Insurance Program Results

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Medical Clinics: Growth Potential

Crittenden expects carriers to increase premium volume for medical clinics as Americans newly insured under the Affordable Care Act create additional demand for care in outpatient settings. To meet this new demand, medical clinics at all levels of care – ranging from low levels of care at walk-in retail clinics to surgery centers – will continue to expand. Medical clinics are also supplementing care needs amid a shortage of primary care physicians, with many nurse practitioners and physician assistants stepping up to provide care. Clinics are also helping to close a gap in care in rural areas as well.

Submissions will increase from retail health clinics, walk-in clinics and urgent care this year, especially as more retailers, such as CVS, expand offerings and open more clinics. Revenue at outpatient care centers is on the rise and during the first quarter of this year was 8.7 percent higher compared to the first quarter of last year, reaching $28.4 million. Retail health clinics, similar to urgent care centers, provide convenient primary care, but are often staffed by midlevel providers.

Claims at these clinics tend to arise around misdiagnosis, failure to diagnose and patients not liking how a diagnosis was explained to them. A lack of doctor-patient relationship can also create additional claims situations since the healthcare provider relies solely on information provided by the patient. Comparatively, a physician practice would already know about comorbidities and prior medical history, and take that information into consideration. Mobile clinics have also emerged in the last two years as home health agencies add physicians to care for homebound residents and others who would prefer to have the physician visit, in a twist on concierge medicine.

Competition and low minimum premiums, often as low as $2,500 for full coverage, will make it difficult for carriers to post significant premium expansion in this segment, especially with additional capacity from many Lloyd’s of London-backed programs. XL Catlin, James River, Kinsale, Admiral, Allied World, Hiscox USA, Ironshore and General Star are among the non-admitted carriers that may pick up additional medical clinic accounts and premium, but their gains will likely be tempered by low rates. These non-admitted carriers tend to price risks based on exposures and often walk away from underpriced accounts. Most carriers will focus in on adding services and perks to promote retention as well as provide additional tools to insureds to improve patient outcomes. Ironshore began offering a toll free risk management hotline in June to respond to any risk management questions related to outpatient care.

New Discrimination in Underwriting

Crittenden expects selectivity to be a key component of carriers’ strategies to maintain profitability in this increasingly competitive segment. When underwriting a medical clinic, Lloyd’s-backed Allied Protector Plan considers size, annual revenue, and number/type of licensed medical personnel. This has aided the Allied Protector Plan to report a low loss ratio during the program’s five years on the market. General Star can cover to a wide range of clinics, including walk-in, urgent care and community health clinics, but won’t back outpatient medical clinics without a medical director or inpatient/residential facilities. General Star can offer limits up to $5 million. It works with wholesale brokers.

James River prefers true medical clinics but will consider at all types including wellness centers, aesthetics and mobile medical. The carrier won’t cover risks with overnight patient care (other than sleep labs), facilities with gyms or fitness centers on premises, and any centers in West Virginia. James River offers professional liability/general liability with and without physicians/providers, and broad terms. Its minimum premium is $3,500 without a physician and $5,000 with a physician. Primary limits are available up to $1 million/$3 million with excess available up to $5 million. James River works with authorized brokers.

Kinsale offers coverage to outpatient clinics, surgery centers, emergency care/urgent care, outpatient rehab, health/wellness clinics, but won’t write risks in West Virginia. It can offer primary or excess limits up to $5 million and follow-form excess limits up to $5 million on an unsupported or supported basis and can include auto and employer’s liability. Kinsale works with surplus lines brokers.

Carriers and program administrators are reporting additional accounts and opportunities despite heavily competitive conditions. The Lloyd’s/Allied Protector Plan has had significant success outside of mainland U.S. in areas such as Hawaii and Puerto Rico. Clinics are already a top-selling class for a one-year-old Lloyd’s-backed program at Greenhill Insurance Services. Arch expects an expansion of services specifically at urgent care clinics to create additional opportunities. Arch can offer primary limits up to $1 million/$3 million and umbrella limits up to $10 million. It works with Arch Healthcare appointed brokers. XL Catlin anticipates picking up new urgent care accounts via small startups and young organizations. XL Catlin offers professional liability/general liability limits up to $5 million/$10 million. It works with wholesale brokers.

The Lloyd’s/Allied Protector Plan program can offer professional liability/general liability, a sexual abuse and molestation sublimit, and excess. Outside of its in-house program, Allied Protector Plan can also offer, in some cases, property coverage, hired non-owned auto, EPLI and full cyber/privacy liability. Its base limit is typically $1 million/$3 million or $2 million/$4 million, but excess coverage up to $10 million can be secured from Lloyd’s partners. The program administrator doesn’t set a hard minimum premium but premiums typically start at about $2,000 for clinical risks.

Other classes can be as low as $500. The Lloyd’s/Allied Protector Plan program can write a variety of medical clinics from urgent care and hospitals to outpatient ambulatory surgery centers. Allied Protector Plan works primarily with wholesale brokers and large retail agencies. It doesn’t have any hard requirements and will quote to a new broker and later determine if the relationship makes sense.

Copyright © Crittenden Research Inc., September 14th, 2015

Miscellaneous Medical

Administered By: Beazley

Distribution: Direct/Broker

Industries:

Blood/Tissue Banks, Clinical Trials, Clinics/Infirmaries (Correctional Health), Dialysis Centers, Emergency Response Services (Ambulance), Home Healthcare, Laboratories, Medical Clinics/Infirmaries, Medispas, Mental Health/Behavioral (Counseling/Counselors), Pharmacies, Rehabilitation Facilities, Research/Research Organizations (Clinical, Etc.), Substance Abuse Rehabilitation Facilities & Services

Carriers: Beazley Insurance Co. Inc.

Coverage: Commercial Auto, Employee Benefits Liability, Errors & Omissions (E&O), Excess, General Liability, Products & Complete Operations Liability, Professional Liability, Umbrella/Excess

Limits: up to $25 million (Primary, Excess, Excess Follow Form, Umbrella)

Miscellaneous Medical (Small Business/Private Enterprise)

Administered By: Beazley

Distribution: Direct/Broker

Industries:

Acupuncturist, Adult Day Care, Allied Health, Audiologists, Behavioral/Mental Health Organizations, Dialysis Centers, Emergency Response Services (Ambulance), Fitness Professionals, Home Healthcare, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Massage Therapy/Therapists, Medical Clinics/Infirmaries, Medical Labs, Mental Health/Behavioral (Counseling/Counselors), Nurses, Nurses (Visiting), Nutritionist/Dietitian, Occupational Therapist, Optometrists, Pharmacies, Psychologists, Social Services, Speech Therapy/Therapists, Substance Abuse Rehabilitation Facilities & Services, Therapy/Therapists

Carriers: Beazley Insurance Co. Inc.

Coverage: Cyber Liability, Employee Benefits Liability, General Liability, Privacy Liability/Notification Expense, Products Liability, Professional Liability

Limits: up to $11 million (Aggregate Limit), up to $1 million (Employee Benefits Liability), up to $1 million/$3 million (Professional/General Liability), up to $1 million (Privacy Liability), up to $1 million/$3 million (Products Liability)

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

Carriers: Lloyd's of London

Coverage: General Liability, Professional Liability

Limits:

Medical Lab & Clinics Ins

Administered By: PPIB

Distribution: MGU

Industries:

Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs

Carriers: Lloyd's of London

Coverage: Professional Liability, Workers' Compensation

Limits: Call for - Limits

Hospitals & Facilities

Administered By: Coverys

Distribution: Carrier Direct

Industries:

Community Health Centers, Hospitals, Laboratories, Medical Clinics/Infirmaries

Carriers: Coverys, Medical Professional Mutual Insurance Co.

Coverage: Cyber Liability, Excess, General Liability, Professional Liability, Risk Management, Umbrella/Excess, Workers' Compensation

Limits: $2,000,000 Occurence - $6,000,000 Aggregate (Labs, community health centers & clinics. Aggregate varies by state. ), $2,000,000 Occurence - $20,000,000 Aggregate (Hospitals. Aggregate varies by state. )

Clinic Coverage

Administered By: NORCAL Group

Distribution: Direct/Broker

Industries:

Medical Clinics/Infirmaries

Carriers: NORCAL Mutual Insurance Co.

Coverage: Professional Liability

Limits: $1,000,000 Per Claim - $3,000,000 Aggregate

ProAssurance Hospital and Healthcare Facilities

Administered By: ProAssurance Corp.

Distribution: Direct/Broker

Industries:

Healthcare Systems, Hospitals, Medical Clinics/Infirmaries

Carriers: ProAssurance Group

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

Carriers: Capitol Specialty Insurance Corp.

Coverage: Professional Liability, Regulatory Liability

Limits: up to $11 million

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

Carriers: Markel Corp.

Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess

Limits: up to $25 million (Umbrella/Excess), up to $5 million (Primary)

Medical Schools & College-Based Clinic

Administered By: Physicians Reciprocal Insurers

Distribution: Carrier Direct

Industries:

Allied Health, Colleges & Universities, Medical Clinics/Infirmaries, Schools

Carriers: Physicians' Reciprocal Insurers

Coverage: General Liability, Professional Liability

Limits: $1,000,000 - $3,000,000 (Primary or Excess)

Medical Umbrella

Administered By: Markel

Distribution: Direct/Broker

Industries:

Blood/Tissue Banks, Clinical Trials, Clinics/Infirmaries (Correctional Health), Emergency Response Services (Ambulance), Home Healthcare, Hospitals, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Nurse/Staffing Registries, Occupational Therapist, Pharmacies, Physical Therapists, Social Services

Carriers: Markel Corp.

Coverage: Umbrella/Excess

Limits: up to $25 million

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

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

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)

Miscellaneous Medical Professional

Administered By: Admiral Insurance Group

Distribution: Direct/Broker

Industries:

Allied Health, Cancer Treatment Centers, Emergency Response Services (Ambulance), Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Medispas, Mental Health/Behavioral (Counseling/Counselors), Nurse Practitioners, Nurse/Staffing Registries, Occupational Therapist, Physician Assistants, Psychologists, Radiology/Radiologists, Research/Research Organizations (Clinical, Etc.), Therapy/Therapists, Urgent Care

Carriers: Admiral Insurance Co.

Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess

Limits: up to $5,000,000 (Primary and Excess)

Allied Health Rapid Response

Administered By: Kinsale Insurance

Distribution: Carrier Direct

Industries:

Adult Day Care, Allied Health, Home Healthcare, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Mental Health/Behavioral (Counseling/Counselors), Pharmacies, Rehabilitation Facilities, Wellness/Preventative Care

Carriers: Kinsale Insurance Co.

Coverage: General Liability, Professional Liability

Limits:

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

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

Carriers: The Navigators Group Inc.

Coverage: General Liability, Professional Liability

Limits: up to $5 million (Primary or Excess)

Beta Suite (Alternative Risk & Insurance Services)

Administered By: BETA Healthcare Group

Distribution: Direct/Broker

Industries:

Clinics/Infirmaries (Correctional Health), Community Health Centers, Healthcare Systems, Hospitals, Medical Clinics/Infirmaries, Rehabilitation Facilities

Carriers: BETA Healthcare Group, BETA Risk Management Authority

Coverage: Excess, Miscellaneous Professional Liability, Regulatory Claims, Risk Management

Limits:

Clinics

Administered By: Arch Insurance Group

Distribution: Direct/Broker

Industries:

Medical Clinics/Infirmaries, Physicians

Carriers: Arch Insurance Co.

Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess

Limits:

Directors & Officers

Administered By: Kinsale Insurance

Distribution: Carrier Direct

Industries:

Adoption/Foster Services & Facilities, Assisted Living Facilities, Auto/Car Dealerships, Behavioral/Mental Health Organizations, Blood/Tissue Banks, Camps (Youth, Sports & Enrichment), Churches/Religious Institutions/Organizations, Colleges & Universities, Community Associations, Crisis Call Centers, Day Care (Child or Adult), Education & Nonprofit, Groups & Clubs, Hospice, Libraries, Medical Clinics/Infirmaries, Mental Health/Behavioral (Counseling/Counselors), Nonprofit Organizations, Private/Charter Schools, Restaurants, Social Services, Substance Abuse Rehabilitation Facilities & Services

Carriers: Kinsale Insurance Co.

Coverage: Directors & Officers (D&O)

Limits: up to $5 million/$5 million (Primary)