Liability Insurance - University of Kansas Medical Center

MEMORANDUM
TO:
FROM:
Program Coordinators
Ruth Kamm, University Risk Manager
Jessica Johnson, Legal Counsel Administrative Assistant
DATE: April 2, 2009
SUBJECT:
Malpractice Coverage for Residents
The Kansas Department of Insurance requires that the attached Notice of Basic Coverage Form
be completed for all residents and fellows enrolled in our programs in order to provide malpractice
coverage through the Kansas Health Care Stabilization Fund. The attached notice covers fiscal year
July 1, 2009 to June 30, 2010. If a resident or fellow enters the program before July, an additional
notice is required for the date he/she entered the program. (For example, if a resident or fellow enters
the program on April 30, 2008 you would complete a notice of basic coverage from April 30, 2008 to
June 30, 2008 and an additional one from July 1, 2009 to June 30, 2010). Please make certain the
fund level of coverage is corrected to $800,000/2,400,000. The Fund is requesting that all notices
of basic coverage reflect this change.
Residents and fellows that are changing specialties, please make sure that the date the resident
or fellow enters the program is the date that he or she first enrolled as a resident or intern. Complete
each year from internship to fellowship, if applicable. See attached for an example.
Additionally, the attached Termination Notice is required by the Board of Healing Arts and the
Kansas Department of Insurance within 10 days of the resident’s or fellow’s termination. The
termination forms are mailed to both entities by our department. Under NO circumstances should a
termination notice be completed for residents transferring to another program or fellowship.
Notices of Basic Coverage must be completed and forwarded to the GME Institutional
Office by June 12, 2009. The GME Office will then forward them to the Office of Legal Counsel
by June 15, 2009. I realize that not all license numbers and addresses will be known by then, but
please forward forms as soon as this information is available. The Office of Legal Counsel will be
responsible for sending the notices to the Kansas Department of Insurance and/or the Board of Healing
Arts. The attached form was designed to reuse each year until the resident or fellow completes their
KU graduate medical education. You may make as many copies as you require.
If you have any questions, please contact Ruth Kamm or Jessica Johnson at 588-7281. Thank
you for your cooperation in complying with the directives of the Kansas Health Care Stabilization
Fund and the Board of Healing Arts.

NOTICE OF BASIC COVERAGE
KU/WCGME INTERN, RESIDENT, FELLOW SELF INSURANCE PROGRAM
AS PROVIDED BY K.S.A. 40-3414d
_____ Adding New Individual To Program
_____ Changing Specialty
_____ Continuation of Compliance
Name of Resident: ___________________________________________________________________
Last Name First Name M.I.
Legal Address of Resident: ____________________________________________________________
____________________________________________________________
____________________________________________________________
Board of Healing Arts License/Registration No: ___________________________________________
Speciality of Resident Training Program:
______________________________________________ ISO Code #:__________________
__________________________________________________________________________________
Health Care Stabilization Fund Level of Coverage: ________________________(as established by the
University of Kansas Medical Center).
Annual Compliance Documentation for Period of:
Intern: ____________________ * to ____________________
R2: ____________________ * to ____________________
R3: ____________________ * to ____________________
R4: ____________________ * to ____________________
R5: ____________________ * to ____________________
R6: ____________________ * to ____________________
*Enter the current compliance period for each individual resident. Usually this will be for each annual
self insurance period starting on July 1 and ending on June 30, of the subsequent year.
Other than Annual Compliance Documentation for period of:
_____________________ ** to _______________________
** For those residents entering or with an ending date other than the appropriate dates should be
entered.
Date Resident Entered the KUMC Training Program: ________________________________
Approved by GME Institutional Office ___________________________________________