Insurance Program Results
Rankings: OB/GYN Writers |
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Carrier (Segment) |
Extent of Coverage |
Crittenden’s Customer Service Rating |
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The Doctors Co. |
OB/GYN (No Deliveries), OB/GYN (All Other), Gynecology (Major Surgery), Gynecology (With In-Vitro Fertilization), Certified Nurse Midwives with Separate Limits |
5 Stars |
|
NORCAL Mutual Insurance Co. |
Gynecology (Major Surgery), Gynecology (Minor Surgery), Gynecology (No Surgery), Obstetrics & Gynecology, Midwives. |
5 Stars |
|
MagMutual Insurance Co. |
OB/GYN (Surgery), Gynecological (Surgery), Gynecology (Minor Surgery), Midlevel Providers as Additional Insureds (Nurse Practitioners, Physician Assistants, Certified Nurse Midwives). |
5 Stars |
|
ISMIE Mutual Insurance Co. |
OB/GYN (Surgery), OB/GYN (No Major Surgery) Gynecology (No Surgery), Gynecology (Surgery), Midlevel Providers (Obstetrical RN, Certified Nurse Midwife) with Shared or Separate Limits. |
5 Stars |
|
Physicians Insurance A Mutual |
Gynecology (No Surgery), Gynecology (Minor Surgery), Gynecology (Surgery - No Obstetrics), OB/GYN (Surgery), Obstetrics (Surgery), Nurse Midwives Shared Limits and Nurse Midwives (Separate Limits). |
5 Stars |
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LAMMICO |
OB/GYN, Obstetrics, Gynecology (Major Surgery). |
4 Stars |
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FD Insurance Co. |
Gynecology (Surgery), Gynecology (No Surgery), Gynecology (Minor Surgery), Obstetrics & OB/GYN (Surgery), Nurse Midwife. |
3 Stars |
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Liberty International Underwriters |
OB/GYN (Surgery), Gynecologists (Surgery), Gynecologists (Minor Surgery), Gynecologists (No Surgery). |
3 Stars |
OB/GYNs: Premium, Frequency Remain Low
Crittenden expects physician carriers to keep OB/GYN rates flat after several years of decreases as well as offer broader coverage. Pricing for this class declined 30 percent to 40 percent during the past eight-plus years, in line with falling frequency. Most carriers will maintain careful underwriting to contain loss ratios when claims do rise again for this risky class. Many physician carriers, such as The Doctors Co. (TDC), NORCAL Mutual, ISMIE, Physicians Insurance A Mutual and MagMutual, will continue to provide dividends and premium credits for members of professional associations or those participating in continuing education courses. These carriers will also offer additional coverages to maintain their competitiveness in this segment.
Even though obstetrics claims have declined to single digits per 10,000 deliveries during the last five years, high levels of risk and exposures remain. An obstetrics study of closed claims by TDC and shared with Crittenden revealed that among 882 claims closed from 2007 to 2014, delay in the treatment of fetal distress was a top claim, followed by improper performance of vaginal delivery and improper management of pregnancy. Birth-related injuries have become more severe as well, and they are now a cause of multi-million dollar shock losses that have crept into medical professional liability. Compounding claims costs are plaintiff attorneys’ increased expenditures of time, energy and resources in developing and presenting life care plans. Claims that could become more troublesome include “wrongful life” lawsuits that allege that if a child’s ailment could be determined before birth through tests and the mother had known, she could have aborted the fetus. Not all venues allow for this type of lawsuit, but some, including New Jersey, do and have already seen hefty claims of this nature.
Could Shift Portend Rise in Claims?
A demographic shift within this specialty could also transform the claims environment. Residents entering this specialty tend to be women. When these female OB/GYNs end up having families of their own, they often remove obstetrics from their practices to focus only on gynecology, which is not as grueling and doesn’t require being available 24/7. This has led to older men becoming a larger demographic within the OB/GYN class. Claims data shows that claims are filed against female OB/GYNs less than their male counterparts, giving rise to concern that this demographic shift could result in more frequent claims.
Crittenden anticipates that carriers will revise rating methodologies to provide a clear differentiation between OB/GYNs who perform deliveries and those that do not. ISMIE Mutual offers a separate gynecology-only coverage for doctors who do not offer obstetrics services. TDC will update its rating structure for OB/GYNs in August and September, depending on the state. It will split the rating between OB/GYNs who deliver babies and those who do not. OB/GYNs who do not perform deliveries will have a rate 15 percent less than the OB/GYN (all other) category.
Expect carriers to write more midlevel providers within an OB/GYN practice as additional insureds due to a greater use of these providers. Greater demand for care under the Affordable Care Act as well as a pending shortage in specialists will continue to amplify the need for these providers. MagMutual expects to see additional coverage opportunities with the use of nurse practitioners, physician assistants and certified nurse midwives in OB/GYN practices. As a result, it will closely monitor the losses directly attributable to increased reliance on these midlevel providers. It also expects additional interstate coverage opportunities with increased use of telemedicine, primarily for remote fetal monitoring via a review of ultrasound studies. MagMutual will cautiously insure telemedicine risks after reviewing education, licensing, area, specialty and structure of the practice.
Carriers’ expansion of programs into new regions and territories will bring an increase in competition. NORCAL Mutual entered Texas in May. FD Insurance Co. entered Georgia last month. Liberty Insurance Underwriters will expand its physicians and surgeons program into Florida in September, if approved, and will cover OB/GYNs who provide surgery as well as gynecologists who provide surgery, including minor surgery, or don’t perform surgery.
Carriers will broaden coverage with additional cyber liability limits and other coverages. Effective this month, ISMIE will offer higher limits of $1 million for purchase. Policies include basic coverage with $100,000 limits for individual physicians or $500,000 for clinic-insured entities. ISMIE previously expanded its coverage at the start of the year to include content on a practice’s website, reimbursement for expenses related to crisis management and public relations, and fines and costs incurred under the terms of a credit/debit merchant services agreement. For its corporate liability coverage, ISMIE offers shared limits that reduce the expense of insuring a corporate entity under the clinic option. TDC expanded the limits offered in its CyberGuard/MediGuard coverage to $1 million/$1 million. TDC’s rates will be identical to those used by Underwriters at Lloyd’s, which have been used on a non-admitted basis to cover some of TDC’s current physician insureds.
Rates will remain competitive, depending on the territory and the size of the practice. Groups that cover hospitals 24/7 or OB/GYNs delivering more than 140 babies per year – the recommended amount issued by the American Congress of Obstetricians and Gynecologists – may see higher pricing because of heightened exposures. LAMMICO reduced rates by 51.6 percent overall in Mississippi at the start of this month. Claims-made rates for OB/GYNS now stand at $52,604 per $1 million/$3 million in limits. Occurrence rates are now $55,234 for the same coverage. COPIC, MMIC, UMIA and Physicians Insurance A Mutual are among the physician carriers that will keep base rates stable for the current policy year. Expect rate announcements for the new policy year in the coming months.
ISMIE will announce its rates this summer for the 2015-2016 policy year. It kept premiums flat last year after cutting rates for OB/GYNS by 1.9 percent in 2013. ISMIE offers coverage with $1 million/$3 million limits at base rates ranging from $62,812 to $144,224, depending on the county where the physician practices and the procedures performed. Base premiums for physicians practicing gynecology range from $18,712 to $69,028, with doctors practicing gynecological surgery priced at the high end of that range. Insureds can qualify for premium credits or discounts earned through participation in ISMIE’s risk management program.
Like other specialties, the underwriting of OB/GYNs will entail a greater number of questions. Physicians Insurance A Mutual takes into account surgical/non-surgical, retroactive dates, full/part-time, number of office locations, number of practice staff (including midlevel providers with shared limits), electronic medical records, board certification, hospital privileges and training/CME. The carrier’s standard limits are $1 million/$3 million but higher limits are available.
MagMutual will consider medical schools, residency programs, board certification, the venue in which doctor will practice, solo or group practice, loss history, license status, work history, membership in any state-special birth injury funds and the volume of ancillary staff the doctor will supervise. MagMutual offers first-dollar coverage within limits in most states with limits of $1 million/$3 million, $2 million/$4 million or $3 million/$5 million. The carrier provides separate limits in all states for a mother’s claim and a baby’s claim. In Georgia, MagMutual provides defense-costs only coverage for any alleged violation of Georgia Statute OCGA 16-12-140, or the criminal abortion statute which punishes doctors for performing abortions outside of the state’s requirements.
Copyright © Crittenden Research Inc., July 13, 2015
Clinic Option Professional Liability (Physicians)
Administered By: ISMIE Mutual
Distribution: Direct/Broker
| Industries: |
Allied Health, OB/GYN, Physicians |
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Carriers: ISMIE Mutual Insurance Co.
Coverage: Professional Liability
Limits: $500,000/$1,500,000 - $2,000,000/$4,000,000
Medical Professional Liability Insurance (Physicians)
Administered By: MagMutual Insurance
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Midwives, Nurse Practitioners, OB/GYN, Physician Assistants, Physicians, Podiatrists, Surgeons |
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Carriers: MAG Mutual Insurance Co.
Coverage: Professional Liability
Limits: up to $3 million/$5 million
Physicians & Surgeons
Administered By: Coverys
Distribution: Carrier Direct
| Industries: |
OB/GYN, Physicians, Surgeons |
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Carriers: Coverys, Medical Professional Mutual Insurance Co.
Coverage: Cyber Liability, Excess, Professional Liability, Risk Management, Umbrella/Excess
Limits: up to $3,000,000 (Primary Per Occurrence)
Group Policy (Physicians)
Administered By: NORCAL Group
Distribution: Direct/Broker
| Industries: |
Bariatric Surgery, OB/GYN, Physician Groups, Physicians, Surgeons |
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Carriers: NORCAL Mutual Insurance Co.
Coverage: General Liability, Medical Malpractice, Professional Liability
Limits: up to $2 million/$10 million (For Entity/Organization), $500,000/$1 million - $3 million/$5 million
Physicians & Surgeons
Administered By: NORCAL Group
Distribution: Direct/Broker
| Industries: |
Anesthesiologists, Bariatric Surgery, Midwives, Nurse Practitioners, OB/GYN, Physicians, Podiatrists, Surgeons |
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Carriers: NORCAL Mutual Insurance Co.
Coverage: General Liability, Medical Malpractice, Professional Liability
Limits: up to $3 million/$5 million
Ob-Gyn Risk Alliance
Administered By: ProAssurance Corp.
Distribution: Direct/Broker
| Industries: |
OB/GYN |
|---|
Carriers: ProAssurance Group
Coverage: Professional Liability
Limits:
Physicians & Surgeons
Administered By: Physicians Reciprocal Insurers
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, OB/GYN, Physicians, Podiatrists, Surgeons |
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Carriers: Physicians' Reciprocal Insurers
Coverage: Professional Liability
Limits: $1,300,000 - $3,900,000 (Primary Limits if Physician wants to continue excess coverage)
Medical Groups
Administered By: BETA Healthcare Group
Distribution: Direct/Broker
| Industries: |
OB/GYN, Physician Groups, Physicians, Surgeons |
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Carriers: BETA Risk Management Authority, Health Providers Insurance Reciprocal, RRG
Coverage: Excess, Professional Liability, Umbrella/Excess
Limits: $1 million/$3 million - $3 million/$5 million (Hired and Non-Owned Auto)
Medical Professional Liability : Individuals
Administered By: Physicians Insurance A Mutual
Distribution: Direct/Broker
| Industries: |
Anesthesiologists, Midwives, OB/GYN, Physicians, Podiatrists, Surgeons |
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Carriers: Physicians Insurance A Mutual
Coverage: Professional Liability
Limits: $1,000,000 / $5,000,000 - $5,000,000/$9,000,000
Partnerships and Corporations (Physicians)
Administered By: Physicians Insurance A Mutual
Distribution: Direct/Broker
| Industries: |
OB/GYN, Physicians, Surgeons |
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Carriers: Physicians Insurance A Mutual
Coverage: Professional Liability
Limits: $1,000,000/$5,000,000 - $5,000,000/$9,000,000
Physicians & Surgeons
Administered By: The Doctors Co.
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Bariatric Surgery, Gastroenterologist, Midwives, Nurse Practitioners, OB/GYN, Physician Groups, Physicians, Podiatrists, Psychiatrists, Radiology/Radiologists, Surgeons |
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Carriers: The Doctors Co.
Coverage: General Liability, Medical Malpractice, Professional Liability
Limits: up to $1 million/$3 million (Higher limits available. )
Individual Physicians & Physician Business Enterprises
Administered By: Mutual Insurance Co of Arizona
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Gastroenterologist, OB/GYN, Physicians, Podiatrists, Surgeons |
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Carriers: Mutual Insurance Co. of Arizona
Coverage: Professional Liability
Limits:
Individual Policy (Physicians)
Administered By: Medical Mutual Insurance Maine
Distribution: Carrier Direct
| Industries: |
Allied Health, Anesthesiologists, Gastroenterologist, Hospitals, OB/GYN, Physicians, Podiatrists, Surgeons |
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Carriers: Medical Mutual Insurance Co. of Maine
Coverage: Professional Liability
Limits: $11 million Per Claim - $13 million Aggregate
Physicians
Administered By: UMIA
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Gastroenterologist, OB/GYN, Physicians, Podiatrists, Surgeons |
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Carriers: Utah Medical Insurance Association
Coverage: Professional Liability
Limits:
Physicians SELECT Program
Administered By: General Star
Distribution: Carrier Direct
| Industries: |
OB/GYN, Physicians |
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Carriers: General Star Indemnity Co., General Star National Insurance Co.
Coverage: Professional Liability
Limits: $1,000,000 Per Claim - $3,000,000 Aggregate
Physicians & Surgeons
Administered By: Preferred Professional Insurance
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Gastroenterologist, OB/GYN, Physicians, Podiatrists, Surgeons |
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Carriers: Preferred Professional Insurance Co.
Coverage: Professional Liability
Limits:
Physicians & Surgeons
Administered By: Medical Liability Mutual
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Gastroenterologist, Nurse Practitioners, OB/GYN, Physicians, Podiatrists, Surgeons |
|---|
Carriers: Medical Liability Mutual Insurance Co.
Coverage: Professional Liability
Limits: $25,000 or - $100,000 (Defense only coverage ), $1,000,000 Per Claim - $3,000,000 Aggregate (Separate Limits for Entity), $1,300,000 Each person - $3,900,000 annual aggregate (Primary)
Physicians & Surgeons
Administered By: MedPro Group
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Bariatric Surgery, Cosmetic Surgeons/Aesthetic Professionals, Gastroenterologist, Midwives, OB/GYN, Physician Groups, Physicians, Podiatrists, Psychiatrists, Radiology/Radiologists, Surgeons, Telemedicine |
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Carriers: Medical Protective Co.
Coverage: Cyber Liability, Excess, General Liability, Medical Malpractice, Professional Liability, Settlements - Medical
Limits: up to $10 million
Physicians & Surgeons
Administered By: Liberty Intl Underwriters
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Cosmetic Surgeons/Aesthetic Professionals, Gastroenterologist, Midwives, Nurse Practitioners, Nurses (CRNA), OB/GYN, Physician Assistants, Physician Groups, Physicians, Podiatrists, Radiology/Radiologists, Surgeons |
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Carriers: Liberty International Underwriters
Coverage: Cyber Liability, General Liability, Medical Malpractice, Professional Liability
Limits: up to $1 million/$3 million
Physicians & Surgeons
Administered By: LAMMICO
Distribution: Carrier Direct
| Industries: |
Anesthesiologists, Bariatric Surgery, Cosmetic Surgeons/Aesthetic Professionals, Gastroenterologist, Nurse Practitioners, Nurses (CRNA), OB/GYN, Physician Groups, Physicians, Physicians (Locum Tenens), Podiatrists, Psychiatrists, Radiology/Radiologists, Surgeons |
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Carriers: Louisiana Medical Mutual Insurance Co.
Coverage: Cyber Liability, Medical Malpractice, Professional Liability
Limits: up to $1 million/$3 million (Higher Limits Available)