Cross-Coverage Group Agreement

The object and purpose for which this Cross-Coverage Group is established is to continue the operation of the practice of a participating dentist in the event that an actual emergency is created due to the death or disability of a participating dentist in order to continue such dentist’s practice during the period of disability, or to provide a sufficient period following the death of a participating dentist to make the necessary arrangements for the sale of such deceased dentist’s practice and equipment.

This plan is not intended to supplant or replace any disability insurance or loss of income insurance coverage.

I.  Membership

  1. The group will consist of at least 16 Practice Management Club members, who are in good standing, and who are actively practicing general dentistry.
  2. Each member of the group shall be and remain a member of the ADA, WSDA, SDDS and abide by the ADA Code of Ethics.
  3. Each member shall maintain malpractice insurance during the period when the agreement is in force, with not less than $1 million/$3 million limits, and shall provide proof of coverage to the group upon request of the Vice President.
  4. New members will be required to join the PMC Cross-Coverage Group if they are actively practicing general dentistry.
  5. The length of the contract for receiving coverage is to continue until age sixty-five, or as long as the PMC membership is maintained.
  6. Election not to participate will be accepted at any time cross-coverage is not in effect.  If cross-coverage is being provided, all members will be expected to fulfill their commitment to the group.
  7. Any member missing any scheduled Cross-Coverage fill-in days without a reasonable excuse may be automatically dropped from Cross-Coverage Group.
  8. All expenses occurring from the operation of this program are to be pro-rated and charged to all members equally.

II.  TERMS OF COVERAGE

All provisions of this agreement become effective upon signature of participants and receipt of the agreement by the Vice President.  Direct request to the Vice President must be provided by the stricken member or his representative before coverage will be initiated.

A.  Disability

  1. Any non-elective disability in which a stricken member is expected to be unable  to perform the functions of his practice for a minimum period of twenty-one calendar days, but with the intent of returning to his practice will be eligible for coverage.
  2. When a member is stricken, the Vice President will organize a meeting within the first week between the PMC members, the stricken member’s spouse, and the stricken member’s staff.  This meeting is to be held at the stricken member’s office.  It is at this meeting that dates of coverage will be assigned to each member who is present.  Those members who are not in attendance at this meeting will then be assigned coverage dates.  It is the responsibility of each individual dentist to arrange coverage if he/she is unavailable on the assigned date (e.g. a locum tenens dentist), at the expense of the covering member dentist.
  3. Disability precluding any future return to the practice of dentistry will be covered as in death benefits.
  4. In the event of questionable cases, the Vice President will contact the stricken member and his physician.  All pertinent facts will be presented to the membership.  Majority decision will rule.
  5. Coverage will start within seven calendar days from the start of the disability and continue on a four-day a week, regular office hours of the stricken office basis for a maximum period of one hundred-twenty calendar days, or until the stricken member is able to return to his practice, whichever occurs first.
  6. No member shall receive more than one hundred-twenty calendar days of Cross-Coverage in any twelve month period of time except in the event that death follows disability.  The death coverage will then automatically become effective.
  7. When a member reaches the age of sixty, the time of disability coverage will decrease to one-half the total number of days.
  8. When a member reaches the age of sixty-five, cross coverage benefits are terminated.

B.  Death

  1. Upon the death of a member, the Vice President will organize a meeting within the first week between the PMC members, the stricken member’s spouse, and the stricken member’s staff.  This meeting is to be held at the stricken member’s office.  It is at this meeting that dates of coverage will be assigned to each member who is present.  Those members who are not in attendance at this meeting will then be assigned coverage dates.  It is the responsibility of each individual dentist to arrange coverage if he/she is unavailable on the assigned date (e.g. a locum tenens dentist), at the expense of the covering member dentist.
  2. Members already having made arrangements for the disposal of their practice in the event of their death must notify the Vice President in writing of this fact.
  3. Aid will start no more than seven calendar days from the date of request and continue on a four-day a week, regular office hours of the stricken dentist basis for a maximum period of ninety calendar days or until the practice is transitioned to a new dentist, whichever occurs first.
  4. Upon the death of a member, the group shall offer a plan for evaluation of the practice and advise the deceased’s widow and/or attorney.
  5. A letter from the group on the letterhead of the deceased dentist will be made available to patients advising them that the Practice Management Club members will provide dental care until a successor dentist assumes the practice.
  6. When a member reaches the age of sixty, the time of death cross coverage will decrease to one-half the total number of days.
  7. When a member reaches the age of sixty-five, disability benefits are terminated.

III.  SERVICES

  1. All services will be performed in the stricken member’s office and he will be responsible for providing all materials and maintenance deemed necessary by the Vice President.
  2. The stricken member’s account will be credited with all proceeds from the Cross-Coverage Group.
  3. The stricken member’s office will:
    • Notify each patient in advance as to the identity of the substitute dentist, as per the schedule provided by the Vice President.
    • Provide a list of fee schedules, laboratories, and referral offices to the substitute dentists.
    • Provide a copy of the day’s schedule, at least two days in advance, to the substitute dentist covering that day.
    • Be responsible for all business functions and provide assistance to the substitute dentist.
    • Be responsible for all office operating expenses incurred during the period of coverage.
    • Arrange for after-hour emergency coverage.
  4. The substitute dentist may at his discretion and expense bring his own chairside assistant with him to the stricken member’s office.
  5. The substitute dentist must inform the stricken member’s office staff of any dental procedures they do not perform.
  6. Referral of all services of a specialized nature will be at the mutual agreement between the benefiting office and substituting dentist
  7. All emergencies will be treated or referred to the appropriate specialty office at the discretion of the substitute dentist and/or the patient.
  8. Recall patients will be treated according to the policy of the individual office involved; prophylaxis, x-rays, examination and restorations as would normally be performed.
  9. New patients will be accepted and all needs cared for.
  10. Any of the services listed can be altered by proposal of the Vice President with approval of two-thirds of the Cross-Coverage Group membership.

IV.  SUGGESTIONS AND RECOMMENDATIONS

  1. Each member will attempt to render the best possible service to both the patient and fellow members in the circumstances under which he must work.
  2. The practice of the beneficiary shall be conducted in such manner as recommended by the beneficiary or his estate and in keeping with the code of ethics of the component dental society.
  3. The program is designed to help our fellow member, his family and auxiliary personnel, thus the coverage should not be considered a contest of comparative office efficiency.  The goal is to hold practice and staff together.
  4. Under no circumstances shall a substituting dentist accept a patient seen at the disabled member’s office for a period of one year, or in the event of death until Cross-Coverage has been terminated.
  5. The substituting dentist shall not solicit or hire the employees of the stricken dentist’s office for a period of one year, or in the event of death until 6 months after completion of the practice transition.
  6. There will be no discussion of the quality of dentistry provided.
  7. In the event that a non-member dentist is engaged by the benefiting office, his days of service will be coordinated through the Vice President.
  8. The value of aid is directly proportional to the efforts of the stricken member’s staff.  Inefficient scheduling lowers production and often frustrates the substitute dentist.  This point cannot be overemphasized.
  9. The individual’s malpractice insurance is in force regardless of the office being used.
  10. Each member should have a plan for the disposal of his practice, and notify their family and the Vice President of this plan.
  11. Complete and whole-hearted cooperation of each and every member will make this a successful program.

V.  COVERAGE IF TWO OR MORE MEMBERS ARE DISABLED OR DECEASED

Should a period of coverage with respect to one member overlap with the period of coverage with respect to another member, then the number of days per week and the number of hours per day for which coverage is provided may be proportionately reduced so that the members providing coverage shall be putting in the same amount of time as if there were only one member receiving coverage.

VI.  PENALTY FOR NONPERFORMANCE

Should any member, for whatever reason, fail or refuse to provide the dental services for which he is responsible under this plan, the member shall pay $300/hour, up to a maximum of seven hours per day, for each day that would have been covered, to the stricken dentist or his/her representative within thirty days of written notice from the Vice President.  The non-performing member may have his/her membership in the PMC terminated upon majority vote of the other members.

 

DATE: ______________________   DENTIST:  ______________________________________