident and $3M aggregate per policy year. This insurance must be with an insurance carrier approved by the Wisconsin Office of Commissioner of Insurance to qualify for the unlimited excess coverage of the Injured Patients and Families Compensation Fund (IPFCF). Illinois by comparison has no requirement for physicians to carry insurance, no excess liability fund and no tort reform, thus insurance premiums and severity of claim awards are much higher than in Wisconsin.

It is important for you to know and track the type of Med Mal policy you have throughout your career. The two types are Claims-Made and Occurrence; the primary difference being whether the policy covers claims that are MADE during the policy year or claims where the alleged wrongful event OCCURRED during the policy year.

Graphic explaining Claims-Made and Occurrence Med Mal

The most important difference is that if you have a Claims-Made policy and you leave your employer or cancel the policy, all coverage ends unless an “Extended Reported Period,” commonly called “Tail” coverage, is purchased. If you are employed, you need to know if your policy is Claims-Made and who is responsible for purchasing a Tail per your contract. If your employer requires you to pay for the tail upon leaving, then it would be beneficial to check with your employer’s risk manager, insurance agent, or company to determine the cost. The IPFCF requires that a tail is purchased.

Understanding your responsibilities under the IPFCF is an important responsibility that rests with each individual physician. In January 2023, the IPFCF implemented a new policy and administration system that allows participants to review their status and pay online. Your employer may handle the primary insurance and payment of IFPCF fees; however, it is the responsibility of every resident and physician to know their status and maintain compliance with the IPFCF. Click here for more information.

We recommend all physicians keep their own file on their Med Mal coverage. This file should include a Certificate of Insurance for each year of coverage. This certificate will show your policy number, insurance carrier information, and limits of coverage. Generally, Medical Staffing and Credentialing offices can provide you with copies of your insurance information. You should also keep a file on any claims including dates and final resolution. This will allow for a much smoother credentialing and on-boarding experience.

Wisconsin is a great state to practice medicine, especially for physicians. As discussed above, the IPFCF and the state law that established it, Wis. Statute Chapter 655, create certain responsibilities to carry Med Mal insurance and pay annual IPFCF fees. That said, Statute 655 and the tort reform that the Wisconsin Medical Society advocates for and works hard every year to protect make Wisconsin one of the best judicial environments with the lowest Med Mal premium rates. Only eight states have some sort of excess patient compensation fund for Med Mal, and Wisconsin is the only state to provide unlimited coverage beyond the required $1M primary Med Mal insurance.

Please contact your WisMed Assure agent or shawna.bertalot@wismedasure.org with any questions.

*Thirty-three states have imposed caps on damages sustained in Med Mal lawsuits. The caps range from $250,000 per incident to as much as $2.25 million. In Wisconsin, non-economic damages are capped at $750,000.

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.