Ken Schnauder, Executive Director

Tel: (225) 362-5262
Fax: (225) 362-5265
Email: Ken.Schnauder@la.gov

Physical Address:
8225 Florida Blvd., 2nd Floor
Baton Rouge, Louisiana 70806
1-866-469-9555
225-362-5400

Mailing Address:
P.O. Box 3718
Baton Rouge, Louisiana 70821

Get A Game Plan Louisiana Recovery Authority LaTrac

FAQ - Coverage and Surcharges
Can I wire my surcharge? If so, how is this done?

Wires should be sent to:
Bank:       J.P. Morgan Chase Bank, National Association
                Transit/Routing Number 021000021
                451 Florida St., Baton Rouge, LA 70801

Account:  State of Louisiana
                Central Depository Account
                Account Number 708024344

When wiring your surcharge payment, please be sure to send the appropriate paperwork to the PCF so your surcharge can be posted timely. You can email it to Cathy Moss (cathy.moss@la.gov), fax it to 225-362-5265 or mail it to P.O. Box 3718, Baton Rouge, LA 70821. Please include a note with your paperwork that you wired your surcharge payment.



If I am a nurse or technician or other ancillary health care employee and I work for a hospital, clinic, or practice group do I need separate coverage with the PCF?

Most ancillary health care providers, such as nurses, LPNs, lab techs, x-ray techs, physical therapist, etc who are employees of a hospital or clinic or group do not need to be individually enrolled in the PCF for coverage.  It is part of the coverage provided by the hospital's coverage. However, there are some providers that will need to be individually enrolled in the PCF to obtain coverage.  This would include pharmacists, advanced practice nurses, EMTs associated with an ambulance service, Locum Tenen physicians.  If there is a question, please contact the office to ensure you are properly covered.



What is the difference between claims made coverage and occurrence coverage?

An occurrence policy is the same as what most people have on their cars and homes.  It provides coverage for incidents that OCCUR during the life of the policy.  If you cancel the policy and a claim comes in that occurred during the policy period, the claim should be covered.  If the incident occurred before the effective date or after the termination date, it would not be covered. A claims made policy requires that the claim must have occurred during the policy period AND the policy must still be in place at the time a claim is filed. If a policy is not continued, the coverage is not continued for any claims that are received after the termination date of the policy, regardless of the fact that the incident occurred during the life of the prior policy. Claims made coverage is normally used for a new healthcare provider that is establishing a practice. The rates are lower and grow over a five year period. They never equal what an occurrence form of coverage would cost, but have the provision that the policy must be renewed for coverage to be continued.



What is "tail" coverage and why is it necessary?

This is an extended reporting endorsement that is necessary when a health care provider moves from a Claims Made form of coverage to an occurrence form or stops coverage all together and the health care provider had claims made coverage. This ensures that claims that are received or filed after the termination of the claims made coverage will be considered covered and the provider will be considered a qualified health care provider and eligible for the cap on damages and the personal protection afforded under the medical malpractice act.



What is the enrollment process and how long does it take?

For new enrollees, the application and surcharge payment must be received on or before the date coverage is to be effective. For those providers with underlying insurance coverage, we will need a copy of a Certificate of Insurance.



Who is eligible for enrollment?

Any licensed or certified health care provider is eligible.  The definition per the statutue is:

 

(10) "Health care provider" means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution licensed or certified by this state to provide health care or professional services as a physician, hospital, nursing home, community blood center, tissue bank, dentist, registered or licensed practical nurse or certified nurse assistant, offshore health service provider, ambulance service under circumstances in which the provisions of R.S. 40:1299.39 are not applicable, certified registered nurse anesthetist, nurse midwife, licensed midwife, pharmacist, optometrist, podiatrist, chiropractor, physical therapist, occupational therapist, psychologist, social worker, licensed professional counselor, licensed perfusionist, or any nonprofit facility considered tax-exempt under Section 501(c)(3), Internal Revenue Code, pursuant to 26 U.S.C. 501(c)(3), for the diagnosis and treatment of cancer or cancer-related diseases, whether or not such a facility is required to be licensed by this state, or any professional corporation a health care provider is authorized to form under the provisions of Title 12 of the Louisiana Revised Statutes of 1950, or any partnership, limited liability partnership, limited liability company, management company, or corporation whose business is conducted principally by health care providers, or an officer, employee, partner, member, shareholder, or agent thereof acting in the course and scope of his employment.



Is enrollment in the PCF mandatory?

No it is not, at least not by any law. It may be required by a health care provider's underlying professional liability insurer since enrollment in the PCF may play a factor in the type of policy they write and the coverage they provide. It may also be required by a hospital or health insurance plans.



How does a new health care provider enroll in the PCF?

A health care provider who has an underlying insurance policy must provide proof of financial responsibility in the form of a Certificate of Insurance from the insurer evidencing, at a minimum, coverage limits of $100,000/$300,000. The health care provider must then pay the appropriate surcharge based on specialty/class as found in the PCF rate manual. If a provider wishes to be self-insured, a completed self-insured application, approved form of security in the amount of $125,000.00 (Letter of Credit, Certificate of Deposit, Bond, etc.), and pledge agreement is needed. If a new enrollee with underlying insurance coverage, either the insurance company/agent or the PCF must have the Certificate of Insurance and PCF surcharge payment on or before the effective date of coverage. A new self-insured enrollee, the completed application and security must be in our office on or before the effective date of coverage. All necessary forms and rates can be found on the web site. If the insurer has a standard Certificate of Insurance that contains all the necessary information as outlined on the PCF form, it can be substituted for the PCF form.



How do I know how much to pay for the PCF coverage?

For physicians the PCF surcharge rate is based on the specialty, from which a class number is assigned and the type of coverage. If a facility, it will be based on your licensure, class and type of coverage. There is a list of specialties and their associated classes found in the rate manual. Once the class is determined it is used to find the PCF surcharge rate from our rate chart. The rate charts also show surcharge rates for hospitals, nursing homes, ambulatory surgical centers, dialysis centers, dentists, CRNA's, and the advanced practice nurses. The rate manual contains some additional surcharge rates for other health care providers not listed on the charts and some exceptions.



Are there any discounts available?

The PCF does allow discounts for working part time. These can be found in the rate manual. They are based on a 40 hour work week and are as follows:

35 hours of practice a month or less   = 75% credit

65 hours of practice a month or less   = 50% credit

85 hours of practice a month or less   = 25% credit

More than 85 hours a month                = No credit



If I am already a member of the PCF with primary insurance, how do I renew my PCF coverage?

The PCF surcharge payment must be received by your insurance company/agent NO LATER than 30 days after the expiration of the PCF coverage and underlying policy, which should match. The insurer or agent will then forward payment along with your Certificate of Insurance to our office. Failure to pay the PCF surcharge timely could result in a gap in PCF coverage, even though there may not be a gap in the underlying policy. If your insurer or agent does not collect the PCF surcharge and forward it to the PCF, then the health care provider will be responsible for ensuring the check is received timely and a copy of the Certificate of Insurance submitted with the check. Specific questions or problems along these lines need to be addressed with the PCF surcharge staff. The PCF does send out reminder notices and expired coverage notices.



If I am already a self-insured member of the PCF, how do I renew my PCF coverage?

PCF invoices are sent 65 and 15 days prior to the expiration of the self-insured coverage.  Proof that the security in the amount of $125,000.00 is still valid, the front page of the PCF application with the top portion completed (if nothing has changed within the practice) and the appropriate surcharge payment must be received by the PCF on or before the effective date.  However, if more time is needed, please contact the staff of the surcharge section.



Does the PCF Corporation Application need to be completed?

If PCF coverage is desired for the corporation (LLC, AMPC, Inc.) or partnership, then the answer is yes.  All eligible owners and employees must be verified by our office.  This is also important for a "doing business as" trade name.  Such documentation ensures our records are complete and there can be a decision made regarding coverage and qualification should a claim be received.  It also provides proof of PCF coverage for court proceedings.



If my underlying policy is already in place, can I enroll in the PCF mid-policy period?

Yes, the PCF surcharge can be pro-rated; however, when there is underlying insurance coverage, the effective dates nay not match as the effective date for PCF coverage will be determined by the date of payment of the PCF surcharge. The termination dates should match so the renewal dates match.



If I join the PCF mid-policy, how do I determine what claims made maturity year to use at renewal?

If the initial pro-rated time period is less than 8 months, the PCF will allow a provider to remain at 1st year claims made; however, if the pro-rated period is 8 months or more, the provider must pay the 2nd year claims made rate at the time of the PCF renewal.



If I already have PCF coverage but want to change the renewal date, can that be done?

This is normally allowed when a provider is changing employment, which would also change the effective dates of coverage with a new or even existing carrier and the PCF as well.  It can also happen when a provider simply wishes to have the PCF surcharge and underlying insurance premium payment moved to a more convenient month. While we certainly wish to accommodate a health care provider and allow a change to a different renewal month, the underlying insurer must also allow such.  This type of change will not be allowed by the PCF on a repeated basis and must be justified.



If I cancel my coverage mid-policy am I eligible for a refund?

Yes, upon request a pro-rated refund will be issued to the payee of the surcharge unless otherwise notified. Keep in mind that if Claims Made coverage is involved, an extended endorsement may be necessary for continued coverage and the refund can be applied towards that surcharge.



How long do I have to purchase an extended reporting endorsement or tail coverage?

Providers have 45 days from the date of termination of their claims made policy to pay the PCF tail surcharge either directly to the PCF or the underlying insurer to forward to the PCF. In order to have PCF tail coverage, there must also be tail coverage with the underlying insurer, prior acts coverage with a new insurer or a self-insured security in the  amount of $125,000 in place specifically for tail coverage.  Tail coverage is not needed for providers with occurrence type of coverage.  There are some exceptions regarding tail coverage and these can be found in the rate manual.



Does the PCF finance the surcharge payments or can I pay my PCF surcharge in installments?

No, per the Medical Malpractice Act payment of the PCF surcharge is remitted on an annual basis and it must be paid in full for PCF coverage.  It can be financed through a bank or finance company, but full payment must be made to the PCF.



I am an insurance agent, when should I remit payment on behalf of my client?

PCF payment must be made to an insurer or agent on or before the effective date of coverage for new PCF enrollees and within 30 days of the expiration of the prior PCF coverage for renewals and to avoid gaps in PCF coverage.  Insurers and agents then have 30 days from the date of receipt of the provider's payment to remit it to the PCF to avoid penalties for late remittance.

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