2023-24 Supplementary Professional Liability Insurance

2023-24 Supplementary Professional Liability Insurance

CPBA recognizes that some pharmacists may be provided automatic E&O coverage through their employer. In order to have peace of mind, pharmacists now have the option to purchase a “supplementary” policy that will help cover you for potential possible coverage gaps in your employer’s policy. It is important to note that you must have VALID primary coverage with a minimum $2 Million Limit in order for the supplementary insurance to respond. Please ensure that the primary coverage has not lapsed, was cancelled nor is invalid.

Policy period: July 1, 2023, to July 1st, 2024

(Note: The effective date of the policy will be set to the date of application if completed after July 1st)

CONTACT INFORMATION

Name*
Address*

MEMBERSHIP INFORMATION

Important: Enter license Number as XX – XXXX (include the dash)

Supplementary Professional Liability Insurance

Coverage period: July 1, 2023 to July 1, 2024

NOTE: Members who are already insured with an employer’s professional liability insurance policy have the option to purchase a “Supplementary” policy that will cover you for potential gaps in your employer’s policy. You must hold a minimum 2M VALID primary coverage in order for the Supplementary Professional Liability insurance to respond. Please ensure that the primary coverage has not lapsed, was cancelled, nor is invalid.
$3 Million per claim
$5 Million aggregate
_______________________
$50.00 – Premium
$7.50 – RST (Insurance Premium Tax)
$15.00 – PANL Administration Fee
$2.25 – HST
$74.75 – Total
Has any application for Professional Liability insurance ever been denied or cancelled?*
Have you ever sustained a Professional Liability loss or has such a claim been made against you in the last five years? Only answer Yes if you have not already reported this to BMS/Insurer.*
Have you any knowledge of any negligent act, error or omission or breach of duty which might give rise to a claim against you? Only answer Yes if you have not already reported this to BMS/Insurer.*
Confirmation*
If you have answered YES to one or more of the insurance questions above, please continue with your membership renewal. CPBA’s insurance program broker, BMS Canada Risk Services Ltd., will facilitate the insurance component of your purchase. Please contact BMS at cpba.insurance@bmsgroup.com to review your insurance application and they will assist you in securing coverage under the CPBA program.
Declaration*
I declare that during the last five years no insurer has cancelled, declined or refused to issue me any form of liability insurance and that this application discloses the hazards known to exist at the date of this application. I declare that the statements made herein are in every respect true and correct and hereby apply for a contract of insurance to be based upon the truth of the said statements. Submitting this form does not bind the Applicant or company to complete the insurance but is agreed that this form shall be the basis of the contract should a policy be issued. The insurance premium is fully retained and not refundable.

Proof of Coverage & Consent

Section 14(e) of the Pharmacy Act, 2012 requires that “pharmacists’ provide proof that he or she has obtained professional liability insurance coverage in a form and amount satisfactory to NLPB. The malpractice insurance policy purchased through PANL satisfies this requirement under the ACT.
Applicant's consent to the transmission of the information contained in the application.*
I hereby acknowledge that the information collected in the Application form is acquired by my insurance broker to be transmitted to the insurer for the sole purpose of obtaining an insurance policy, and will be kept confidential.
Consent*
I consent to be contacted directly by e-mail by BMS Canada Risk Services Ltd. concerning the professional liability insurance coverage (primary and supplementary), they make available to me through the Canadian Pharmacists Benefit Association and the Pharmacists’ Association of Newfoundland and Labrador, and my eligibility and application for, and renewal of, such insurance coverage. I understand that I may withdraw this consent at any time.
I declare that the above statements are true and that I have not omitted, suppressed or misstated any material facts.

PAYMENT

Please note that this form is used for Liability insurance. If you have any questions, please contact PANL Office at 709-753-7881 prior to submitting. If there is an error in selecting the appropriate form and a refund is required, there will be a $15.00 administration fee applied automatically.
$15 +HST
$ 0.00 CAD
This field is for validation purposes and should be left unchanged.