Insurance Program Results
Ambulatory Surgery Centers: Tempered Growth Expected
Rankings: Ambulatory Surgery Center Writers(Listed Alphabetically) |
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|
Carrier (Administrator) |
Extent of Coverage/Risk Appetite/Notes |
Distribution |
Crittenden’s Customer Service Rating |
|
ACE |
Considers most common coverages and risks. |
Brokers and Agents |
4 Stars |
|
Admiral |
Most procedures with limitations on neurosurgery and high-risk bariatric procedures. |
Wholesale Brokers |
5 Stars |
|
AIG/Lexington |
Considers most common coverages and risks. |
Brokers |
3 Stars |
|
Allied World |
Ambulatory surgery centers with sound financials and appropriate investments in risk management and patient safety. |
Wholesale and Retail Brokers (who understand this class of business.) |
4 Stars |
|
Arch |
Considers most common coverages and risks. |
Independent Retail and Wholesale Brokers |
5 Stars |
|
AXIS |
Single-Location Ambulatory Surgery Centers and Multiple Location Ambulatory Surgery Center Systems. Considers most common coverages and risks. |
Brokers |
3 Stars |
|
Berkshire Hathaway Specialty Insurance |
Targets Large Risks. |
Brokers |
4 Stars |
|
CNA |
Working to expand its presence in the segment and could target merger or startups. |
Independent Agents |
5 Stars |
|
Colony Specialty |
Considers most common coverages and risks. |
Brokers |
3 Stars |
|
FD Insurance |
Standalone, Single-Specialty and Multi-Specialty Ambulatory Surgery Centers. Writes risks in Florida. |
Agents |
3 Stars |
|
General Star |
Ambulatory Surgery Centers (with medical directors), Single-Specialty Ambulatory Surgery Centers (including endoscopy/digestive health; eye/Lasik/refractive, gamma knife, pain management, urology) and Multi-Specialty Ambulatory Surgery Centers (including general surgery, gynecology, ENT and plastics, orthopedics, podiatry.) |
Wholesale Brokers |
5 Stars |
|
GuideOne National and United Specialty (Promont Advisors) |
Outpatient Surgery Centers (in all states except Louisiana and Mississippi.) |
Retail Agents and Wholesale Brokers (In-House Brokerage to Service Retailers) |
5 Stars |
|
Hiscox USA |
Considers most common coverages and risks. |
Wholesale Brokers |
4 Stars |
|
Ironshore Inc. |
Ambulatory Surgery Centers (All types. Prefers centers that offer multiple procedures or those that are highly specialized in one type of procedure. Will consider bariatric surgery and cosmetic procedures as part of the services provided.) |
Brokers (Open) |
5 Stars |
|
James River |
Ambulatory Surgery Centers (performing all types of procedures including LASIK, endoscopy, orthopedic and cosmetic procedures except spinal, cardiac, and neurosurgery.) Doesn’t write business in Wisconsin or West Virginia or Birthing Centers. Will not write coverage for overnight patient stays. |
Authorized Brokers |
5 Stars |
|
Kinsale |
Considers most common coverages and risks. Doesn’t write in West Virginia. |
Select Surplus Lines Brokers |
5 Stars |
|
Lloyd’s of London |
Considers most common coverages and risks (with anesthesia and without anesthesia). |
Wholesale Brokers; Some Retail Brokers (Open) |
5 Stars |
|
Lloyd’s of London |
Considers most common coverages and risks. |
Agents, Brokers, Wholesalers, MGAs |
5 Stars |
|
Lloyd’s of London (U.S. Risk) |
Considers most common coverages and risks. |
Brokers and Agents |
3 Stars |
|
Lloyd’s of London |
Surgicenters (in all states except Alaska and Hawaii). |
Focus on Wholesalers; Will work with |
5 Stars |
|
Markel |
Considers most common coverages and risks. |
Specialized Producers |
4 Stars |
|
MedPro Group |
Considers most common coverages and risks. |
Agents, Brokers and Wholesalers |
3 Stars |
|
Navigators |
Considers most common coverages and risks. |
Open Brokerage |
3 Stars |
|
NORCAL Group |
Considers most common coverages and risks. |
Agents |
4 Stars |
|
OneBeacon Insurance Group |
All sizes of Ambulatory Surgery Centers. |
Specialized Wholesalers |
3 Stars |
|
Physicians Reciprocal Insurers |
Considers most common coverages and risks. Limited to New York. |
Brokers |
3 Stars |
|
ProAssurance Mid-Continent Underwriters |
Surgicenters (with anesthesia and without anesthesia). |
Brokers |
5 Stars |
|
XL Catlin |
Will write coverage for most procedures except bariatric, podiatry and orthopedic involving spine. |
Wholesale Brokers |
5 Stars |
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Copyright © 2015 Crittenden Research Inc. |
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The scramble for additional premium has carriers eying the rapid growth and expansion of ambulatory surgery centers. Creating potential for additional premium is an expansion of some ASCs into high-risk procedures such as bariatric and cosmetic surgery. Many carriers known for writing healthcare facilities remain hungry for new business, particularly with stagnation in the hospital segment due to rapid merger and acquisition activity.
These carriers are likely to aggressively target the new ASC startups breaking ground each month. There are about 5,500 ASCs in the U.S., a number rivaling the 5,600 community hospitals across the country. California and Florida have the highest number of state-licensed ASCs. But unlike the hospital industry, in which budgetary constraints have led to closings and mergers with other larger hospital systems, the ASC industry continues to grow. Roughly five to seven new ASCs open each month, including those owned by health systems. An industry push to provide more procedures in an outpatient setting will continue to drive the need for ASCs. Some of these facilities offer high-risk procedures, creating the type of risk for which E&S carriers hope to shine. But the risks seem to be shifting in the ASC market. Allied World is monitoring a shift in patient demographics. Previously, patients seeking care in ASCs tended to be young healthy individuals. Now, ASCs are treating older sicker patients who may require more lengthy procedures requiring a greater amount of time under anesthesia.
Crittenden projects premium growth in the ASC segment could be tempered by consolidation. Hospitals continue to buy out ASCs. Additional capacity in recent years from AXIS and Berkshire Hathaway Specialty will also stifle growth. CNA expects flat ASC premium volume due to outpatient facilities merging with hospitals. Competition from other programs and exclusive deals with brokers and insureds has XL Catlin expecting minimal growth in the segment.
Offsetting consolidation is the continuing expansion of ASC services and the opening of facilities focused on specific services and procedures. More surgery centers are opening to offer cosmetology work. Bariatric surgery has also emerged as an outpatient procedure at ASCs. Ironshore’s IronHealth will consider cosmetology procedures as part of other services provided in covering ASCs. It will also consider bariatric procedures. Admiral, which can cover cosmetic procedures, expects elective surgery to provide additional opportunities to grow ASC premium.
Allied World expects a greater potential to cross-sell other coverages to ASCs, with cyber/privacy coverage being one example. Allied World recently introduced its Allied World // FrameWRX product in June to provide pre-incident risk management to help clients avoid, manage and mitigate privacy and network-related risks. It also launched a Miscellaneous Medical Suite Package toward the end of last year.
Even with more procedures being pushed into the outpatient setting, ASCs haven’t posted any significant claims activity during the last year, allowing rates to remain low and competitive. A review of IronHealth’s book last month did not show any claims activity of note other than a step-up in the number of physicians not procuring insurance, specifically in Florida, leaving surgery centers taking the brunt of a physician claim. These types of claims, however, have led to only a slight rise in severity. Some of Admiral’s largest claims have come about after a surgeon lets his or her insurance lapse, resulting in the facility becoming the holder of the primary policy.
Responding to this evolution of ASCs, underwriters will be more selective about the types of risks they will write. Allied World will target organizations it deems financially sound that make appropriate investments in risk management and patient safety. The carrier will also look for tenured healthcare leaders. XL Catlin will avoid most bariatric, podiatry and orthopedic work involving the spine unless the insured purchases what the carrier judges to be adequate coverage and terms. James River excludes spinal and cardiac procedures and neurosurgery. General Star won’t cover ASCs without a medical director.
Allied World will underwrite to the exposure rather than simply the number of procedures. Specifically, the carrier’s underwriting considers the volume and types of procedures, trends in loss history, venue, physician exposure, accreditation, risk management practices and patient safety initiatives. Allied World can offer a risk management program developed specifically to the needs of ASCs. For newly opened surgery centers, IronHealth considers the experience of the partners, often physicians, as well as loss history, the types of procedures and how often performed, and will want physicians to carry the same limit as the surgery center.
Ironshore’s IronHealth division began offering a 1-800 toll free risk management hotline in June to respond to any risk management related questions related to outpatient care. IronHealth can offer professional and general liability with primary limits up to $1 million/$3 million, with per location and policy aggregate limits for surgery center operations with multiple locations. It will consider accounts that span across the country. The carrier offers a broad form with blanket additional insured language, punitive damages coverage and direct patient care for medical directors. Optionally the carrier offers coverage for HIPAA violations, evacuation expense reimbursement, public relation events reimbursement and patient loss of property. Minimum premiums are $5,000. IronHealth works with wholesalers or retailers on an open-market basis.
Allied World offers professional and general liability limits of $1 million/$3 million and a $1 million tower for sexual abuse and molestation. The carrier can provide excess/umbrella of $25 million. Its minimum premium is $7,500. Allied World offers deductible options that include first-dollar coverage. Allied World works with wholesale and retail brokers, who understand this class of business.
Copyright © 2015 Crittenden Research Inc.
Healthcare Services Insurance
Administered By: MagMutual Insurance
Distribution: Carrier Direct
| Industries: |
Ambulatory Surgery Centers (ASCs), Dialysis Centers, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories |
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Carriers: MAG Mutual Insurance Co.
Coverage: Professional Liability
Limits: Limits - vary.
Allied Health
Administered By: PPIB
Distribution: MGU
| Industries: |
Adoption/Foster Services & Facilities, Allied Health, Ambulatory Surgery Centers (ASCs), Audiologists, Cancer Treatment Centers, Dialysis Centers, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs, Mental Health/Behavioral (Counseling/Counselors), Nutritionist/Dietitian, Occupational Therapist, Physicians (Nonstandard), Social Services, Speech Therapy/Therapists |
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Carriers: Lloyd's of London
Coverage: General Liability, Professional Liability
Limits:
Health Care Facilities Policy
Administered By: NORCAL Group
Distribution: Direct/Broker
| Industries: |
Ambulatory Surgery Centers (ASCs), Dialysis Centers, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Urgent Care |
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Carriers: NORCAL Mutual Insurance Co.
Coverage: Professional Liability
Limits:
Healthcare
Administered By: CapSpecialty
Distribution: MGU
| Industries: |
Ambulatory Surgery Centers (ASCs), Blood/Tissue Banks, Clinical Trials, Federal Tort Claims Act Clinics, Home Healthcare, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs, Medispas, Nurse/Staffing Registries, Pharmacies, Research/Research Organizations (Clinical, Etc.), Urgent Care |
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Carriers: Capitol Specialty Insurance Corp.
Coverage: Professional Liability, Regulatory Liability
Limits: up to $11 million
Hospitals & Facilities
Administered By: Physicians Reciprocal Insurers
Distribution: Carrier Direct
| Industries: |
Ambulatory Surgery Centers (ASCs), Colleges & Universities, Community Health Centers, Dialysis Centers, Home Healthcare, Hospitals, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Rehabilitation Facilities, Schools, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: Physicians' Reciprocal Insurers
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: $1,000,000 - $3,000,000 (Primary or Excess)
Medical Facilities (non-hospital)
Administered By: TDC Specialty Underwriters
Distribution: Carrier Direct
| Industries: |
Ambulatory Surgery Centers (ASCs), Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Labs, Urgent Care |
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Carriers: TDC Specialty Insurance Co.
Coverage: General Liability, Professional Liability
Limits: up to - $15 million (Excess), up to - $1/3 million $2/4 million (Primary)
Medical Professional Liability
Administered By: Markel
Distribution: Direct/Broker
| Industries: |
Allied Health, Alternative Medicine, Ambulatory Surgery Centers (ASCs), Behavioral/Mental Health Organizations, Blood/Tissue Banks, Community Health Centers, Cosmetic Surgeons/Aesthetic Professionals, Home Healthcare, Hospice, Hospitals, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medispas, Nurse/Staffing Registries, Occupational Therapist, Pharmacies, Physical Therapists, Physicians (Locum Tenens), Senior Living Facilities, Sleep Clinics, Urgent Care, Weight Loss Clinics |
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Carriers: Markel Corp.
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: up to $25 million (Umbrella/Excess), up to $5 million (Primary)
Miscellaneous Medical Facilities
Administered By: Ironshore
Distribution: Direct/Broker
| Industries: |
Adoption/Foster Services & Facilities, Adult Day Care, Allied Health, Ambulatory Surgery Centers (ASCs), Bariatric Surgery, Behavioral/Mental Health Organizations, Blood/Tissue Banks, Cancer Treatment Centers, Community Health Centers, Cosmetic Surgeons/Aesthetic Professionals, Dialysis Centers, Emergency Response Services (Ambulance), Home Healthcare, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Nurse/Staffing Registries, Pharmacies, Physical Therapists, Rehabilitation Facilities, Substance Abuse Rehabilitation Facilities & Services, Urgent Care, Weight Loss Clinics |
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Carriers: Ironshore Inc.
Coverage: Employee Benefits Liability, Excess, General Liability, Hired & Non-Owned Auto, Professional Liability
Limits: up to $1 million/$3 million (Primary), up to $10 million (Follow-Form Excess)
Allied Medical
Administered By: JaVA Underwriting
Distribution: MGU
| Industries: |
Allied Health, Ambulatory Surgery Centers (ASCs), Audiologists, Community Health Centers, Counseling (Marriage & Family), Dialysis Centers, Emergency Medical Technicians (EMTs), Home Healthcare, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Nurses, Occupational Therapist, Pharmacies, Physical Therapists, Physician Assistants, Psychologists, Speech Therapy/Therapists |
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Carriers: Lloyd's of London
Coverage: General Liability, Hired & Non-Owned Auto, Professional Liability
Limits: $100,000/$300,000 - $5 million
Allied & Miscellaneous Program
Administered By: PRA Mid-Continent Underwriters
Distribution: MGA
| Industries: |
Adult Day Care, Allied Health, Ambulatory Surgery Centers (ASCs), Audiologists, Behavioral/Mental Health Organizations, Counseling (Marriage & Family), Dialysis Centers, Emergency Medical Technicians (EMTs), Fitness Professionals, Freestanding Medical Facilities, Home Healthcare, Home Medical Equipment, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Massage Therapy/Therapists, Medical Clinics/Infirmaries, Medical Directors, Medical Labs, Mental Health/Behavioral (Counseling/Counselors), Non Emergency Transportation (Medical), Nurse Practitioners, Nurse/Staffing Registries, Nurses, Occupational Therapist, Opticians, Physical Therapists, Physician Assistants, Psychologists, Social Workers, Speech Therapy/Therapists, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: ProAssurance Group
Coverage: Abuse & Molestation Liability, Employee Benefits Liability, General Liability, Hired & Non-Owned Auto, Professional Liability
Limits: up to $5 million/$7 million (Primary Limits)
Ambulatory Surgery Center Professional Liability
Administered By: Admiral Insurance Group
Distribution: Direct/Broker
| Industries: |
Ambulatory Surgery Centers (ASCs) |
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Carriers: Admiral Insurance Co.
Coverage: Excess, Professional Liability, Umbrella/Excess
Limits: up to $5,000,000 (Excess), up to $5,000,000 (Primary)
Allied Healthcare
Administered By: James River Insurance Co.
Distribution: MGA
| Industries: |
Adoption/Foster Services & Facilities, Adult Day Care, Allied Health, Ambulatory Surgery Centers (ASCs), Assisted Living Facilities, Behavioral/Mental Health Organizations, Emergency Response Services (Ambulance), Home Healthcare, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Independent Living Facilities, Laboratories, Long-Term Care Facilities (LTC), Medical Clinics/Infirmaries, Mental Health/Behavioral (Counseling/Counselors), Nurse/Staffing Registries, Pharmacies, Psychiatric Facilities/Hospitals, Rehabilitation Facilities, Senior Living Facilities, Substance Abuse Rehabilitation Facilities & Services, Weight Loss Clinics |
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Carriers: James River Insurance Co.
Coverage: Excess, General Liability, Professional Liability
Limits: up to $5,000,000 (Excess over multiple underlying coverages - supported & unsupported), up to $1,000,000/$3,000,000 (Primary)
Allied Healthcare
Administered By: Navigators Management Co. Inc.
Distribution: Carrier Direct
| Industries: |
Adult Day Care, Ambulatory Surgery Centers (ASCs), Blood/Tissue Banks, Chiropractors, Cosmetic Surgeons/Aesthetic Professionals, Counseling (Marriage & Family), Home Healthcare, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs, Medispas, Pharmacies, Physical Therapists, Psychiatric Facilities/Hospitals, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: The Navigators Group Inc.
Coverage: General Liability, Professional Liability
Limits: up to $5 million (Primary or Excess)
Allied Professional Liability Insurance
Administered By: XL Catlin (Formerly Catlin)
Distribution: Direct/Broker
| Industries: |
Adult Day Care, Allied Health, Ambulatory Surgery Centers (ASCs), Blood/Tissue Banks, Colleges & Universities, Dialysis Centers, Emergency Response Services (Ambulance), Gyms/Fitness Facilities, Home Healthcare, Home Medical Equipment, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medispas, Nurse/Staffing Registries, Opticians, Pharmacies, Physical Therapists, Psychiatric Facilities/Hospitals, Schools, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: Catlin Specialty Insurance Co.
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: $5,000,000 Per Claim - $10,000,000 aggregate
Ambulatory Surgery Centers
Administered By: Allied World
Distribution: Direct/Broker
| Industries: |
Ambulatory Surgery Centers (ASCs) |
|---|
Carriers: Allied World Assurance Co.
Coverage: Abuse & Molestation Liability, Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: up to $1 million/$3 million (Professional and General Liability), up to $25 million (Excess/Umbrella), up to $1 million (Sexual Abuse & Molestation)
Ambulatory Surgery Centers
Administered By: James River Insurance Co.
Distribution: MGA
| Industries: |
Ambulatory Surgery Centers (ASCs), Cosmetic Surgeons/Aesthetic Professionals |
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Carriers: James River Insurance Co.
Coverage: Excess, General Liability, Non Owned Auto, Professional Liability
Limits: up to $1,000,000/$3,000,000 (Primary), up to $5,000,000 (Excess over multiple underlying layers, supported and unsupported)
Excess Healthcare Entity Comprehensive Liability
Administered By: BETA Healthcare Group
Distribution: Direct/Broker
| Industries: |
Ambulatory Surgery Centers (ASCs), Clinics/Infirmaries (Correctional Health), Hospitals |
|---|
Carriers: BETA Healthcare Group, BETA Risk Management Authority
Coverage: Employee Benefits Liability, Excess, General Liability, Miscellaneous Professional Liability, Professional Liability
Limits: $500,000 - $3 million (Self-Insured Retentions), $1 million - $40 million (per occurrence (professional & general liability))
Healthcare Facilities
Administered By: Arch Insurance Group
Distribution: Direct/Broker
| Industries: |
Allied Health, Ambulatory Surgery Centers (ASCs), Cancer Treatment Centers, Clinics/Infirmaries (Correctional Health), Colleges & Universities, Community Health Centers, Day Spas, Dialysis Centers, Home Healthcare, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Medispas, Nurse/Staffing Registries, Pharmacies, Rehabilitation Facilities, Schools, Urgent Care |
|---|
Carriers: Arch Insurance Co.
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: up to $11,000,000
Healthcare Facilities
Administered By: Promont Advisors
Distribution: MGU
| Industries: |
Ambulatory Surgery Centers (ASCs), Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Urgent Care |
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Carriers: GuideOne Insurance Cos., Lloyd's of London
Coverage: Abuse & Molestation Liability, Commercial Auto (Hired & Non-Owned), Commercial Property, Crime, Employee Benefits Liability, Employment Practices Liability (EPL), Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: up to $1,000,000/$3,000,000 (Professional Liability ), up to $1,000,000/$3,000,000 (Employee Benefits), up to $5 million (Excess Liability ), up to $5 million (Property TIV), up to $1,000,000/$3,000,000 (General Liability )
Healthcare Professional Liability
Administered By: XL Catlin (Formerly Catlin)
Distribution: Direct/Broker
| Industries: |
Alternative Medicine, Ambulatory Surgery Centers (ASCs), Bariatric Surgery, Clinics/Infirmaries (Correctional Health), Dentists, Medical Clinics/Infirmaries, Nurse/Staffing Registries, Physicians (Locum Tenens), Physicians (Nonstandard), Surgeons, Telemedicine, Urgent Care |
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Carriers: Catlin Specialty Insurance Co., XL Catlin Insurance Co., Inc.
Coverage: Excess, General Liability, Medical Malpractice, Professional Liability
Limits: up to $20,000,000 (Policy Aggregate), up to $3,000,000 (Per physician/per loss event)