Medical Indemnity (Prudential Supervision and Product Standards - Notice of Provision of Run-off Cover)
Determination 2007
Medical Indemnity (Prudential Supervision and Product Standards) Act 2003
I, ANTHONY JOHN ABBOTT, Minister for Health and Ageing, make this Determination under subparagraph 26D(2)(b)(iii) of the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003.
Dated                                        ____15/6/ 2007
Tony Abbott
ANTHONY JOHN ABBOT
Minister for Health and Ageing
                                                                                                                                   
 
 
 
 
Contents
 
1.           Name of Determination  3
2.           Commencement 3
3.           Interpretation  3
4.           Notification of matters in relation to eligible practitioners  4
 
 
 
 
 
1.                      Name of Determination
This Determination is the Medical Indemnity (Prudential Supervision and Product Standards - Notice of Provision of Run-off Cover) Determination 2007.
2.                      Commencement
This Determination commences on the day after it is registered.
3.                      Interpretation
(1)        In this Determination:
Act means the Medical Indemnity (Prudential Supervision and Product Standards) Act 2003.
eligible practitioner means a person to whom subsection 34ZB(2) of the Medical Indemnity Act 2002 applies.
GST has the same meaning as in the A New Tax System (Goods and Services Tax) Act 1999.
insurer has the same meaning as in subsection 26D(2) of the Act.
optional medical indemnity cover means medical indemnity cover provided by an insurer to a medical practitioner that is in addition to the insurer's standard medical indemnity cover.
private medical practice has the same meaning as in section 34ZB of the Medical Indemnity Act 2002.
run-off cover means medical indemnity cover referred to in paragraph 26A(1)(d) or subsection 26C(1) of the Act.
standard medical indemnity cover means medical indemnity cover provided by an insurer to a medical practitioner on the same terms and conditions as the cover usually offered by the insurer to other practitioners in the same category or class as the practitioner.
UMP support payment means the payment imposed under  the Medical Indemnity (UMP Support Payment) Act 2002.
(2)        A reference in paragraphs 4(3)(b), (c), (d), (e) and (g) of this Determination to an amount does not include any component of the amount that is attributable to GST, stamp duty or UMP support payment.
(3)        A reference in this Determination to an amount being paid by a person includes a reference to the amount being paid on behalf of the person.
(4)        To avoid doubt, a reference in subsections 4(3), (4) and (5) of this Determination to the most recent period during which the person was provided with medical indemnity cover does not include any period during which the person was provided with medical indemnity cover under subsection 26A(1) or 26C(1) of the Act.
Note:         Terms used in this Determination have the same meaning as in the Act―see section 13 of the Legislative Instruments Act 2003.  These terms include:
eligible practitioner
MDO
medical indemnity cover
4.                      Notification of matters in relation to eligible practitioners
(1)        For subparagraph 26D(2)(b)(iii) of the Act, the written notice to be given by the insurer must state the matters set out in subsections (2) to (5).
Note:         The reference to a 'written notice' in this Determination is a reference which is intended to adopt the explanation of 'writing' in section 25 of the Acts Interpretation Act 1901 and would include the provision of data via an electronic data transfer.
General
(2)        The written notice must state the following matters in relation to the person to whom medical indemnity cover is provided:
(a)                    the person's gender; and
(b)                   the person's date of birth; and
(c)                    the year in which the person was first registered or licensed as a medical practitioner under a State or Territory law that provides for the registration or licensing of medical practitioners; and
(d)                   the person's most recent provider number as provided by the person to the insurer; and
(e)                    the State or Territory in Australia, external Australian Territory or overseas country in which the person’s most recent principal place of practice was located; and
Note          Subsection 4(6) of this Determination provides an explanation of a person's most recent principal place of practice.
(f)                     the unique identifier assigned to the person by the insurer; and
(g)                    the date (the first cover start date) on which the person was first provided with medical indemnity cover by:
(i)                      the insurer; or
(ii)                     another insurer that has been taken over by the insurer; or
(iii)                   an associated MDO; and
Note          Subsection 4(7) of this Determination provides an explanation of when an insurer has been taken over by another insurer.
(h)                    the date (the last full cover end date) on which the most recent period (if any) ended during which the person was provided with medical indemnity cover by the insurer or an associated MDO under a full premium paying arrangement in relation to:
(i)                      medical services provided for payment in the course of private medical practice; or
(ii)                     medical services provided by the person for which the person was remunerated; or
(iii)                   medical services provided by the person in the course of medical practice other than private medical practice; and
(i)                      the status of the person in relation to run-off cover in terms of whether they are:
(i)                      continuing to pay premiums to the insurer (contributing); or
(ii)                     eligible for run-off cover (eligible); or
(iii)                   both continuing to pay premiums to the insurer and eligible for run-of cover (eligible and contributing); or
(iv)                   inactive; and
(j)                     which of the following categories best describes the current progress of the person’s ROCS status:
(i)                      a run-off cover contract has been issued to the person; or
(ii)                     a run-off cover claim has been lodged; or
(iii)                   the person's eligibility has been identified on the basis of MDO data; or
(iv)                   the person is eligible but no run-off cover contract has been issued; and
(k)                   the class of eligible practitioners that the person belongs to, being:
(i)                      65 years and over and retired from all medical practice; or
(ii)                     65 years and over and retired from private medical practice; or
(iii)                   maternity; or
(iv)                   permanent disability; or
(v)                    deceased; or
(vi)                   temporary resident doctor; or
(vii)                 not engaged in any medical practice for more than three years; or
(viii)                not engaged in private medical practice for more than three years; and
(l)                      the level of medical indemnity cover provided to the person under subsection 26A(1) or 26C(1) of the Act, being:
(i)                      ROCS Level of Cover 1: Private fee-charging practice – fully indemnified; or
(ii)                     ROCS Level of Cover 2: Public sector cover – fully indemnified; or
(iii)                   ROCS Level of Cover 3:  Other medical practice MI cover – one or more of the following: Medico-legal; gratuitous services; Good Samaritan; and other partial cover; and
(m)                  if the insurer ceased to sell medical indemnity cover for the person in relation to incidents occurring during a period mentioned in paragraph (b) or (c) of the definition of medical practice period in subsection 26A(9) of the Act - the date when the person ceased to be covered under that medical indemnity cover (the termination date).
Note for subsection (2) 
Subparagraphs 26D(2)(b)(i) and (ii) of the Act also require the written notice to state the name of the person for whom the medical indemnity cover under subsection 26A(1) or 26C(1) of the Act is provided and the date from which the medical indemnity cover took effect.
Most recent period - medical indemnity cover
(3)        For the most recent 12 month period (or such lesser period) prior to the insurer providing medical indemnity cover under subsection 26A(1) or 26C(1) of the Act (the period), during which the person was provided with medical indemnity cover under an arrangement, the written notice must state the following matters:
(a)                    the total amount paid by the person during the period to an insurer or an MDO in relation to medical indemnity cover (including a subsidy paid to an insurer or an MDO on behalf of the person under the Premium Support Scheme 2004, as in force from time to time); and
(b)                   the amount of premium paid by the person during the period to an insurer for standard medical indemnity cover; and
(c)                    the amount of premium paid by the person during the period to an insurer for optional medical indemnity cover; and
(d)                   the amount paid by the person during the period to an insurer or an MDO by way of membership fees; and
(e)                    the sum of the amounts of administration fees, separately identified in an invoice issued by an insurer, that were paid by the person during the period; and
(f)                     the amount of discount given by an insurer to the person in relation to a premium paid during the period for medical indemnity cover; and
(g)                    the amount of loading in relation to a premium paid by the person during the period to an insurer for medical indemnity cover, being an additional amount paid by the person to take account of the risk being assumed by the insurer; and
(h)                    the amount of UMP support payment the person was liable to pay during the period (if any); and
(i)                      the sum of:
(i)                      all amounts of GST paid by the person during the period for any supply made by an insurer for which an amount paid for medical indemnity cover was consideration; and
(ii)                     all amounts of stamp duty paid by the person during the period; under a law of a State or Territory, in connection with medical indemnity cover provided under an arrangement; and
(j)                     whether an arrangement under which an insurer provided medical indemnity cover for the person during the period required the person to pay an excess to the insurer in relation to a claim that may be made against the person under the arrangement; and
(k)                   the year when the period ended; and
(l)                      the specialty in the medical profession in which the person practised during the period.
Second most recent period - medical indemnity cover
(4)        For the second most recent 12 month period (or such lesser period) during which the person was provided with medical indemnity cover under an arrangement, the written notice must state the matters mentioned in subsection (3).
Third most recent period - medical indemnity cover
(5)        For the third most recent 12 month period (or such lesser period) during which the person was provided with medical indemnity cover under an arrangement, the written notice must state the matters mentioned in paragraphs (3)(k) and (l).
Interpretation
(6)        In this section, a person's most recent principal place of practice is the principal place of practice identified in the most recent medical indemnity contract that was issued to the person by the insurer.
(7)        In this section, a reference to an insurer having taken over another insurer has the same meaning as in subsection 26A(3) of the Act.
(8)        For the avoidance of doubt, an insurer must give the Medicare Australia CEO a written notice in accordance with subsection 26D(2) of the Act stating the matters listed in this Determination if the insurer has the relevant information in its possession, custody or control.