January 1 2019 Pennsylvania Insurance Department

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INTRODUCTION 3,MCARE PARTICIPATION 3,2019 MCARE LIMITS 3. EXEMPTIONS 4,CONTACTING MCARE 4,SECTION I REMITTANCE ADVICE FORM Form e 216 5. A General Information 5,B Payment 6,C Electronic Submissions 6. SECTION II REPORTING GUIDELINES 7,A Credit Balances 7. B Comment Column 9,C Related License and Assigned Numbers 10.
D Cancellations 11,E Endorsements 11,F Corrections 12. SECTION III CALCULATING THE MCARE ASSESSMENT 13, A Physicians Podiatrists and Certified Nurse Midwives 13. B Professional Corporations Professional Associations and Partnerships 13. C Hospitals 16,D Nursing Homes 17,E Primary Health Centers 18. F Birth Centers 18,G Self Insured Entities 19,H Telemedicine 19. SECTION IV ADDITIONAL ASSESSMENT RATING FACTORS 20. A Part Time 20,B New Physicians or New Podiatrists 20.
C Residents and Fellows 21,D Slot Positions 21,E Daily Rating 22. F Bifurcation 23, SECTION V NONPARTICIPATING TRANSMITTAL Form e 316 23. A General Information 23,B Electronic Submissions 23. 2019 Assessment Manual 1 Contents, SECTION VI CLAIMS MADE COVERAGE REQUIREMENTS AND REPORTING 23. A General Information 23,B Extended Reporting Coverage 24.
C Reporting Extended Reporting Coverage Generally 24. D Reporting Extended Reporting Coverage with a Retroactive Date Prior to January 1 1997 24. SECTION VII DEFINITIONS 25,SECTION VIII FORM e 216 CHECKLIST 26. SECTION IX CHANGES TO MEDICAL SPECIALTIES TERRITORIES 28. SECTION X LIST OF EXHIBITS 29, Exhibit 1 Rates for Physicians Surgeons Podiatrists and Certified Nurse Midwives 30. Exhibit 2 Rates for Hospitals Nursing Homes and Primary Health Centers 31. Exhibit 3 Specialty Classification Codes for Physicians Surgeons and Other HCPs JUA 32. Exhibit 4 Remittance Advice Form Form e 216 See link on our website Tab e 216 40. Exhibit 5 Corporation Association Partnership Worksheet See Tab MC WS on e 216 41. Exhibit 6 Hospital Worksheet See Tab HS WS on e 216 42. Exhibit 7 Nursing Home Work Sheet See Tab NC WS on e 216 43. Exhibit 8 Primary Health Center Worksheet See Tab PC WS on e 216 44. Exhibit 9 Birth Center Worksheet See Tab BC WS on e 216 45. Exhibit 10 Nonparticipating Transmittal Form Form e 316 46. Exhibit 11 County Code List 47,2019 Assessment Manual 2 Contents. Commonwealth of Pennsylvania,Insurance Department, Medical Care Availability and Reduction of Error Fund Mcare. 2019 ASSESSMENT MANUAL,Introduction, This manual should be used to calculate the Mcare assessment for 2019 as required by Act 13 of 2002.
Act 13 It is essential that this manual is read in its entirety While the manual is intended to clarify and. periodically modify procedures associated with calculating the assessment the manual is not a substitute. for complying with Act 13 40 P S 1303 101 et seq and the regulations 31 Pa Code 242 1 et seq. Although the information in this manual is intended to complement Act 13 and its attending rules and. regulations if a conflict exists Act 13 and its regulations are controlling. The Mcare assessment is a percentage of the Pennsylvania Professional Liability Joint Underwriting. Association JUA rates as approved by the Pennsylvania Insurance Department For 2019 Mcare. assessment calculation purposes the JUA rates to be used are the base rates that are effective January 1. 2019 It has been determined that the 2019 assessment rate is 19. TIP CONSULTING THE JUA RATE MANUAL AT WWW PAJUA COM MAY PROVIDE DETAILS NOT SPECIFICALLY. ADDRESSED IN THIS MANUAL,MCARE PARTICIPATION, If a health care provider HCP is licensed in Pennsylvania and 50 or more of the patients to whom. the HCP renders healthcare services are in Pennsylvania participation in Mcare is mandatory If a HCP. is licensed in Pennsylvania and less than 50 but more than 0 of patients to whom the HCP renders. healthcare services are in Pennsylvania the HCP may choose to participate in Mcare However if the. HCP opts out of participating in Mcare the HCP must still meet the mandatory insurance requirements. of Act 13 of 2002 See the Nonparticipating Transmittal Form e 316. Although not defined as a health care provider those professional corporations professional. associations and partnerships that are entirely owned by HCPs and which elect to purchase basic. insurance coverage must also participate in Mcare,2019 MCARE LIMITS. Act 13 provides that the total required amounts of medical professional liability coverage including. primary and Mcare coverage for HCPs excluding hospitals are 1 000 000 per occurrence and. 3 000 000 per annual aggregate For hospitals the required total coverage amounts are 1 000 000 per. occurrence and 4 000 000 per annual aggregate As in recent years Mcare Fund participating HCPs. will be required in 2019 to obtain primary coverage in the amount of 500 000 per occurrence and. 1 500 000 per annual aggregate Hospitals must obtain primary coverage in the amount of 500 000. per occurrence and 2 500 000 per annual aggregate Mcare provides participating HCPs coverage of. 500 000 per occurrence and 1 500 000 per annual aggregate in excess of the primary coverage. 2019 Assessment Manual 3 Contents,EXEMPTIONS, HCPs as defined in the Mcare Act are exempt from participating in Mcare if they exclusively provide. Outside the Commonwealth of Pennsylvania or have not provided care to Pennsylvanians. As employees of the federal state or local government including the military. As a forensic pathologist, If a health care provider also provides care in other than exempted category they must participate in. Mcare for that part s of their practice, HCPs who provide care in the Commonwealth of Pennsylvania may be exempt from participation in.
Mcare under the following circumstances that include restrictions. Less than 50 of the care provided by the HCP is in Pennsylvania however they must still. maintain medical malpractice coverage as required by the Mcare Act. The care provided by the HCP is exclusively within the restrictions of a Volunteer License. Physicians with Active Retired licenses providing care only to themselves or their immediate family. Additionally, HCPs without an active license for whatever reason who are not providing care are exempt from. Mcare participation,CONTACTING MCARE, This manual addresses assessment calculation issues that most commonly arise The principles. contained in this manual can also be applied to many novel situations After reading this manual. anyone with questions regarding calculation of the Mcare assessment should submit their questions in. writing to Mcare,USPS Mailing Address,Division of Coverage. P O Box 12030,Harrisburg PA 17108 2030,For Non USPS Deliveries. Division of Coverage,1010 North 7th Street Suite 201.
Harrisburg PA 17102 1410,Phone 717 783 3770,Form e 216 submission e mail. ra in remittance pa gov,2019 Assessment Manual 4 Contents. SECTION I REMITTANCE ADVICE FORM Form e 216, A GENERAL INFORMATION Form e 216 serves as both a coverage reporting form and an. accounting form Electronic submission of the Excel Form e 216 is the preferred method for primary. insurers and self insurers to report basic insurance coverage to Mcare Prior written permission must. be obtained from Mcare before alternate electronic submissions will be accepted Although a hard. copy Form 216 will be accepted in isolated circumstances that are preapproved by Mcare submitting. both an electronic and hard copy of the same Form 216 is unacceptable. Always download a new Form e 216 from our website each time you need to complete another. Form e 216 Mcare periodically improves Form e 216 Downloading a new Form e 216 each time will. ensure the latest version is used Form e 216 along with all applicable Worksheet Exhibits is available. 1 Visiting our website at www insurance pa gov, 2 Selecting Mcare from the Regulation menu at the top right. 3 Selecting Coverage from the Resources section on the right. 4 Selecting the link for the appropriate year s assessment manual. 5 Selecting the e 216 Remittance Advice Form link,6 Opening or saving the file.
Form e 216 is a Microsoft Excel Macro Enabled Worksheet xlsm Macros must be enabled to ensure. that Form e 216 works as intended Please keep the file in xlsm format to preserve functionality. Form e 216 calculates the assessment payable for physicians podiatrists and certified nurse midwives. based on the information provided in columns A through N Facility and entity worksheets are. tabbed at the bottom of Form e 216 These required worksheets will calculate the assessment for. hospitals HS WS corporations MC WS birth centers BC WS nursing homes NC WS and. primary health centers PC WS The coverage data entered on these worksheets can be transferred to. the e 216 automatically using the Transfer to e 216 button Additionally an optional Cncl WS is also. tabbed on Form e 216 to assist with cancelling facilities and entities See the Mcare e 216 Tools. Manual for further information on the Transfer to e 216 button and Cncl WS this manual can be found. on our website alongside the 2019 Assessment Manual and e 216. The 2019 Form e 216 is to be used to report coverage only for policies issued or renewed in 2019. This is because the 2019 Form e 216 will calculate the assessment based on 2019 rates When. reporting mid term additions and deletions to an existing master policy use the effective year of the. master policy to determine the applicable assessment year and rates. NOTE FORM E 216 IS A TOOL TO ASSIST IN THE CALCULATION OF THE ASSESSMENT HOWEVER ALL ASSESSMENTS. MUST BE REVIEWED FOR ACCURACY BEFORE SUBMITTING TO MCARE TRANSACTIONS SHOULD BE REPORTED AND. RECEIVED AT MCARE IN CHRONOLOGICAL ORDER, Coverage information along with collected assessment payments if applicable should be received by. Mcare within 60 days of the effective date of coverage in order to be considered timely Failure to pay. a sufficient assessment within 60 days of the effective date of coverage may result in disciplinary. action against a HCP s medical license and the denial of Mcare coverage in the event of a claim. against the HCP or eligible entity,2019 Assessment Manual 5 Contents. B PAYMENT If payment is due the payment must be sent to Mcare at or about the same time as the. e 216 is e mailed but within 60 days of the effective date of coverage When money is due to Mcare. the check ACH or wire number and payment amount must be included in the Form e 216 and the. carrier code must be included on the face of the check or in the designated space of your ACH or wire. so we can match the e 216 with the payment Please make payments payable to Medical Care. Availability and Reduction of Error Fund or Mcare, Setting Up Electronic Payment Assessment payments may be made through an electronic funds. transfer EFT payment process The EFT payment method is an alternative to the check payment. method To learn more about this payment option and the required minimum standards please send an. e mail to Mcare s Fiscal Unit at ra in mcare exec web pa gov expressing your interest. If payment is due with your Form e 216 the assessment total must be equal to the payment amount. remitted unless the primary insurer or self insurer has a prior credit balance and it is properly. documented on the e 216 If utilizing a credit the payment amount should equal the amount due For. more information on credit balances and tracking them on the e 216 please see page 7. NOTE WHEN PAYMENT IS DUE WITH AN E 216 THE RECEIVED DATE IS THE DATE THE FULL PAYMENT HAS BEEN. RECEIVED BY MCARE WHEN NO PAYMENT IS DUE WITH AN E 216 THE RECEIVED DATE IS THE DATE THE VALID E 216. IS RECEIVED BY MCARE, C ELECTRONIC SUBMISSIONS Electronic submission of Form e 216 is the preferred method of. reporting basic insurance coverage to Mcare A hard copy 216 is no longer required when submitting. your e 216 with or without payment The e 216 and accompanying documentation must be sent to ra. in remittance pa gov, When remitting to Mcare please include the following in your e mail.
A subject line with proper formatting Proper subject line formatting for your e 216 submission. is very important as your e mail will be sorted based upon this information The correct subject. line is automatically populated on your e 216 in cell G9 and may be copied and pasted to your. A brief description of what is being submitted in the body of the e mail A cover letter is no longer. required but information formerly contained in the cover letter should be provided in the body of. the e mail, An attached Form e 216 with credit balances being tracked when appropriate. Supporting documentation provided as separate attachments. The above requirements can be met easily using the Submit e 216 button seen on the next page. Clicking this button will create an email with the appropriate subject line a brief description of your. submission and a copy of your Form e 216 attached If you are submitting multiple e 216s or need to. include any supporting documentation these will need to be attached to the email manually For more. on the Submit e 216 button see the Mcare e 216 Tools Manual this manual can be found on our. website alongside the 2019 Assessment Manual and e 216. 2019 Assessment Manual 6 Contents,Submit e 216 button. Additional information on electronic submissions, The Commonwealth of Pennsylvania s e mail system will not accept an e mail with a file size of 10. 2019 Assessment Manual 2 Contents SECTION VI CLAIMS MADE COVERAGE REQUIREMENTS AND REPORTING 23 A General Information 23 B Extended Reporting Coverage 24 C Reporting Extended Reporting Coverage Generally 24 D Reporting Extended Reporting Coverage with a Retroactive Date Prior to January 1 1997 24 SECTION VII DEFINITIONS 25

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