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