The following Frequently asked Questions will be kept updating. We have been listening to the comments from different stakeholders, and will keep posting more and more questions and answers.

How to Insure

    1. From where can I obtain the ‘Compulsory professional liability insurance for healthcare providers’?
      You may obtain the “Compulsory Professional Liability Insurance for Healthcare Providers" from several authorised insurance companies in Macao. For details of the insurers, you can refer to our website under the heading of “Contact Information of the Insurers”.

    2. How should I buy the ‘Compulsory professional liability insurance for healthcare providers’?
      Healthcare providers need to complete the application form provided by the insurer and submit related documents. After the insurer has completed the underwriting procedures, if the applicant agrees to the terms and conditions, the insurer shall issue the insurance policy and collect the premium.

    3. When I complete the application form, what should I pay attention to?
      For your protection, you should answer all the questions contained on the proposal form in details in accordance with your actual situations truthfully. If you have doubts, you should consult the insurer. Please take note that, the policy may become void if there are any fraudulent replies or concealment.

    4. If I have queries, whom should I ask?
      If you have queries on insurance, you can call our hotline: 83952265 / 83952221 / 83952236; or directly contact the insurers. For inquiries in relation to Article 4 of the “Legal Regime of Medical Malpractice”, the definition and classification of healthcare providers, please contact the Licensing Department of the Health Bureau at 28713734 / 28713735 .

    5. What should I do if I cannot get the “Compulsory professional liability insurance for healthcare providers”?
      Where the acceptance of insurance is refused by at least three insurers, the healthcare provider may turn to Monetary Authority of Macao for the definition of the special conditions of acceptance. 
      Application requirements:  Healthcare providers must have submitted application form and all required documents to the insurers for underwriting, and refused by at least three insurers.   
      Application procedures:  Come in person to the Monetary Authority of Macao during office hours, and fill in the form provided by the Monetary Authority of Macao.
      Response time:  The Monetary Authority of Macao shall forward the application documents provided by the applicant to the insurers for underwriting and quotation, the reply shall be sent to the applicant within five working days upon receipt of completed application information.  The applicant should decide which insurer to choose and contact the insurer directly to apply for the insurance.
      Important Note:  The special terms and conditions under this application should not be subject to the upper limit of the premium under the Executive Order.  The conditions shall be based on the underwriting decisions of the insurers.

    6. If I belong to a member of the medical associations, can I buy the insurance together with the other members as a group?
      For group policy, the healthcare providers should form an association, and the representative of the association shall be responsible for assisting its members to apply for the insurance. The representative has to collect the completed proposal form and submit to the insurer for underwriting. After underwriting, the insurer shall then forward the policy to the representative who will then distribute to its members. In the case of claims, the involved person shall directly liaise with the insurer and the representative shall not be required in claims handling.

    7. How do I determine the sums to be insured?
      The compulsory professional liability insurance for healthcare providers has laid down the minimum sums to be insured in accordance with different categories of healthcare providers. If healthcare providers find that the minimum sums insured are not adequate, they can ask the insurer to provide a higher sum insured.

    8. After I purchased the “Compulsory professional liability insurance for healthcare providers”, I changed the address of my healthcare establishment or change the category of healthcare licence, is it necessary for me to notify the insurer?
      Yes, to protect your own interests, if there are any changes, you should inform the insurer within 8 days because the insurer may need to re-assess your risks.

    9. If the healthcare provider retires or terminates his/her services, but wish to maintain its liability insurance, what should he/she do?
      If the healthcare provider retires or terminates his/her services, he/she is not mandatorily required to buy the compulsory insurance. However, if he/she wants to continue to have insurance cover due to personal reasons, he/she can buy the voluntary liability insurance from the insurer.

    10. If the doctor already has a medical malpractice insurance policy with an overseas insurer, does it mean that he/she has complied with the compulsory insurance in Macao? Or can he/she extend the insurance policy with the overseas insurer to cover the compulsory insurance in Macao?
      According to the provisions of the Administrative Regulation, the compulsory insurance is required to be insured under the uniform policy.  Since the overseas insurer is not an authorised insurer in Macao, its policy cannot be considered as the compulsory insurance in Macao.

    11. I have signed and returned the quotation slip to insurance company, since I have not paid any premium and the policy has not yet been issued, can I request to cancel the policy?  Can the insurance company request me to pay part of the premium?
      When a proposed insured signed the quotation slip, it means that he/she agrees to accept terms and conditions provided by the insurer.  Even though the premium is not yet paid and the policy has not yet been issued, the insurer is actually providing cover to the insured, thus when the policyholder cancels the policy, according to Article 3 of Executive Order No.45/2017, the insurer can request for a short period premium from the policyholder.

      Scope of Cover

    12. When the healthcare providers are accused of or claimed for an insured event covered by the Compulsory Professional Liability Insurance, apart from indemnifying the victims, what other expenses are covered under the insurance?
      With the written consent between the healthcare providers and the insurers, the litigation fees, attorney’s fees and other emerging expenses associated with the claim incurred are borne by the insurer. Nevertheless, including the amount claimed by the victim, the total amount of indemnity to be paid by the insurer equals the limit of indemnity for the policy (which is also known as the sum insured).
      Once the insurer has received the notification from the insured regarding the medical incident when such incident first became aware, the insurer should immediately assist the insured in respect of investigation, verification, defense or reconciliation.

    13. Is indemnity derived from criminality covered?
      The civil liabilities derived from criminality are covered by the compulsory insurance (except intentional acts). However, fines or penalties of the insured’s criminal, disciplinary, or any other nature are not covered.

    14. What is Excess?
      Excess, or deductible, is the amount that the insured is liable as the first part of loss in the event of a claim. The purpose of setting Excess is to prevent frequent occurrence of claims with small indemnity amount, which is also to raise the insured’s attention avoiding the occurrence of indemnity incident.
       
    15. Are medical incidents occurred outside of Macao Special Administrative Region covered under the policy of the “Compulsory Professional Liability Insurance for Healthcare Providers”?
      Only those medical incidents occurred in the Macao Special Administrative Region are covered under the insurance policy.

    16. What are the exclusions under the policy of the “Compulsory Professional Liability Insurance for Healthcare Providers”?
      The exclusions are mainly listed as below:
        • Intentional acts or omissions;
        • Liabilities arising from services rendered by the healthcare provider while under the influence of alcohol, intoxicants or drugs;
        • Criminal, disciplinary or any other nature’s fines or penalties;
        • Loss or damage claims arising from the family members of the healthcare provider up to the third degree of consanguinity, or partners, shareholders, executive members, or legal representatives of the healthcare establishment where the healthcare provider renders services;
        • Loss or damage resulting from any type of clinical trial;
        • Act committed outside the Macao Special Administrative Region or liability for damages brought against the healthcare provider in a court of law outside the Macao Special Administrative Region.

    17. Should a medical malpractice incident be caused by an employee (who is not a healthcare provider) of the pharmacy, is it an insured event?
      Since the Health Bureau defines a pharmacy as a healthcare provider, any medical malpractice arising from any medical incident by the pharmacy should be covered by the Compulsory Professional Liability Insurance for Healthcare Providers

      Retroactive Period

    18. What is retroactive date?
      Retroactive date is the date specified in the Policy Schedule and is the date on or after which losses may be covered under this Policy.

    19. The healthcare provider first buys the Compulsory Professional Liability Insurance starting on 26th February 2017 and renews the policy each year. A healthcare service is provided in August 2017 and the doctor is totally not aware of the medical incident at the time of August 2017. The patient files the claim for medical malpractice in November 2019. The retroactive date of the policy is 26th February 2017. If the doctor reports the incident to the insurer immediately, will it be covered?
      The following two conditions of the medical incident must be fulfilled in order to be covered within the scope of insurance:
      1. When the medical incident is first known by the insured, the insured should immediately report such incident to the insurer within the effective period of the insurance.
      2. The medical incident must be occurred in the period from the retroactive date to the end of the policy.
      As the doctor first knows the medical incident within the period of insurance and reports to the insurer immediately, and the policy retroactive date is earlier than August 2017, therefore the particular medical incident is covered under the insurance policy.

    20. The healthcare provider first buys the Compulsory Professional Liability Insurance starting on 26th February 2017. A healthcare service is provided in August 2017 and the doctor is not aware of the medical incident at the time of August 2017. The patient files the claim for medical malpractice in November 2019. The doctor has retired and terminated his medical services since March 2019 and has not renewed the insurance policy. The last policy retroactive date is 26th February 2017. Will the above-mentioned healthcare services provision be covered in the insurance? If not, does it mean that the retired doctor needs to continue to buy the insurance?
      No. As at the time when the doctor first knows the medical incident, it is not within the effective period of insurance, the doctor will not have any insurance coverage.
      As the retired doctors or those who terminate the medical services are no longer classified as healthcare providers, they are not mandatorily required to buy the Compulsory Professional Liability Insurance. However, they can negotiate terms and conditions with the insurers for extending the insurance coverage to suit their own needs.

    21. How is the retroactive date defined if the insurance policy is renewed by another insurer? 
      Retroactive date means the date specified in the Policy Schedule, and is the date on or after which losses may be covered under this Policy.  If the retroactive date stated on the policy schedule is a date before the policy effective date, and the insured person eventually renewed the policy with another insurer, he/she should agree with the new insurer about maintaining the original retroactive date so that any medical malpractice after the retroactive date first notified to the new insurer under the new insurance policy would be covered. 

      The obligation of “Compulsory professional liability insurance for healthcare providers”

    22. If my “Compulsory Professional Liability Insurance for Healthcare Providers” is bought by my employer (e.g. hospital), will the other volunteered community healthcare service which I participate personally be covered by the insurance policy?
      No, the scope of insurance policy only covers the healthcare services provided within the address of healthcare establishment of the employer. Natural person who provides other healthcare service out of the scope could voluntarily buy extra liability insurance for his/her own needs, but this is not mandatory.

    23. Who is responsible for the claims when the amount of indemnity exceeds the sum insured of the “Compulsory Professional Liability Insurance for Healthcare Providers” bought by my employer (e.g. hospital)?
      If the total amount of indemnity exceeds the sum insured and the liability of the employee could not be fully settled, the employee (i.e. the natural person of healthcare provider) who is held responsible in the verdict is liable for the excess.

    24. Do medical clinics and the doctors therein required to buy the “Compulsory Professional Liability Insurance for Healthcare Providers”?
      Under the Legal Regime of Medical Malpractice (Law No. 5/2016), definition for healthcare providers include legal persons and natural persons. As explained by the Health Bureau, healthcare establishment meets the definition of a legal person. As stipulated under the provisions of Article 1, paragraph 2 (b) of Decree-Law no. 22/99/M, the legal persons of healthcare providers are the establishment which hold a medical license (ALVARÀ), including clinics or comprehensive clinics, health centers, etc. They are obligated to buy the “Compulsory Professional Liability Insurance for Healthcare Providers” for their establishment and their employees including doctors and nurses. And thus the legal obligations of the employees would be fulfilled and there is no need for the employees to buy the insurance on their own. On the other hand, natural persons of healthcare providers are the healthcare professionals who engage in private healthcare services as stipulated under the provisions of Article 1, paragraph 2 (a) of Decree-Law no. 22/99/M. If such natural healthcare provider has his/her own personal medical clinics, that is, he/she holds a personal license (LICENÇA), the registrant of the personal medical clinics and the individual contracted doctors (i.e. non-employees) who partnered with the registrant will be required to buy the “Compulsory Professional Liability Insurance for Healthcare Providers” on their own.
      For inquiries, please contact the Health Bureau Medical Services Licensing Section on the following hotline: 28713734 / 28713735.

    25. Are government departments, commercial companies, drug store, schools, nursery, homes for the elderly or other institutions regarded as “legal persons” healthcare providers?  Are the salespersons of drug store or other persons working in it regarded as ‘natural persons” healthcare providers?
      All healthcare providers as defined in accordance with the provisions of Article 4 of the “Legal Regime of Medical Malpractice”, natural or legal persons rendering services for the purpose of preventing, diagnosing, treating or rehabilitating , are required to buy the insurance. Relating to government departments, commercial companies, drug store, schools, nursery, homes for the elderly or other institutions, it is necessary to consider whether they are rendering services for the purpose of preventing, diagnosing, treating or rehabilitating.  

      According to the existing law, the Health Bureau is responsible for issuing licence to persons carrying on healthcare and medicine business.  Also, according to Article 9 of Administrative Regulation No. 5/2017 (Compulsory Professional Liability Insurance for Healthcare Providers),  the Health Bureau is the competent authority to supervise healthcare providers’ compliance with this Regulation, in particular the provisions of Articles 3 and 4 in connection with compliance with the persons obliged to buy compulsory insurance and the minimum sum insured.  Therefore, anyone or institution who has doubts as to whether they are regarded as “natural person” or “legal person” healthcare providers, they should immediately contact the Heath Bureau, Licensing Department to confirm, telephone no. 28713734 /28713735。

    26. Should the drug store buy the compulsory insurance for the pharmacist and the pharmacist need not buy insurance for himself/herself?
      The “legal person” healthcare provider should buy the compulsory insurance for itself and those “natural persons” healthcare providers working in its premises. If the “legal person” healthcare provider has bought the compulsory insurance for the “natural persons”, the latter are not required to buy the compulsory insurance.

      As to whether drug store should be regarded as “legal person” healthcare providers, please refer to the preceding question.  (If in doubt, please contact the Health Bureau, Licensing Department to confirm, telephone no.  28713734 / 28713735).

    27. For ‘natural persons” healthcare providers working on ‘freelance’ for several clinics, how should they buy the compulsory insurance?Administrative Regulation No. 5/2017 does not stipulate about ‘freelance’ “natural persons” healthcare providers.  According to the Regulation, all “legal persons” are required to buy compulsory for all the “natural persons” working in its premises.  Therefore, it is necessary to state clearly on the application form the total number of doctors working in its clinic for the purpose of proper underwriting by the insurers.  If the “legal persons” have bought the compulsory insurance for the “natural persons”, the latter do not need to buy the compulsory insurance.   (If in doubt, please contact the Health Bureau, Licensing Department to confirm, telephone no.  28713734 / 28713735).

    28. How is ‘surgical interventions’ defined?
      According to the Health Department, doctors need to declare whether they need to perform “surgical interventions” on the application form.  Also, doctors can only perform interventions in hospitals or private medical institutions which comply with the Health Department’s guidelines on Private Hospitals with Surgical Rooms.  (If in doubt, please contact the Health Bureau, Licensing Department to confirm, telephone no.  28713734 / 28713735).

    29. For a clinic which employs a doctor and two freelance doctors, how should the clinic buy the compulsory insurance?
      Administrative Regulation No. 5/2017 does not stipulate about ‘freelance’ “natural persons” healthcare providers.  According to the Regulation, all “legal persons” are required to buy compulsory for all the “natural persons” healthcare providers working in its premises.  Therefore, it is necessary to state clearly on the application the total number of doctors working in its clinic for the purpose of proper underwriting by the insurers. (If in doubt, please contact the Health Bureau, Licensing Department to confirm, telephone no.  28713734 / 28713735).

    30. Clinics have bought the compulsory insurance for the doctors.  If the doctors are assigned to work in other designated places, can this can be covered by the insurance policy?
      Since the risk might be different, the “legal persons” healthcare providers are required to make the declarations of the location to the insurers.

    31. When a pharmacy buys insurance for its pharmacists, is it compulsory to provide the name list of pharmacists to the insurer?
      When a legal person healthcare provider buys insurance for its pharmacists, it shall provide detailed information about all the pharmacists to the insurer, enabling the insurer to underwrite the risk insured and propose appropriate premium. 

    32. There are four pharmacists employed by a pharmacy, during business hours, there will be at most two pharmacists on duty, based on how many pharmacists should the minimum sum insured be determined?
      Healthcare provider who is a legal person shall buy insurance according to the number of natural person healthcare providers providing healthcare services at its establishment, thus the minimum sum insured should be determined based on four pharmacists, therefore the minimum sum insured should be MOP1,750,000.

    33. I am an owner of a pharmacy group with 10 branches, all the employed pharmacists will be on duty in the different 10 location, how should the insurance be bought?
      Given that all the 10 branches are owned by the same owner, one insurance policy can be bought to cover all the 10 branches.  At the same of applying for the insurance, you should ensure that all detailed information about the 10 branches, all employed pharmacists and their respective place of providing healthcare services should be provided to the insurer for underwriting purpose.

      Premiums and Sum of Insurance

    34. What are my premiums and sum of insurance?
      Subsequent to consultation with the healthcare sector and hearing comments from the Health Bureau, the minimum sum of insurance has been determined by Health Bureau in accordance with the needs and classification of the current medical profession classification system in Macao (as shown in the table below).  Premiums and excess are determined according to different healthcare professions with upper limit as stipulated for each category.

      Category

      Healthcare Profession

      Sum of insurance
      (per accident per year)

      MOP

      Maximum annual premium
      MOP

      Maximum excess per accident
      MOP

      I

      Chinese medicine practitioners, pharmacists, nurses, pharmacies technical assistants, Chinese medicine practitioners, dentists, acupuncturists, masseurs, medical assistants, therapists

      500,000

      3,200

      10,000

      II

      Doctors
      (Except those listed below)

      Doctors (Anesthesiology, Cardiology, Stomatology, Intensive Care Unit, Gastroenterology, Pediatrics, Neurology, Radiology & Imaging, Otolaryngology、Ophthalmology)

      Dentist

      1,000,000

      7,400



      10,000

       


      10,000

      10,000

      III

      Doctor who performs surgical interventions (except those listed below)

      Doctor who performs surgical interventions (Obstetrics and gynecology, plastic surgery, liposuction and spinal surgery)

      2,000,000

      28,000



        56,000

      25,000



       50,000


      In addition to the medical profession of healthcare providers, the insurer may increase the upper limit of the premiums and excess referred to in the preceding paragraph by up to a maximum of 50%, based on the past claim history of the healthcare provider, the number of healthcare establishments in which the healthcare provider renders medical services, professional experience and professional risk; in such cases, the insurer shall explain the reason and method of calculation to the policyholder after underwriting.

      If the Policyholder is a legal person healthcare provider, the amount of premium and excess shall be determined by agreement between the Policyholder and the insurer, taking into account the nature of the risk.

      (If in doubt, please contact the Health Bureau, Licensing Department to confirm, telephone no.  28713734 / 28713735).

    35. How is the premium determined? Why is the premium higher than the neighboring jurisdictions?
      Compulsory liability insurance in the form of uniform policy is rarely found in neighboring jurisdiction, and the commercial insurance contracts have different insurance coverage and conditions.  Irrespective of the seemingly higher sum of insurance or lower premiums offered  in some policies, the scope of insurance coverage and exclusions would differ. Therefore, the premiums and the pricing of those insurance policies from neighboring jurisdictions are not comparable to the Compulsory Liability Insurance in Macao.  The Monetary Authority of Macao has referred to the experience of the neighboring jurisdictions and considered for the situation in Macao in setting out the existing premium framework.  Meanwhile, the mechanism of premium review has been stipulated in the Administrative Regulation of the compulsory insurance. If necessary, the Monetary Authority of Macao and the Health Bureau may initiate the mechanism of premium review based on the operating result.

    36. How is the sum of insurance determined?
      The current minimum sum of insurance is determined in consideration of the recommendation from the healthcare sector and the Health Bureau. The purpose of legislation of compulsory liability insurance is to provide a minimum protection for both healthcare providers and patients. If the applicant believe that the minimum sum of insurance is not enough, they can voluntarily request increase of the insurance amount with the consensus of the insurer.

    37. I am a cardiologist, but my license is only for general practice. How much should the premium be?
      As there is no specialized license system in Macao, all license can only show as "general practitioner". In order for the insurer to clearly understand your risk situation, and to accurately underwrite and determine the corresponding premium amount, and most importantly, to provide necessary coverage should medical incident occurs, applicants must truthfully declare his/her medical professional category (in this case, "Cardiology"), the scope of medical services provided, and whether would involve performance of operation or surgery etc.  If the applicant is a cardiologist, the maximum premium would be MOP $10,000.  If the applicant would perform operation or surgery, the maximum premium would be MOP $28,000.

    38. Is there any flexibility on premium?
      The current Administrative Regulation only sets out upper limit of premiums for natural persons of healthcare provider. The insurer would determine premium according to the declaration of the applicant’s actual medical profession and related information provided. Therefore, the quotations from each insurers may not be the same. Applicants can enquire different insurers for comparison in relation to quotations, insurance terms and conditions, and choose the most suitable insurer.

    39. Would the sum insured and premium be affected if the dentist does not perform surgical interventions?
      According to the provisions of the Executive Order, the statutory minimum sum insured for dentist should be MOP1 million, and the upper limit of premium should be MOP10,000.  The applicant must declare on the application form whether he/she performs interventions and types of interventions for the purpose of underwriting by the insurer.  In addition to the medical profession of healthcare providers, the insurer may increase the upper limit of the premiums and excess above mentioned by up to a maximum of 50%, based on the past claim history of the healthcare provider, the number of healthcare establishments in which the healthcare provider renders medical services, professional experience and professional risk; in such cases, the insurer shall explain the reason and method of calculation to the policyholder after underwriting.

      Healthcare provider, legal person

    40. What are the sums of insurance for the healthcare provider, legal person?
      As recommended from the Health Bureau and the health care industry, the minimum sums of insurance for the healthcare provider, legal person are as below:

      Category Healthcare establishment Minimum sum of insurance
      MOP
      IExcluding western medicine or dentistry services, according to the number of natural person healthcare providers︰
      A      less than or equals to 3
      B      4 to 7
      C      8 to 10
      D      more than or equals to 11


      1,000,000
      1,750,000
      2,500,000
      3,500,000
      IIIncluding western medicine or dentistry services, according to the number of natural person healthcare providers︰
      A      less than or equals to 3
      B      4 to 7
      C      8 to 10
      D      11 to 20
      E      more than or equals to 21


      2,000,000
      3,500,000
      5,000,000
      7,500,000
      10,000,000
      IIIHealth Bureau and the private health units regulated by Decree-Law no. 22/99/M, of May 31
      20,000,000



    41. What is the sum of insurance for Hospitals?
      As recommended by the Health Bureau, the Minimum Sum of Insurance for hospitals is 20,000,000 patacas.

    42. What are the premium and excess for the legal persons of healthcare providers?
      As the services provided by the legal persons of healthcare providers and the risks associated with are relatively intricate, the maximum premium and excess for the natural persons of healthcare providers are not applicable for the legal persons of healthcare providers.  The legal persons of healthcare providers can negotiate with the insurer for the premium and excess in accordance to its risk characteristics.

      Claims

    43. If the indemnity is higher than the sum of insurance, who is responsible for paying the remaining indemnity payable?
      The maximum indemnity liability of the insurers are limited to the sum of insurance only. When the indemnity is higher than the sum of insurance, the insured is liable for paying the extra amount.

    44. When a patient filed a medical malpractice complaint, how should the healthcare provider handle the case?
      If it is aware or suspects that a medical malpractice situation has happened, the insured should inform the Health Bureau within 24 hours. The insured should also inform the insurer through written notice with related supporting documents and informations within 8 days.

    45. Is it possible for the patient to disagree to the result of the Mediation Proceeding and take an appeal?
      Patient, healthcare provider, and insurer have the right to seek for final arbitration from the court.

    46. After handed in all claims information and supporting documents, when will the insurer make the indemnity?
      Provided with all information needed for the claims, the insurer should indemnify within 45 days once the investigation and verification are complete.  Shall the indemnity is overdue without reasonable explanation or cause, the insurer should pay a delay interest fee.

    47. Would the insurer participate in the verification procedure of the medical incident?
      As clearly stated in Item 1 of Article 13 of the Law No. 5/2016, healthcare provider or patient may apply for verification of whether there is a medical incident at the Medical Incident Verification Committee.  However, insurers are not obliged to participate on the verification procedure.  Nevertheless, the insurer should carry out the investigation and identification for verifying the Insurance incident, identifying the Insured’s liability, assessing the indemnification amount for damage, and to obtain the verification report for medical incident as soon as possible.

    48. Would the insurer participate in the mediation procedure of the medical incidence?
      It is set out in the Administrative Regulation of the Medical Litigation Mediation Center, that healthcare provider who participates in medication procedure needs to inform the insurer for such participation.  Moreover, the insurer and the insured need to participate together at such procedure.  The medical litigation mediation is conducted by professionally recognized mediator, who utilize professional knowledge in clarifying the liability and recommending the indemnification amount.  Insured needs consent from the insurer for reaching an indemnification agreement.   Otherwise claims might not be eligible.


Last revision: 2020-10-30 16:26:21