Insurance Program Results
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
Healthcare Entity Comprehensive Liability
Administered By: BETA Healthcare Group
Distribution: Direct/Broker
| Industries: |
Clinics/Infirmaries (Correctional Health), Home Healthcare, Hospice, Hospitals, Long-Term Care Facilities (LTC), Medical Clinics/Infirmaries |
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Carriers: BETA Risk Management Authority, Health Providers Insurance Reciprocal, RRG
Coverage: Employee Benefits Liability, Environmental/Pollution Liability, Excess, Professional Liability, Umbrella/Excess
Limits: up to $500,000/$1 million (Pollution Liability Sublimit), up to $1 million/$40 million (PL & GL), up to $500,000/$500,000 (Fire & Water Damage Legal Liability Sublimit)
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 |
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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)
HealthcarePros (Miscellaneous Healthcare)
Administered By: U.S. Risk
Distribution: MGA
| Industries: |
Allied Health, Ambulatory Surgery Centers (ASCs), Assisted Living Facilities, Chiropractors, Dental Hygienists, Home Healthcare, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Medical Labs, Medispas, Mental Health/Behavioral (Counseling/Counselors), Non Emergency Transportation (Medical), Nurse/Staffing Registries, Nurses (CRNA), Opticians, Paramedics , Pharmacies, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: Lloyd's of London
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: $100,000/$300,000 - $2 million/$4 million
Miscellaneous Healthcare Facilities
Administered By: Colony Specialty
Distribution: Carrier Direct
| Industries: |
Ambulatory Surgery Centers (ASCs), Cannabis/Medicinal Marijuana Dispensaries, Dialysis Centers, Emergency Response Services (Ambulance), Home Healthcare, Home Medical Equipment, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Directors, Medical Labs, Medispas, Non Emergency Transportation (Medical), Nurse/Staffing Registries, Physical Therapists |
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Carriers: Argo Group US Inc., Colony Specialty Insurance Co.
Coverage: Abuse & Molestation Liability, General Liability, Hired & Non-Owned Auto, Professional Liability
Limits: up to $10 million (Excess), $100,000/$300,000 - $1 million/$3 million (Separate or Combined CGL/PL )
Miscellaneous Medical Facilities
Administered By: Allied World
Distribution: Direct/Broker
| Industries: |
Adoption/Foster Services & Facilities, Blood/Tissue Banks, Community Health Centers, Developmentally Disabled Services/Facilities, Dialysis Centers, Emergency Response Services (Ambulance), Federal Tort Claims Act Clinics, Home Healthcare, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Medispas, Mental Health/Behavioral (Counseling/Counselors), Non Emergency Transportation (Medical), Nurse/Staffing Registries, Pharmacies, Rehabilitation Facilities, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: Allied World Assurance Co.
Coverage: Excess, Professional Liability, Umbrella/Excess
Limits: $100,000 - $300,000 (EPLI Primary Only), $1,000,000 - $1,00,000 (Sexual Misconduct Sublimits), up to $25,000,000 (Excess/Umbrella), $1,000,000 - $3,000,000 (Standard Primary)
Miscellaneous Medical Malpractice
Administered By: NAS Insurance Services
Distribution: MGA
| Industries: |
Allied Health, Ambulatory Surgery Centers (ASCs), Behavioral/Mental Health Organizations, Dentists, Dialysis Centers, Home Healthcare, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs, Medispas, Nurse/Staffing Registries, Nurses (CRNA), Opticians, Pharmacies, Pharmacists, Physical Therapists, Psychiatric Facilities/Hospitals, Research/Research Organizations (Clinical, Etc.), Substance Abuse Rehabilitation Facilities & Services |
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Carriers: Lloyd's of London
Coverage: Cyber Liability, General Liability, Professional Liability
Limits: up to $1 million (Professional liability ), up to $3 million (GL aggregate), up to $1 million (Commercial general liability), up to $3 million (PL aggregate), up to $50,000 (Fire legal liability), up to $1 million (Products/completed operations), up to $1 million (Personal & advertising injury), up to $5 million (Excess liability)
Outpatient Allied
Administered By: Pro-Praxis Insurance
Distribution: MGU
| Industries: |
Allied Health, Community Health Centers, Dialysis Centers, Emergency Response Services (Ambulance), Home Healthcare, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Devices, Medical Labs, Nurse/Staffing Registries, Pharmacies, Rehabilitation Facilities, Substance Abuse Rehabilitation Facilities & Services, Urgent Care, Weight Loss Clinics |
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Carriers: Lloyd's of London
Coverage: Abuse & Molestation Liability, Excess, Hired & Non-Owned Auto, Professional Liability, Umbrella/Excess
Limits: up to $1 million (Hired & Non-Owned Auto), up to $10 Million, up to $1 million (Sexual Misconduct Liability)
Outpatient Medical Facilities
Administered By: Kinsale Insurance
Distribution: Carrier Direct
| Industries: |
Ambulatory Surgery Centers (ASCs), Behavioral/Mental Health Organizations, Dialysis Centers, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Medispas, Rehabilitation Facilities, Urgent Care, Wellness/Preventative Care |
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Carriers: Kinsale Insurance Co.
Coverage: General Liability, Professional Liability
Limits: up to $5,000,000 (Follow-form excess on both supported and unsupported basis and can include auto and employer's liability), up to $5,000,000 (Primary Or Excess )
Specialized Medical Facilities
Administered By: James River Insurance Co.
Distribution: MGA
| Industries: |
Alternative Medicine, Community Health Centers, Dialysis Centers, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs, Mental Health/Behavioral (Counseling/Counselors), Occupational Therapist, Rehabilitation Facilities, Sleep Clinics, Substance Abuse Rehabilitation Facilities & Services, Urgent Care, Wellness/Preventative Care |
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Carriers: James River Insurance Co.
Coverage: Excess, General Liability, Non Owned Auto, Professional Liability
Limits: up to $5 million (Excess liability over multiple underlying coverages, supported and unsupported.), up to $1 million/$3 million (Primary)
Allied Health Facilities
Administered By: CNA
Distribution: Carrier Direct
| Industries: |
Allied Health, Ambulatory Surgery Centers (ASCs), Cancer Treatment Centers, Colleges & Universities, Community Health Centers, Dialysis Centers, Home Healthcare, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Mental Health/Behavioral (Counseling/Counselors), Pharmacies, Rehabilitation Facilities, Schools, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: CNA Insurance Cos
Coverage: Employee Benefits Liability, Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: up to $1 million/$3 million (Employee Benefits claims-made basis), up to $15 million
Allied Health (Large Entities)
Administered By: Hiscox Bermuda (Syndicate 3624)
Distribution: Direct/Broker
| Industries: |
Allied Health, Dialysis Centers, Emergency Response Services (Ambulance), Home Healthcare, Medical Clinics/Infirmaries, Nurse/Staffing Registries, Pharmacies, Radiology/Radiologists, Social Services |
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Carriers: Hiscox (Lloyd's Syndicate 3624)
Coverage: Excess, General Liability, Professional Liability, Reinsurance, Umbrella/Excess
Limits: up to $25 million
Allied Healthcare
Administered By: Hiscox USA
Distribution: Carrier Direct
| Industries: |
Acupuncturist, Adoption/Foster Services & Facilities, Adult Day Care, Allied Health, Assisted Living Facilities, Audiologists, Body Piercing/Tattoo Parlors, Chiropractors, Cosmetic Surgeons/Aesthetic Professionals, Dental Hygienists, Dialysis Centers, Emergency Response Services (Ambulance), Fitness Professionals, Home Healthcare, Hospice, Laboratories, Medical Clinics/Infirmaries, Medical Directors, Medispas, Mental Health/Behavioral (Counseling/Counselors), Nurse Practitioners, Nurse/Staffing Registries, Nurses, Nutritionist/Dietitian, Occupational Therapist, Opticians, Pharmacies, Pharmacists, Physical Therapists, Psychiatric Facilities/Hospitals, Psychologists, Research/Research Organizations (Clinical, Etc.), Speech Therapy/Therapists, Substance Abuse Rehabilitation Facilities & Services, Therapy/Therapists, Urgent Care, Veterinarians/Veterinary Risks, Weight Loss Clinics |
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Carriers: Hiscox Insurance Co. Inc.
Coverage: Abuse & Molestation Liability, Crime, Cyber Liability, Excess, General Liability, Privacy Liability/Notification Expense, Professional Liability, Umbrella/Excess
Limits: up to $10,000,000
Allied Healthcare
Administered By: Greenhill Insurance Services
Distribution: MGU
| Industries: |
Acupuncturist, Adult Day Care, Allied Health, Ambulatory Surgery Centers (ASCs), Audiologists, Behavioral/Mental Health Organizations, Consultants/Consulting Risks, Counseling (Marriage & Family), Dialysis Centers, Emergency Response Services (Ambulance), Fitness Professionals, Gyms/Fitness 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), Nurse Practitioners, Nurses, Occupational Therapist, Opticians, Optometrists, Pharmacies, Physical Therapists, Physician Assistants, Psychologists, Speech Therapy/Therapists, Substance Abuse Rehabilitation Facilities & Services |
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Carriers: Lloyd's of London
Coverage: Abuse & Molestation Liability, Employee Benefits Liability, General Liability, Hired & Non-Owned Auto, Professional Liability
Limits: up to $1 million/$3 million (Sexual Abuse), up to $1 million/$3 million (Hired & Non-Owned Auto), up to $2 million/$4 million (Primary Limits)
Extended Reporting Period/Tail
Administered By: MedPro Group
Distribution: Carrier Direct
| Industries: |
Allied Health, Ambulatory Surgery Centers (ASCs), Blood/Tissue Banks, Cancer Treatment Centers, Dentists, Dialysis Centers, Freestanding Medical Facilities, Hospitals, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs, Medispas, Physician Groups, Physicians, Senior Living Facilities, Surgeons |
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Carriers: Medical Protective Co.
Coverage: Extended Reporting Period/Tail
Limits: up to Any (Flexible Terms)
Facilities
Administered By: MedPro Group
Distribution: Carrier Direct
| Industries: |
Blood/Tissue Banks, Cancer Treatment Centers, Community Health Centers, Dialysis Centers, Freestanding Medical Facilities, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Directors, Medical Labs, Medispas, Pharmacies, Rehabilitation Facilities, Sleep Clinics, Urgent Care |
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Carriers: Medical Protective Co.
Coverage: Directors & Officers (D&O), Employment Practices Liability (EPL), Excess, General Liability, Medical Malpractice, Professional Liability
Limits: up to Any (Excess), up to $1 million/$3 million (Primary), up to $5 million (Additional Cyber Limits), up to $5 million (Regulatory Fines & Penalties (optional)), up to $5 million (D&O or EPLI (optional))
Healthcare Professional Liability
Administered By: Berkshire Hathaway Specialty Ins
Distribution: Direct/Broker
| Industries: |
Ambulatory Surgery Centers (ASCs), Blood/Tissue Banks, Healthcare Systems, Hospitals, Long-Term Care Facilities (LTC), Medical Clinics/Infirmaries, Physician Groups, Rehabilitation Facilities, Senior Living Facilities |
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Carriers: Berkshire Hathaway Specialty Insurance
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: up to $80 million (Or More)
HealthServicesGuard
Administered By: Willis Programs
Distribution: Program Administrator
| Industries: |
Ambulatory Surgery Centers (ASCs), Community Health Centers, Dialysis Centers, Directors & Officers (D&O), Hospitals, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Laboratories, Medical Clinics/Infirmaries, Mental Health/Behavioral (Counseling/Counselors), Rehabilitation Facilities, Sleep Clinics, Weight Loss Clinics, Workers Compensation |
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Carriers: AIG
Coverage: Business Interruption, Commercial Property, Crime, Directors & Officers (D&O), Employee Benefits Liability, Employment Practices Liability (EPL), Equipment Breakdown, Excess, General Liability, Inland Marine, Professional Liability, Umbrella/Excess, Workers' Compensation
Limits: up to $10,000,000 (Umbrella ), up to $5,000,000 (Professional Liability ($3 Million per Occurrence) ), up to $5,000,000 (Standard General Liability ($2 Million per Occurrence) )
Large Physician Clinics & Group Practices
Administered By: CNA
Distribution: Carrier Direct
| Industries: |
Medical Clinics/Infirmaries, Physician Groups, Physicians, Surgeons |
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Carriers: CNA Insurance Cos
Coverage: Professional Liability
Limits: