The provider shall purchase and maintain insurance as listed below from a company, which is licensed and authorized to do business in the State of North Carolina by the North Carolina Department of Insurance. Should any of the described policies be reduced or canceled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. Any loss of insurance shall be the basis of a payback to the LME/MCO for services billed during this period and may result in the termination of the Contract. All insurance requirements of the Contract must be fully met unless specifically waived in writing by LME/MCO. The provider shall purchase and maintain the following minimum coverage:
- Professional Liability
Professional Liability Insurance protecting the provider and any employee performing work under the Contract for an amount of not less than $1,000,000.00 per occurrence/$3,000,000.00 annual aggregate.
- Comprehensive General Liability
Bodily Injury and Property Damage Liability Insurance protecting the provider and any employee performing work under the Contract from claims of Bodily Injury or Property Damage arising from operations under the Contract for an amount of not less than $1,000,000.00 per occurrence/$3,000,000.00 annual aggregate.
- Automobile Liability
If provider transports enrollees, Automobile Bodily Injury and Property Damage Liability Insurance covering all owned, non-owned, and hired automobiles for an amount not less than $500,000.00 each person and $500,0000.00 each occurrence. Policies written on a combined single limit basis shall have a minimum limit of $1,000,000.00.
- Workers’ Compensation and Occupational Disease Insurance, Employer’s Liability Insurance
Workers’ Compensation and Occupational Disease Insurance as required by the statutes of the State of North Carolina, and Employer’s Liability Insurance for an amount not less than Bodily Injury by Accident $100,000.00 each Accident/Bodily Injury by Disease $100,000.00 each Employee/Bodily Injury by Disease $500,000.00 Policy Limit.
- Tail Coverage
Liability insurance may be on either an occurrence basis or on a claims-made basis. If the policy is on a claims-made basis, an extended reporting endorsement (tail coverage) for a period of not less than three (3) years after the end of the contract term, or an agreement to continue liability coverage with a retroactive date on or before the beginning of the contract term, shall also be provided.
- Any provider utilizing any model for self-directing Innovations services and/or Agency With Choice services for Innovations enrollees shall carry Workers Compensation Insurance in accordance with the requirements of the DMA and LME/MCO Contract and Innovations Waiver §1915(c) rules.
- Provider shall:
- Submit new Certificate of Insurance (COI) no later than ten (10) business days after the expiration of any listed policy to ensure documentation of continual coverage without demand by the LME/MCO
- Notify the LME/MCO in writing at least thirty (30) calendar days before any coverage is suspended, voided, canceled or reduced
- Provide evidence to the LME/MCO of continual coverage at the levels stated above within two (2) business days if PROVIDER changes insurance carriers during the Term of the Contract, including tail coverage as required for continual coverage, and
- Notify the LME/MCO in writing within two (2) business days of knowledge or notice of a claim, suit, criminal or administrative proceeding against provider and/or practitioner relating to the quality of services provided under this Contract. Upon notification, LME/MCO, in its sole discretion, shall determine within ten (10) days of receipt of notification whether termination of the Contract or other sanction is required, and
- All insurance requirements of this Contract shall be fully met unless specifically waived in writing by both the LME/MCO and provider.
Provider shall have the right to self-insure provided that provider’s self-insurance program is currently licensed/approved by the Department of Insurance of the State of North Carolina and has been actuarially determined sufficient currently to pay the insurance limits required in the Contract. Evidence of such self-insurance may be submitted to the LME/MCO for review and approval in lieu of some or all of the insurance requirements above.