Insurance Program Results
Mental Health Facilities: Growth Expected
AIG will take on a larger share of the behavioral and mental health market through a partnership with one of the largest programs in the segment. The carrier will file paperwork throughout the summer to begin backing NSM Insurance Group’s Additional Treatment Providers. It’s expected the AIG-backed program will grow 10 percent to 20 percent this year, similar to recent years. Much of this growth will be in extended care in both in sober living under addiction treatment and supported housing for mental health. ACE-backed Irwin Siegel Agency (ISA) expects additional coverage opportunities to emerge regionally as more states, including New York and California, fund mental health, leading to the creation of additional organizations.
This is a market for which premium can be expected to organically grow as mental health services are expanded under the Affordable Care Act, state legislature efforts to fund treatment and general expansion of the industry. The Centers for Medicare & Medicaid Services recently released new information regarding the expansion of substance abuse and mental health treatment under Medicare and Medicaid. Private health insurance companies are required to cover mental health treatment under healthcare reform. The rise in heroin and prescription drug abuse as well as a rise in mass shootings and other violent events has increased the focus on addiction and mental health treatment.
NSM previously worked with Arch for the Additional Treatment Providers program, which includes behavioral and mental health facilities. After AIG made a significant investment in NSM earlier this year, the administrator began transitioning many of its programs to AIG paper. NSM will use Arch paper until the AIG admitted filings gain approval in all states. The program administrator expects this new relationship to provide access to additional coverage enhancements, expanded risk appetite and additional niche-specific risk management services. The program and coverage will otherwise remain the same.
Expanding Appetites
ISA also expanded its risk management services to address new exposures with its clients. Other carriers likely to write more mental/behavioral health risks include Scottsdale and Mental Health RRG through Negley Associates, James River, Lloyd’s of London through various programs, Ironshore and Allied World. Nearly all carriers will process more submissions from primary care services due to the collocation of mental health and primary care within a single setting. ACE/ISA has sold more coverage for primary care this year after offering this coverage on an as needed basis for several years. AIG/NSM can also write coverage for primary care exposures but won’t cover pure primary care facilities, such as minute clinics. Providers in this segment have discovered that patients often receive referrals from primary care physicians for mental health issues but that patients tend not to make an appointment unless the mental health provider is in the same office or nearby. There is some evidence that collocated primary care and mental health services have raised the quality of care and more mental health clinics are beginning to offer primary care and wellness services, such as treatment for diabetes and high blood pressure. At the same time, offering more professional services will inevitably increase the likelihood of a liability claim.
Crittenden expects claims will likely remain stable. Suicide claims remain the most common claim but most facilities often have clear protocols in place to best handle these situations, with not every attempted suicide ending in death. There are concerns that an increase in violent shootings could lead to additional claims, especially if the shooter was previously under mental health care or denied access to care. Telepsychiatry will continue to increase in popularly and give rise to concerns about credentialing of these programs and quite possibly complicated claims scenarios. Look for underwriters to become more diligent in making sure telepsychiatry providers have credentialing in the state in which patients reside.
The creation of sober living as part of addiction treatment is also creating a new exposure since these facilities are often unregulated. ACE/ISA can write sober living if it is a part of a care plan attached to an addiction treatment facility but won’t write standalone sober living facilities. AIG/NSM can write standalone sober living facilities. Expect underwriters to be more mindful of the extent of services a mental health facility provides, especially as more facilities are collocated with primary care. During underwriting, ACE/ISA will consider the population and types of clients served, types of programs offered, and past loss experience in the program. It will look at tougher risks and programs and each individual program has individual underwriting questions.
The AIG/NSM program offers newly expanded risk management services that specifically address behavioral/mental health. Under AIG, NSM will provide expanded umbrella limits of $25 million. Limits were previously set at $10 million. The program will be offered on an admitted basis and include the same coverage as offered under Arch, such as professional and general liability, sexual and physical abuse, property, auto, cyber liability, E&O, EPLI, employee benefits liability and participatory accident. There is no set minimum premium since the program covers a wide range of facilities. The AIG/NSM program will cover the full gamut of addiction and mental health facilities but has a limited appetite in certain litigious venues. The program is offered through retail independent agents with no premium volume commitments.
The ACE-backed program at Irwin Siegel Agency offers a package that includes everything from property, commercial auto, crime and inland marine to general and professional liability, abuse and molestation and umbrella. Ancillary products are also available for D&O, employment practices liability, cyber liability, accident, special events and other coverages. ISA doesn’t have a specific target market and will consider any type of mental health and addiction treatment facility, which includes, but is not limited to, day programs, residential program and crisis stabilization. Basic limits for liability are $1 million/$3 million. The program’s capacity can accommodate $15 million. There are no limits on sizes for property or commercial auto and no specific minimum premium.
ACE/ISA has open distribution and works with referrals from other accounts and brokers. It actively builds relationships with brokers and individual accounts through its marketing department with sales representatives in the field and in house. Individual brokers wishing to work with ISA must be licensed and have E&O insurance. ISA will provide brokerage agreements with brokers/agents. There are no premium level requirements and the program administrator will work with brokers placing one or many accounts. ISA has specialized in social services and mental health for more than 45 years. It began offering additional risk management services earlier this year and partners with a toxicology company to provide education related to states legalizing recreational and medicinal marijuana. The program administrator also began working with a healthcare consulting firm to better address additional medical exposures related to new procedures.
Copyright © Crittenden Research Inc., August 17th, 2015
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)
Human Services
Administered By: CapSpecialty
Distribution: MGU
| Industries: |
Adoption/Foster Services & Facilities, Adult Day Care, Behavioral/Mental Health Organizations, Developmentally Disabled Services/Facilities, Psychiatrists, Psychologists, Residential Facilities, Social Services, Substance Abuse Rehabilitation Facilities & Services, Youth Services/Facilities |
|---|
Carriers: Capitol Indemnity Corp., Capitol Specialty Insurance Corp.
Coverage: Abuse & Molestation Liability, Commercial Property, Crime, Cyber Liability, General Liability, Inland Marine, Professional Liability, Umbrella/Excess
Limits: up to $11 million
Managed Care Organizations
Administered By: TDC Specialty Underwriters
Distribution: Carrier Direct
| Industries: |
Behavioral/Mental Health Organizations, Health Maintenance Organization (HMO), Healthcare Systems |
|---|
Carriers: TDC Specialty Insurance Co.
Coverage: E&O
Limits: up to - $15 million (Primary & Excess)
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)
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 |
|---|
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 & 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)
Behavioral/Mental Healthcare
Administered By: Irwin Siegel Agency, Inc.
Distribution: Program Administrator
| Industries: |
Behavioral/Mental Health Organizations, Counseling (Marriage & Family), Mental Health/Behavioral (Counseling/Counselors), Psychiatrists, Rehabilitation Facilities |
|---|
Carriers: ACE Group
Coverage: Abuse & Molestation Liability, Accident & Health, Commercial Auto, Commercial Property, Crime, Cyber Liability, Directors & Officers (D&O), Employment Practices Liability (EPL), Environmental/Pollution Liability, General Liability, Inland Marine, Professional Liability, Umbrella/Excess
Limits: up to $1 million/$3 million (General Liability Standard. Higher limits available.), up to $1 million/$3 million (Professional Liability Standard. Higher Available.), up to $15 million (Umbrella), up to $1 million (Commercial Auto - Combined Single Limit Liability)
Social Services
Administered By: Huntersure LLC
Distribution: MGA
| Industries: |
Behavioral/Mental Health Organizations, Day Care (Child or Adult), Hospice, Meals on Wheels, Mental Health/Behavioral (Counseling/Counselors), Psychologists, Respite Care, Social Services, Social Workers, Substance Abuse Rehabilitation Facilities & Services |
|---|
Carriers: Chaucer plc
Coverage: Abuse & Molestation Liability, General Liability, Professional Liability
Limits: up to $3 million/$6.4 million
Social Services Program
Administered By: PRA Mid-Continent Underwriters
Distribution: MGA
| Industries: |
Adoption/Foster Services & Facilities, Adult Day Care, Behavioral/Mental Health Organizations, Counseling (Marriage & Family), Developmentally Disabled Services/Facilities, Mental Health/Behavioral (Counseling/Counselors), Respite Care, Social Services, Social Workers, Substance Abuse Rehabilitation Facilities & Services, Tutoring Centers |
|---|
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
Addiction Treatment Providers Program
Administered By: NSM Insurance Group
Distribution: Program Administrator
| Industries: |
Behavioral/Mental Health Organizations, Mental Health/Behavioral (Counseling/Counselors), Psychiatric Facilities/Hospitals, Substance Abuse Rehabilitation Facilities & Services |
|---|
Carriers: AIG, Arch Specialty Insurance Co.
Coverage: Commercial Auto (Hired & Non-Owned), Cyber Liability, Employee Benefits Liability, General Liability, Professional Liability, Property
Limits: up to $1,000,000 (Primary - Separate Limits for Each Coverage Part), up to $10,000,000 (Excess)
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)
Behavioral Health
Administered By: Allied World
Distribution: Direct/Broker
| Industries: |
Behavioral/Mental Health Organizations, Developmentally Disabled Services/Facilities, Mental Health/Behavioral (Counseling/Counselors), Residential Facilities, Substance Abuse Rehabilitation Facilities & Services |
|---|
Carriers: Allied World Assurance Co.
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: $100,000 - $300,000 (Sublimit for EPLI (Fewer than 50 employees)), $1,000,000 - $3,000,000 (Primary (Per coverage part, including $1 million/$1 million standalone sexual abuse coverage)), $25,000 - $75,000 (Sublimit defense for agency proceedings), up to $15,000,000 (Excess or Umbrella)
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)
Healthcare Pros (Social Services)
Administered By: U.S. Risk
Distribution: MGA
| Industries: |
Adoption/Foster Services & Facilities, Behavioral/Mental Health Organizations, Hospice, Private Schools (Deaf & Blind), Rehabilitation Facilities, Residential Facilities, Substance Abuse Rehabilitation Facilities & Services |
|---|
Carriers: Lloyd's of London
Coverage: Crime, General Liability, Inland Marine, Non Owned Auto, Professional Liability, Umbrella/Excess
Limits: $100,000/$300,000 - $2 Million/$4 Million
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 |
|---|
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 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 |
|---|
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 )
Social Services
Administered By: Colony Specialty
Distribution: Carrier Direct
| Industries: |
Adoption/Foster Services & Facilities, Adult Day Care, Behavioral/Mental Health Organizations, Counseling (Marriage & Family), Developmentally Disabled Services/Facilities, Psychiatric Facilities/Hospitals, Social Services, Substance Abuse Rehabilitation Facilities & Services, Youth Services/Facilities |
|---|
Carriers: Argo Group US Inc., Colony Specialty Insurance Co.
Coverage: Abuse & Molestation Liability, Commercial Property, General Liability, Professional Liability
Limits: up to $10 million (Excess), $100,000/$300,000 - $1 million/$3 million (Separate or Combined CGL/PL)
Social Services Professional Liability Insurance
Administered By: XL Catlin (Formerly Catlin)
Distribution: Direct/Broker
| Industries: |
Adoption/Foster Services & Facilities, Behavioral/Mental Health Organizations, Crisis Call Centers, Developmentally Disabled Services/Facilities, Hospice, Meals on Wheels, Mental Health/Behavioral (Counseling/Counselors), Social Services, Substance Abuse Rehabilitation Facilities & Services |
|---|
Carriers: Catlin Specialty Insurance Co.
Coverage: Excess, General Liability, Professional Liability, Umbrella/Excess
Limits: $5,000,000 Per Claim - $10,000,000 aggregate
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 |
|---|
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)
Medical Facilities
Administered By: Allied Protector Plan
Distribution: Program Administrator
| Industries: |
Adult Day Care, Allied Health, Ambulatory Surgery Centers (ASCs), Behavioral/Mental Health Organizations, Cancer Treatment Centers, Dialysis Centers, Hospice, Imaging Centers/Diagnostic Labs (X-Ray, MRI, etc.), Medical Clinics/Infirmaries, Medical Labs, Opticians, Pharmacies, Physical Therapists, Social Services, Substance Abuse Rehabilitation Facilities & Services, Urgent Care |
|---|
Carriers: Lloyd's of London
Coverage: Abuse & Molestation Liability, Business Personal Property/Business, Cyber Liability, Employment Practices Liability (EPL), General Liability, Hired & Non-Owned Auto, Privacy Liability/Notification Expense, Professional Liability
Limits: up to $10 million (Excess)