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How To Submit a Moonlighting Waiver to CRICO


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How To Submit a Moonlighting Waiver to CRICO

By Charles Zizza, CRICO

Duration: 4:53

This is a video walk through of how you fill out CRICO’s moonlighting waiver.


Moonlighting waivers need to be completed and submitted to CRICO Underwriting on behalf of residents and fellows who will be practicing at any site not owned by the physician’s sponsoring institution unless the moonlighting is explicitly part of the residency or fellowship program. Please refer to the chart on your screen for specific physician requirements. You can pause the video here or refer to the same chart on page 29 (Moonlighting Coverage section) of the Underwriting Manual.

Now we will go through the moonlighting waiver step-by-step.

  1. First make sure that you are using the current year’s waiver. If the effective dates are during this year or the year the resident or fellow will be moonlighting, you are using the correct form.
  2. Check either the fellow, resident, or resident, emergency medicine box which corresponds to the physician seeking the extension of coverage.
  3. Choose the physician’s sponsoring institution from the options. This is the CRICO member or sponsor which provides CRICO coverage for the resident or fellow. Please note that only one of these options should be selected.
  4. This section is where you should list all locations where the resident or fellow will be moonlighting. You do not need to include the sponsoring intuition in this list. Additionally, you do not need to include any federal facilities such as VA medical centers. Providers practicing at federal locations are protected by the Federal Tort Claims Act (FTCA) and CRICO coverage is not necessary.
  5. In the next section, list the start and end dates for which an extension is being requested.


    Please note that these dates must fall within the effective dates listed at the top of the waiver. In other words, the requested dates cannot fall within 2 separate calendar years. Coverage can be extended beyond the end of the year, but a separate moonlighting waiver will need to be submitted since the waiver is updated for each policy year.

    For example, if a resident or fellow will be moonlighting from June 1st 2018 – June 30th, 2019, you should submit a 2018 moonlighting waiver with the coverage dates 6/1/2018 – 12/31/2018. When the 2019 moonlighting waiver is published in November 2018, a separate waiver should be submitted for the dates 1/1/2019 – 6/30/2019.

  6. If the resident or fellow will be practicing part-time in an emergency room outside of the Harvard Medical Institutional System, check Yes. Otherwise, choose No.
  7. If you selected Yes, please complete the fields for ACLS, PALS, and ATLS certifications. You can refer to the specific physician requirements chart previously shown or read on page 29 (Moonlighting Coverage section) of the Underwriting Manual to better understand what is required.
  8. At the bottom of the first page, please ensure that the waiver is signed by the resident or fellow and the chief of service.
  9. On page 2 of the moonlighting waiver, complete the evaluation factors section. As you are completing the rest of the waiver, remember the following notes:
    1. Question 3a needs to be answered if the physician checks False on Question 3.
    2. Question 7 and its sub-questions only apply to residents and fellows who will be practicing in an emergency room. Otherwise, you can leave these questions unanswered.
    3. The answer to Question 8 should be false. If the requested clinical extension site or sites will be providing malpractice liability coverage for the physician, an extension of CRICO coverage is not necessary.
    4. If the resident or fellow is moonlighting outside of Massachusetts, they must have a license to practice out-of-state if the board of registration of medicine in that state requires it. If applicable, please complete Question 9.
    5. Question 10 must be answered with the name of the clinician who will be supervising the resident or fellow while moonlighting. If you are requesting multiple moonlighting locations, a supervising clinician is required for each location. If there is not enough space to write the names of all the applicable supervising clinicians, please include their names on a separate page or in your message when submitting the moonlighting waiver. Otherwise, CRICO Underwriting will follow-up with you for any missing names.
  10. Finally, be sure to have the resident or fellow and the chief of service sign the second page of the moonlighting waiver.
  11. Before submitting your waiver, please review the Moonlighting Coverage section of the Underwriting Manual beginning on page 29 to make sure that everything is correct. Once the waiver is complete, you can submit it to CRICO Underwriting by emailing it to or faxing it to (617) 450-8297.

February 22, 2018
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