Corizon Medical Group Insurance Declaration, Lexington Insurance Company, 2014
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LEXINGTON INSURANCE COMPANY WILMINGTON, DELAWARE ADMINISTRATIVE OFFICES: 100 SUMMER STREET, BOSTON, MA 02110-2103 (A Capital Stock Insurance Company) MEDICAL GROUP PROFESSIONAL LIABILITY - OCCURRENCE MEDICAL GROUP ADMINISTRATIVE PROCEEDINGS – OCCURRENCE DECLARATIONS Various provisions in the General Policy Provisions and Conditions and Coverage Parts restrict coverage. Please read all General Policy Provisions and Conditions and Coverage Parts carefully to determine rights, duties, and what is and what is not covered. A complete Policy includes the Declarations, General Policy Provisions and Conditions, and the applicable Coverage Parts. POLICY NUMBER: 6797600 RENEWAL OF NUMBER: Item 1. FIRST NAMED INSURED: VALITAS HEALTH SERVICES, INC Item 2. ADDRESS: 105 WESTPARK DR STE 200 BRENTWOOD, TN 37027-5010 Item 3. POLICY PERIOD: From: 01-01-2014 To: 01-01-2015 at 12:01 a.m. Standard Time at your mailing address shown above. Item 4. DESCRIPTION OF OPERATIONS: Item 5. LIMITS OF INSURANCE: 6797138 Healthcare Services for Correctional Institutions TOTAL POLICY AGGREGATE LIMIT (MAXIMUM PAYABLE UNDER BOTH $ 48,000,000 COVERAGE PARTS) AGGREGATE SELF-INSURED RETENTION (APPLICABLE TO BOTH COVERAGE $ 24,000,000 PARTS)* (a) Medical Group Professional Liability $ 1,000,000 Each Medical Incident – Contractor Insured Limit $ 1,000,000 Each Medical Incident All Other Non-Contractor Insureds Combined Limit $ 3,000,000 Contractor Insured Aggregate Limit $ 10,000,000 All Other Non-Contractor Insureds Aggregate Limit $ 1,000,000 Each Medical Incident – Self-Insured Retention (All Insureds Combined)** (b) Medical Group Administrative Proceedings – Defense Costs Only $ 25,000 Each Administrative Proceeding Limit $ 500,000 Administrative Proceeding Aggregate Limit *The Aggregate Self-Insured Retention reduces the Total Policy Aggregate Limit. The Aggregate Self-Insured Retention is reduced by damages and/or defense costs under the Medical Group Professional Liability Occurrence Coverage Part and administrative expense defense costs under the Medical Group Administrative Proceedings Defense Costs Coverage part. Thus, the maximum total amount payable by Lexington Insurance Company is $24,000,000 (subject to endorsement referred to below) and the maximum total amount payable will be determined as per endorsement listed below. **The Each Medical Incident – Self-Insured Retention (All Insureds Combined) reduces the Each Medical Incident – Contractor Insured Limit and the Each Medical Incident All Other Non-Contractor Insureds Combined Limit in the manner set forth in the “Self-Insured Retention Endorsement”. Note: The Aggregate Self-Insured Retention and the Total Policy Aggregate Limit may be adjusted in accordance with the “Adjustable Total Policy Aggregate Limit and Adjustable Aggregate SelfInsured Retention Endorsement”. MNSCPT (01/14) DECLARATIONS Page 1 of 2