02-031 C.M.R. ch. 630, § 6 - Premium assistance

1. The Superintendent shall apply the standards of prioritization adopted by the Commissioner of Human Services to determine the physicians who shall receive premium assistance.

2. No premium assistance shall be authorized to a physician not found eligible by the Department of Human Services or who owes premiums to any insurer for any policy year prior to the year for which assistance is sought.

3. For each physician eligible for assistance, the Superintendent shall calculate the difference between the medical malpractice premium with and without obstetrical care coverage. For purposes of this calculation, the Superintendent shall use the policy with an effective date occurring in the eligibility period, without regard for any subsequent cancellations and endorsements. The assistance per physician shall be adjusted to comply with the $5,000 minimum and $15,000 maximum established in 24-A M.R.S.A. §6308(2).

4. In determining the difference between the physician's medical malpractice insurance premium with obstetrical care coverage and without obstetrical care coverage, the Superintendent shall consider the following:

(A) The services performed and the applicable insurance rating classification during the Program eligibility period.

(B) The services performed other than obstetrical care and the applicable insurance rating classification without obstetrical care during the Program eligibility period.

(C) The rates and rating rules of the physician's insurer or principal writer during the period for which assistance is sought.

(D) If necessary, the services performed and the applicable insurance rating classification immediately preceding eligibility for Program assistance.

(E) For physicians newly entering practice, and if necessary for other applicants, the training and certification of that physician immediately prior to eligibility for Program assistance.

5. No assistance shall be provided to a class of eligible physicians until all eligible physicians in the next higher priority class have received the entire indicated assistance.

6. If the funds available for distribution to a class of physicians with equal priority are insufficient to provide the amount of assistance indicated, then the amount of assistance shall be adjusted by the ratio the amount available for distribution bears to the calculated cost of premium assistance for the physicians in the priority class.

7. Physicians receiving premium assistance must fully comply with this Rule and rules adopted by the Department of Human Services. Failure to comply may result in the recoupment of the value of assistance already given and withholding of further assistance.

8. The annual premium credit based on the difference in premium shall be determined using the physician's actual premium and coverage, except that if coverage limits exceed $1,000,000 per claim, $3,000,000 aggregate per year, then the premium difference shall be determined at $1,000,000 /$3,000,000 limits.

Notes

02-031 C.M.R. ch. 630, § 6