Category of Practice Guide - Medical Indemnity Insurance · the Practitioner Indemnity Insurance Policy and the premium payable for the policy. For these reasons, it is critical that

Category of Practice Guide

Avant Mutual Group LimitedABN 58 123 154 898V3.1/01/12

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General AdviceThis category guide (the guide) and your insurance policy are issued by Avant Insurance Limited (ABN 82 003 707 471) under Australian Financial Service Licence number 238 765. The information provided is general advice only. The guide, policy wording and product disclosure statement have been prepared without taking account of your objectives, financial situation or needs. Before acting on the advice in the guide or deciding to purchase or continuing to hold a policy with us, you should consider its appropriateness having regard to your personal circumstances. Please read and consider the guide and product disclosure statement and policy wording contained in the policy booklet provided or which are available at avant.org.au or by contacting us on 1800 128 268.

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Section 1 – Purpose of this Guide ............. 3

Section 2 – Categories of Practice ........... 3

Intern and Resident Medical Officer

Categories .................................................... 5

Doctor in Training Category ....................... 6

General Practice Categories ..................... 7

General Practice – Level 1 .......................... 7

General Practice – Level 2A ........................ 9

General Practice – Level 2B ....................... 10

General Practice – Level 2C ...................... 10

Cosmetic Practice Categories ................. 11

Cosmetic Practice – Level A ...................... 11

Cosmetic Practice – Level B ...................... 12

Other Medical Categories ........................ 13

Absentee (Deferment) ................................ 13

Career/Hospital Medical Officer ................ 13

Defence Forces .......................................... 13

Good Samaritan ......................................... 13

Medico-Legal .............................................. 14

Non-Clinical ................................................ 14

Prescribing & Referral ................................ 14

Psychotherapy(Non-Specialist) ................. 15

Surgical Assistant ....................................... 15

Specialist Non-Surgical Categories ........ 16

Anaesthesia ................................................ 16

Dermatology ............................................... 16

Emergency Medicine .................................. 16

Immunology & Allergy ................................ 17

Intensive Care ............................................. 17

Nuclear Medicine ........................................ 17

Occupational Medicine ............................. 17

Paediatrics .................................................. 17

Pain Management ...................................... 17

Palliative Care ............................................. 17

Pathology .................................................... 18

Physician Cardiology-Level 1 .................... 18

Physician Cardiology-Level 2 .................... 18

Physician Gastroenterology ...................... 18

Other Physician Categories ...................... 19

Psychiatry ................................................... 19

Public & Community Health ....................... 19

Radiation Oncology .................................... 19

Radiology .................................................... 20

Rehabilitation ............................................. 20

Sports Medicine ......................................... 20

Ultrasound Diagnostic ............................... 20

Surgeon Categories .................................. 21

Gynaecology ............................................... 21

Obstetrics & Gynaecology ......................... 21

Ophthalmology – Level 1A ......................... 22

Ophthalmology – Level 1B ......................... 22

Surgeon General ......................................... 22

Surgeon Hand ............................................. 22

Surgeon Otolaryngology ........................... 23

Surgeon Plastic & Reconstructive ............. 23

Surgeon Plastic,

Reconstructive & Cosmetic ...................... 23

Surgeon Urology ......................................... 24

Other Surgeon Categories ........................ 24

Allied Health Categories .......................... 25

Dental Categories ..................................... 25

Section 3 – Gross Billings ........................ 26

Section 4 – Definitions ............................. 28

Table of Contents

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Section 1Purpose of this GuideThis guide applies to the Avant Insurance Practitioner Indemnity Insurance Policy and is designed to provide you with information about our categories of practice and details on calculating your gross billings. These two aspects directly affect your cover under the Practitioner Indemnity Insurance Policy and the premium payable for the policy. For these reasons, it is critical that you select the appropriate category of practice which best describes your activities as a healthcare professional and correctly calculate and advise us of your gross billings figure.

Categories of practice are determined by Avant Insurance Limited and may be updated, amended or replaced from time to time.

The section on gross billings explains in detail what this term means. There is also a gross billings calculator to assist you with determining your gross billings estimate.

AssistanceIf you need assistance with selecting the appropriate category of practice or in determining your gross billings estimate, please contact Avant’s Member Services team on 1800 128 268.

Section 2 Categories of Practice

What is your Category of Practice?

Your category of practice:

• is determined by your qualifications and the type of work you do in your professional practice.

• should reflect the work you will undertake during the period for which you seek indemnity insurance.

In order to be fully indemnified for all aspects of your practice you should advise us of any work or procedures you do outside the category of practice you have selected. Failure to do so will result in no cover for a procedure outside your chosen category. You may be asked to supply proof of training or qualifications supporting your application for a particular category or to perform specific procedures or activities.

The categories are divided into nine groups: Intern & Resident Medical Officer, Doctor in Training, General Practice, Cosmetic Practice, Other Medical, Specialist–Non-Surgical, Surgeon, Allied Health and Dental.

To assist you in determining your category of practice, we have listed inclusions and exclusions, which apply to specific categories.

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The inclusions and exclusions are intended to be a guide rather than an exhaustive list of the procedures or activities. If you have any questions about procedures or activities you undertake please do not hesitate to contact us on 1800 128 268. If you perform procedures that are inconsistent with your chosen category of practice, or that are excluded under your chosen category you will not be indemnified.

Note for Staff SpecialistsWe need you to select the category that identifies your practice. The criteria can appear complex, so if in doubt please call Member Services on 1800 128 268 so that we can help you to provide the information we need.

Broadly our approach is:

• if your private practice billings and/or drawing rights are nil or less than $5,000 we will record ‘Staff Specialist – Indemnified’ as well as your practice category

• if your billings and/or drawing rights are $5,000 or more, then we:

(a) will record your staff specialist level (1–5) and FTE status if you are a NSW staff specialist with drawing rights only; or

(b) will ask for your estimated total gross billings if:

(i) you are a NSW staff specialist with drawing rights plus billings from outside private practice; or

(ii) you practise outside NSW.

Changing your Category of PracticeIf the work you undertake changes, and as a result you need to change your category of practice, you must notify Avant as soon as possible.

If you do not notify us of such a change, we will not provide cover for healthcare, which is not consistent with the category specified on your Policy Schedule at the time a healthcare incident occurs.

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2.1 Intern and Resident Medical Officer Categories

Intern

A new graduate with provisional registration from an Australian Medical Board or Council who is engaged in the first year of an internship at a public hospital.

Includes

Private work ONLY where it forms part of the training program.

Excludes

Private practice outside of the training program.

Resident Medical Officer (2nd Postgraduate Year)

A non-specialist medical practitioner who is in their second postgraduate year and employed by a public teaching hospital (and indemnified by that hospital).

Includes

• Private practice and locum work consistent with qualifications and experience

• Surgical assistance.

Excludes

Private practice in obstetrics or cosmetic procedures.

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2.2 Doctor in Training Category

Doctor in Training

A medical practitioner who is:

• a non-specialist medical practitioner in their 3rd, 4th or 5th postgraduate year employed by a public teaching hospital and indemnified by that hospital (Senior Resident Medical Officer PGY3-5); or

• a General Practice Registrar who is enrolled in a training program recognised and approved by the Royal Australian College of General Practitioners (RACGP) for the purpose of training and qualification as a general practitioner; or

• employed for the purpose of training and qualification as a specialist medical practitioner or enrolled in a specialist training program recognised and approved by the relevant Australian/Australasian College and accredited by the Australian Medical Council (Specialist in training); or

• a Hospital Registrar who will begin a training program within 12 months.

Includes

Unlimited private practice:

• where it forms part of your training program

• performed outside of your training program (including locum work and surgical assistance) that is consistent with your qualifications and experience.

Excludes

• Private practice outside of your training program involving: cosmetic procedures, obstetrics, dermatology, pathology, radiology where you bill the patient directly or you are NOT under the direct supervision of a medical practitioner who is qualified to perform such procedures.

• Medical practitioners who already hold a specialist qualification recognised by the relevant Australian/ Australasian College should select another category.

• Hospital Registrars who will not be undertaking any training program within 12 months should select another category, such as Career/Hospital Medical Officer.

• Medical practitioners who have previously engaged in private practice as a general practitioner.

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2.3 General Practice Categories

General Practice–Level 1 (Non-Procedural)

A general practitioner engaging in predominantly consultative practice who performs procedures which most GPs commonly perform in their surgery or rooms.

Note 1: Refers to general practitioners who provide antenatal care for the full antenatal period but are not involved in the induction or management of labour or in the delivery of the infant, except where providing emergency obstetric assistance. If you do provide obstetric services and the hospital does not fully indemnify you for all aspects of the labour or delivery you must select the General Practice – Level 2C (Procedural with Obstetrics) category.

Note 2: Local skin flap definition A local skin flap is an area of skin and subcutaneous tissue designed to be elevated from the skin adjoining a defect requiring closure. The flap remains partially attached by its pedicle and is moved into the defect by rotation, advancement or transposition, or a combination of these manoeuvres. A secondary defect will be created which may be closed by direct suture, skin grafting or sometimes a further local skin flap. A Z-plasty is a particular type of transposition flap repair.

Note 3: General practitioners who intend to insert Implanon® or Implanon NXT must adhere to the RACGP guidelines (refer to www.racgp.org.au) and have completed the relevant training course run by Implanon, Organon or Merck, Sharp and Dohme (MSD). General practitioners who intend to insert Implanon NXT must have completed the training for Implanon NXT. Documentation of adherence to the above conditions will be required in the event of a claim.

Includes

Accident and Emergency including:

• Arterial blood gas estimation • Arterial line insertion• Blood transfusions • Central venous line insertion• Chest tube/drain insertion • Drainage of pleural effusion• Lumbar puncture • Simple fractures & dislocations – closed reductions not requiring general anaesthesia• Suprapubic bladder tap.

Anaesthesia, limited to:

• Local anaesthesia only including digital block, ring block, ankle block and Biers block• IV injections using narcotics and/or benzodiazepines for minor procedures only.

Simple cosmetic procedures, limited to:

• Botox injections• Endovenous Laser Treatment (EVLT)• Fruit acid facial peels (superficial only)• Microdermabrasion

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• Non-permanent dermal fillers (Collagen, Hylaform, Juvederm but NOT Juvederm Voluma Restylane but NOT Restylane sub Q)

• Photodynamic Therapy (PDT) for treatment of skin lesions and acne• Sclerotherapy and microsclerotherapy (excluding applications to the face).

Procedures including:

• Acupuncture• Allergy testing – desensitisation• Antenatal care and post-natal care (See Note 1)• Biopsy including breast lump aspiration (excluding bone marrow and liver biopsies)• Cautery of nose• Colposcopy• Compartment pressure testing• Draining hydrocoele by fine needle aspiration• Exercise stress testing• Excision of small superficial skin lesions, including repair by small local flaps but

excluding hair transplant flaps (See Note 2)• Haemorrhoid treatments (banding, injections and ligation)• Hormone implants including Zoladex and Implanon (under local anaesthetic) (See Note 3)• Hyperbaric chamber medicine• Impotence treatments (non-surgical)• IUD – removal and insertion• Joint aspiration and intra-articular steroid injections• Musculoskeletal medicine (including spinal manipulation under general anaesthetic

but excluding spinal stimulation)• Pap smear tests• Peri-anal haematoma – incision and excision• Post mortems• Proctoscopy and sigmoidoscopy• Psychotherapy (non-specialist)• Skin grafts (split skin and full thickness less than 3cms)• Surgical assistance• Wedge excision of toenail.

Excludes

• Invasive procedures other than those listed in the inclusions• Termination of pregnancy (medical or surgical)• Cosmetic procedures except those listed in the inclusions.

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General Practice –Level 2A (Procedural)

A general practitioner performing procedural activities.

Note 1: Refers to epidermal peels using peeling agents such as Alpha Hydroxy Acids, Resorcinol, Jessner’s solutions and Trichloroacetic Acid. Please contact Avant Insurance if you require more information regarding cover for superficial chemical peels.

Note 2: Refers to IV sedation administered by general practitioners for the purpose of operating lists performed by other practitioners, whether in their rooms or in a hospital or day surgery facility.

Includes

Anything covered under General Practice–Level 1 PLUS:

• Bronchoscopy• Caudal epidurals• Chemical peels – superficial only (See Note 1)• Circumcision (male only)• Colonoscopy• Curetting or excision of meibomian cysts or chalazion• Dilating salivary gland duct• Egg pick-up• Electrophysiology studies• Endoscopy• Gastric band adjustments via portacath• Gynoscan for cytological/ histological investigation of the endometrium• Hysterosalpingography• Incision of lymph gland for drainage due to infection• IV sedation – using benzodiazepines, narcotics and anaesthetic agents such as

propofol (See Note 2)• Non-permanent dermal fillers (Restylane Sub Q, Voluma)• Paracentesis• Phlebectomy• Plasma treatments (PSR) at low levels only• PUVA and UVB treatment• Regional Anaesthesia – minor regional anaesthesia only (including axillary nerve blocks

but excluding spinal or extradural nerve blocks)• Sclerotherapy and microsclerotherapy (including application to the face)• Syringing of tear duct• Vasectomy.

Excludes

• Procedural activities listed under the General Practice–Level 2B Category• Termination of pregnancy (medical or surgical)• Intrapartum obstetrics including caesarean section.

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General Practice–Level 2B (Procedural)

A general practitioner performing procedural activities.

Includes

Anything covered under General Practice–Level 2A PLUS:

• Anaesthesia • Appendectomy • Dilatation and Curettage • Hernia repair • Minor orthopaedic surgery (such as carpal tunnel surgery and knee arthroscopy) • Termination of pregnancy (up to 20 weeks gestation only) • Tonsillectomy • Treatment related to ectopic pregnancy • Vasectomy reversal.

Excludes

Intra-partum obstetrics including caesarean section.

General Practice–Level 2C (Procedural with Obstetrics)

A general practitioner who holds a DRANZCOG or equivalent recognised qualification and performs procedural activities, including obstetrics.

Includes

Anything covered under General Practice–Level 2B PLUS:

• Intra-partum obstetrics including caesarean section.

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2.4 Cosmetic Practice Categories

Cosmetic Practice–Level A

A medical practitioner who does not have specialist recognition (under the processes approved by the Australian Medical Council) qualifying them to perform the cosmetic procedures undertaken.

Note 1: Medium depth peels refer to papillary dermal peels using peeling agents such as Alpha Hydroxy Acids, and augmented Trichloroacetic Acid solutions. Deep chemical peels refers to reticular dermal peels using peeling agents such as Phenol (including Baker Gordon Phenol formula) and Trichloroacetic Acid.

Note 2: Refers to any treatment using Lasers, IPLs or Radiofrequency devices for the purpose of

removal of hair, tattoos, scarring, pigmented or vascular lesions, and/ or resurfacing.

Includes

• Aptos threads• Chemical peels – medium depth and deep chemical peels (See Note 1)• Dermabrasion• Dermal fillers – Aquamid, Radiesse, Sculptra• Fat injections (related to the facial areas only and not involving any major fat grafts from

the body or injections into breasts)• Gor-Tex implants• Hair transplants using Follicular Unit Extraction (FUE)• Intense Pulse Light (IPL) therapy/ photo rejuvenation (See Note 2)• Laser therapy including laser hair removal, laser tattoo removal and laser resurfacing

(See Note 2)• Lipo-dissolving treatments• Microneedle therapy (roll CIT)• Plasma treatments (PSR)• Radiofrequency treatment, including resurfacing and fat/cellulite reduction (See Note 2)• Scalp reductions (simple central scalp reductions only).

Excludes

• All cosmetic procedures involving general or tumescent anaesthesia• All procedures in Cosmetic Practice – Level B.

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Cosmetic Practice-Level B

A medical practitioner who does not have specialist recognition (under the processes approved by the Australian Medical Council) qualifying them to perform the cosmetic procedures undertaken.

Includes

Anything covered under Cosmetic Practice–Level A PLUS:

• Abdominoplasty• Blepharoplasty including laser blepharoplasty• Breast reduction, enhancement or augmentation (Surgical)• Liposuction/ liposculpture• Meloplasty• Otoplasty• Penile lengthening or thickening and cosmetic urological procedures• Rhinoplasty• Scalp reductions.

Excludes

• Cosmetic procedures except those listed in the inclusions• Gender re-assignment surgery• Transfer or injection of non-vascularised fat into the breast.

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2.5 Other Medical Categories

Absentee (Deferment)

A medical practitioner who has ceased medical practice for a period of time. This category is designed for medical practitioners on paternity leave, study leave, overseas work, illness or sabbaticals.

Includes

Unpaid healthcare limited to Good Samaritan acts worldwide, volunteer services and the writing of a prescription or a referral.

Excludes

• Elective clinical healthcare activities (e.g. consultations, procedures or treatments)• Medical practitioners who become eligible for the Run-Off Cover Scheme • Medical practitioners whose professional registration status is suspended or

deregistered or whose current policy is subject to non-standard terms or conditions.

Career/ Hospital Medical Officer

A medical practitioner who is practising in a hospital providing non-specialist medical services.

Excludes

Medical practitioners who hold specialist qualifications that are recognised and approved by the relevant Australian/Australasian College and accredited by the Australian Medical Council.

Defence Forces

A non-specialist medical practitioner employed by an Australian Defence Force service.

Good Samaritan

A medical practitioner who has ceased medical practice and who only requires cover for Good Samaritan acts. This category may be suitable for medical practitioners who hold ‘non-practising’ registration.

Includes

Good Samaritan acts only.

Excludes

• Healthcare or unpaid healthcare (other than Good Samaritan acts)• Past paid practice – you will need to hold a run-off policy prior to applying for this

category to cover your past paid practice.

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Medico-Legal

A medical practitioner who practises predominantly as a medico-legal practitioner.

Includes

• Opinions or reports given in the course of a medico-legal assessment• Medical examinations undertaken in medico-legal practice in assessment of an

examinee (who is not your patient)• Writing referrals to other medical practitioners for conditions identified during the course

of a medico-legal assessment.

Excludes

Elective clinical healthcare activities (e.g. consultations, procedures or treatments).

Non-Clinical

A medical practitioner who does not undertake any clinical practice. This includes practitioners who hold Academic, Research and Medical Administration positions.

Includes

• Lecturing, broadcasting, writing or public health activities relating to general medical advice only

• Unpaid healthcare including the writing of a prescription or a referral (refer to Definition section of policy wording).

Excludes

• Elective clinical healthcare activities (e.g. consultations, procedures or treatments)• Healthcare incidents, which arise out of exercising non-medical knowledge or judgement

such as managerial or administrative skills or which do not relate to patient care.

Prescribing & Referral

A medical practitioner who has ceased medical practice but who has maintained registration as a medical practitioner, which allows them to undertake gratuitous services and unpaid prescribing and referring.

Includes

Unpaid healthcare only of the type allowed by the practitioner’s registration and covered by the policy under the definition of ‘unpaid healthcare’ (refer to Definition section of policy wording).

Excludes

• Past paid practice – you need to hold a run-off policy prior to applying for this category to cover your past paid practice

• Any healthcare where an income is derived• Elective clinical healthcare activities (e.g. consultations, procedures or treatments).

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Psychotherapy (Non-Specialist)

A non-specialist medical practitioner who practises exclusively in the area of psychotherapy.

Surgical Assistant

A medical practitioner who practises as a surgical assistant only, does not act as a primary or supervising surgeon and does not otherwise undertake any clinical practice.

Excludes

• Clinical practice other than surgical assisting• Primary or supervising surgeons.

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2.6 Specialist Non-Surgical Categories

Anaesthesia

A medical practitioner who holds a FANZCA or equivalent recognised qualification in anaesthesia and practises in their specialty.

Includes

• Pain management• Intensive care• Perfusion.

Dermatology

A medical practitioner who holds a FACD or equivalent recognised qualification and practises in their specialty.

Includes

• Blepharoplasty• Botox• Dermal fillers• Dermabrasion• Laser therapy including laser hair removal, laser tattoo removal and laser resurfacing• Thread procedures• Skin peels• Liposuction.

Emergency Medicine

A medical practitioner who practises predominantly in the area of emergency medicine. Includes Fellows of the College of Emergency Medicine.

Includes

Advice and treatment (including procedures) provided in the course of the emergency management of patients.

Excludes

If the practitioner also engages in non-emergency clinical practice then they must ask us if they will be indemnified for that clinical practice and we must agree to cover them. Alternatively, they should choose the category of practice which best describes their clinical practice.

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Immunology & Allergy

A medical practitioner who holds FRACP or equivalent recognised qualification, practises in their specialty, and performs only those procedures within the accredited training for their specialty or recognised sub-specialty.

Intensive Care

A medical practitioner who holds FANZCA, FRACP, JFICM, FCICM or an equivalent recognised qualification and who practises exclusively in the area of intensive care.

Excludes

Medical practitioners with surgeon qualifications.

Nuclear Medicine


Occupational Medicine

A medical practitioner who holds FRACP, FAFOEM or equivalent recognised qualification and practises in their specialty.

Paediatrics


Pain Management

A medical practitioner who holds FANZCA, FRACP, FFPMANZCA or equivalent recognised qualification and practises exclusively in the area of pain management.

Includes

• Dorsal column stimulation• Spinal implants.

Palliative Care


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Pathology

A medical practitioner who holds FRCPA or equivalent recognised qualification and practises in their specialty.

Physician Cardiology-Level 1

A medical practitioner who holds FRACP or equivalent recognised qualification and practises in the area of non-invasive cardiology.

Includes

• Cardiac ultrasound• Cardioversion• Stress testing• Trans-oesophageal echocardiography.

Excludes

Procedures listed in Physician Cardiology-Level 2.

Physician Cardiology-Level 2

A medical practitioner who holds FRACP or equivalent recognised qualification and practises in the area of cardiology.

Includes

Anything covered under Physician Cardiology – Level 1 PLUS:

• Angiograms• Angioplasty• Electrophysiological studies• Pacemaker and ICD insertion• Stent insertion.

Physician Gastroenterology

A medical practitioner who holds FRACP or equivalent recognised qualification and practises in the area of gastroenterology.

Includes

• Colonoscopy• Endoscopic dilatation of gastric stricture• ERCP• Liver biopsy• Percutaneous gastrostomy• Sigmoidoscopy• Stent insertion• Upper GIT endoscopy.

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Other Physician Categories

Physician–Endocrinology

Physician–General

Physician–Genetics

Physician–Geriatrics

Physician–Haematology

Physician–Infectious Diseases

Physician–Nephrology

Physician–Neurology

Physician–Oncology

Physician–Orthopaedics

Physician-Respiratory

Physician–Rheumatology


Psychiatry

A medical practitioner who holds FRANZCP or equivalent recognised qualification and practises in their specialty.

Public & Community Health

A medical practitioner who holds FRACP, FAFPHM or equivalent recognised qualification and practises in the area of public and community health.

Radiation Oncology

A medical practitioner who holds FRANZCR or equivalent recognised qualification and practises in their specialty.

Includes

Administration of radiotherapy.

Excludes

Interventional procedures other than radiotherapy.

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Radiology

A medical practitioner who holds FRANZCR or equivalent recognised qualification and practises in their specialty.

Includes

• Angioplasty (non-coronary)• CNS biopsies• Drainage of abscesses and cysts• Drainage of ascites and pleural effusions• Image-guided biopsies• Insertion of intra-arterial stents• Joint injections• Lung biopsies.

Rehabilitation

A medical practitioner who holds FRACP, FAFRM or equivalent recognised qualification and practises in their specialty.

Sports Medicine

A medical practitioner whose practice takes place either predominately or totally in the area of sports medicine.

Includes

• Intra-articular injections• Compartment pressure testing.

Excludes

Invasive procedures.

Ultrasound Diagnostic

A medical practitioner who practises exclusively in the area of diagnostic ultrasound.

If a practitioner also engages in other areas of medical practice then they must choose the category of practice which best describes that area of practice.

Includes

• Amniocentesis• Chorionic villus sampling• Hysterosalpingogram (HSG)• Ovarian cyst aspiration• Saline infusion sonography.

Excludes

Interventional procedures other than those listed in inclusions.

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2.7 Surgeon Categories

Gynaecology

A medical practitioner who holds FRANZCOG or equivalent recognised qualification and practises in gynaecology only.

Includes

• Cervical biopsy• Colposcopy• Hysterectomy• Implanon or other hormone pellet/ rod insertion subcutaneously• IUD insertion and removal• IVF procedures and antenatal care but not intra-partum care• Laparoscopy• Simple cervical diathermy• Termination of pregnancy• Treatment of miscarriages and ectopic pregnancies.

Excludes

Intra-partum obstetrics including caesarean section.

Obstetrics & Gynaecology

A medical practitioner who holds FRANZCOG or equivalent recognised qualification and practises in their specialty.

If you are an O & G who undertakes intrapartum obstetrics on public patients in public hospitals you may subscribe to the Gynaecology category ONLY if you are fully indemnified for any matter that may arise from the labour and delivery of an infant.

If your employer or state indemnity scheme (e.g. TMF, VMIA) does not fully indemnify you for all matters that may arise from labours and deliveries, then you must select the O & G category.

Includes

Gynaecological procedures plus intra-partum obstetrics including caesarean section.

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Ophthalmology-Level 1A

A medical practitioner who holds FRANZCO, FRACS or equivalent recognised qualification and who performs minor low risk extra-ocular procedures.

Includes

• Cautery/removal of cysts of the eyelid• Electrolysis of lash follicles• Incision and curettage of tarsal cysts• Lavage (syringing, probing) of tear ducts• Punctum snip• Removal of pterygium, corneal or scleral foreign bodies.

Excludes

Surgical procedures except those listed.

Ophthalmology-Level 1B

A medical practitioner who holds FRANZCO, FRACS or an equivalent recognised qualification and practises in their specialty.

Includes

Anything covered under Ophthalmology Level-1A PLUS:

• Surgical procedures including YAG laser, other cosmetic procedures and refractive laser eye surgery.

Surgeon General

A medical practitioner who holds FRACS or equivalent recognised qualification and who does not hold sub-specialty qualifications in the listed categories of practice.

Surgeon Hand

A medical practitioner who holds FRACS or equivalent recognised qualification and who specialises entirely in the field of hand and upper-limb surgery, excluding shoulder surgery.

Includes

Orthopaedic, plastic or general surgery procedures confined to the hand and upper limb.

Excludes

• Surgery or procedures other than hand and upper limb• Shoulder surgery.

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Surgeon Otolaryngology

A medical practitioner who holds FRACS or equivalent recognised qualification in the sub-specialty of otolaryngology surgery and practises in their specialty.

Includes

• Orthopaedic, plastic or general surgical procedures confined to the head and neck• Cosmetic procedures including Rhinoplasty or Otoplasty.

Surgeon Plastic & Reconstructive

A medical practitioner who holds FRACS or equivalent recognised qualification in the sub-specialty of plastic and reconstructive surgery and practises in their specialty.

Includes

Transfer or injection of non-vascularised fat into the breast(s) ONLY as part of breast reconstruction after mastectomy or trauma.

Excludes

Procedures for which there is no Medicare item number assigned or for which a Medicare item number is assigned but is not claimable.

Surgeon Plastic, Reconstructive & Cosmetic

A medical practitioner who holds FRACS or equivalent recognised qualification in the sub-specialty of plastic, reconstructive and cosmetic surgery and practises in their specialty.

Includes

Procedures which are not claimable from Medicare and aesthetic procedures such as:

• Blepharoplasty• Breast augmentation and reduction• Cosmetic penile procedures such as lengthening and thickening• Liposuction• Mastopexy• Meloplasty.

Excludes

Transfer or injection of non-vascularised fat into the breast(s) as a cosmetic enhancement procedure, except as part of breast reconstruction after mastectomy or trauma.

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Surgeon Urology

A medical practitioner who holds FRACS or equivalent recognised qualification in the sub-specialty of urological surgery and practises in their specialty.

Excludes

Cosmetic urological procedures including penile lengthening or thickening. Urologists who perform such procedures should select Cosmetic Practice-Level B.

Other Surgeon Categories

Surgeon Cardio-thoracic

Surgeon Colo-rectal

Surgeon Endocrinology

Surgeon Foot & Ankle

Surgeon Oral & Maxillofacial

Surgeon Neurosurgery

Surgeon Orthopaedic

Surgeon Paediatric

Surgeon Vascular

A medical practitioner who holds FRACS or equivalent recognised qualification, practises in their specialty, and performs only those procedures encompassed within the accredited training for their specialty or recognised sub-specialty.

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2.8 Allied Health Categories

Audiology

Occupational Therapy

Optometry

Orthoptist

Physiotherapy

Radiography

Speech & Learning Pathology

Technician

2.9 Dental Categories

Dental General

Dental Hygienist

Dental Oral & Maxillo-facial Surgeon

Dental Specialist

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Section 3Gross billings

‘Gross billings’ is defined as:

‘The total of all billings generated by you from your provision of private medical services, whether retained by you or otherwise, and before any apportionment or deduction of any expenses and/or tax. This includes, but is not limited to:

(a) Medicare benefits; or

(b) payments by individuals, the Commonwealth Department of Veterans Affairs, workers compensation schemes and third-party and/or vehicle insurers; or

(c) income earned for the practice of your medical profession carried on outside Australia if your contract of insurance with Avant Insurance covers that overseas practice.

Gross billings also includes income you derive from any other sources as part of your medical practice – such as professional fees and incentive payments other than those made under the Australian Government’s Practice Incentive Program (PIP).

Gross billings do not include income from public medical services for which medical indemnity cover is provided by a public sector organisation.

You must provide an accurate estimate of your gross billings otherwise, you may not be covered in the event of a claim against you. Please note that your billings may be audited if a claim arises, or you could be randomly selected for inclusion in a general audit of billings.

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Estimated gross billings calculator

Follow the steps below to work out your estimated gross billings.

Step 1 You need to include your Medicare billable procedures

All procedures for which you are entitled to bill (except for a Dillon Fund or similar scheme where you have indemnity provided by the hospital). Please note that you need to include the amount that you have billed the patient for the procedure – not the Medicare rebate amount.

Step 2 You need to include your non-Medicare billable procedures

Any service or procedure for which you bill that does not have an assigned Medicare Number. This would include, among others, cosmetic surgery, acupuncture, TAC, Work Cover consultations, Veterans Affairs consultations and clinical or medico-legal reports.

Step 3 If you work on contract or receive a salary

If you provide medical services for which you receive an income or salary rather than generate billings (in your name or otherwise) and require indemnity for those services, then your gross income should be included in the calculation of your gross billings. An example of this would be the provision of outsourced healthcare services.

Step 4 Other income

Income derived by you from healthcare activities for which you require indemnity not accounted for in steps 1 to 3. These activities could include articles, lectures and incentive payments. Also, if you have (or intend to apply for) Public Patients Cover with Avant Insurance, you must also include any income derived from the treatment of public patients.

Step 5 No billings generated

When you are on a salary and no billings are generated, you need to declare your gross income. An example of this situation is a healthcare professional working for the defence forces.

Step 6 Total estimated annual gross billings

This is arrived at by adding up all the amounts, which apply to you in steps 1 to 5.

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Section 4Definitions

Cosmetic procedures

Cosmetic procedures are defined as: ‘Operations, procedures and treatments that revise or change the appearance, colour, texture, structure or position of normal bodily features with the sole intention of improving the patient’s appearance or self-esteem. It includes non-surgical cosmetic medical procedures and surgical cosmetic procedures.’

If you undertake any cosmetic procedures, please ensure that you select the correct category for the procedures you are undertaking.

Authorised representative

Avant must have your authority before we will allow any other person to access your information on your behalf. Such an authority is required for your practice manager, secretary, spouse, or similar individual. This can be authorised in writing by you or over the phone after you have been properly authenticated.

An authorised representative may access information on your file, request literature to be issued, or make changes to your policy details but they cannot cancel your policy.

If you wish to authorise a person to access your file, you must complete the ‘Authorised Representatives’ section of your application form or contact our Member Services team on 1800 128 268 for information about our requirements.

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Version 3.1 1 January 2012

Contact us

Adelaide Office Level 6, 108 King William Street Adelaide SA 5000 Telephone 08 7071 9800 Facsimile 08 7071 5250

Brisbane Office Level 11, 100 Wickham Street Fortitude Valley QLD 4006 Telephone 07 3309 6800 Facsimile 07 3309 6850

Hobart Office Level 2, 29 Salamanca Place Hobart TAS 7000 Telephone 03 6220 7800 Facsimile 03 6224 0899

Melbourne Office Level 2, 543 Bridge Rd Richmond VIC 3121 Telephone 03 9026 5900 Facsimile 03 8673 5015

Perth Office Level 1, 91 Havelock Street West Perth WA 6005 Telephone 08 6189 5700 Facsimile 08 6189 5713

Sydney Office Level 28, 580 George Street Sydney NSW 2000 Telephone 02 9260 9000 Facsimile 02 9261 2921

1800 128 268www.avant.org.au

Avant Mutual Group Limited ABN 58 123 154 898

Documents

Category of Practice Guide - Medical Indemnity Insurance · the Practitioner Indemnity Insurance Policy and the premium payable for the policy. For these reasons, it is critical that