Managed Care E&O and D&O for organizations that seek coverage for today’s changing environment.

In today’s complex and challenging healthcare environment, managed care organizations face unique risks and liability exposures around network design and other issues associated with the Affordable Care Act’s provisions and requirements. Our insight into the intricacies of the managed care environment, combined with our broad and deep industry experience, sets us apart in this marketplace. With an end-to-end approach highlighted by our unique risk management resources and knowledgeable claims team, we address the E&O needs of managed care clients, with management liability options available – separate or shared limits for all coverage sections.

Our appetite focus:

Managed Care Organizations of all sizes and categories. Refer to the eligible risks section below for details.

  • Definition of managed care activity expanded for potential new areas of risk, including calculation of medical loss ratio with related distribution and quality improvement organization programs
  • Punitive damages coverage — most favorable venue where permitted by law
  • Simple and insured centric language that is clear and understandable
  • Carveback to the insured vs. insured exclusion for qui tam action claim expenses
  • E&O dovetails with the management liability policy
  • Definition of claim alleviates certain reporting uncertainties by recognizing that demands for internal member or provider reviews/appeals are part of the normal course of business for managed care accounts, not claims
  • Claim expenses include costs of electronic discovery and, with our consent, public relations consultant expenses
  • Simple and logical approach to related claims

In Addition:

This managed care E&O liability product includes

  • Easy to understand language
  • Broader coverage responding to new exposures in the healthcare industry
  • Management liability coverage options for managed care organizations including D&O, EPL, FL, and crime
  • Up to $25 million in capacity
  • Primary and excess coverage available

Managed Care Organizations of all sizes and categories including:

  • Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs)
  • Independent Practice Associations (IPAs) and Physician Hospital Organizations (PHOs)
  • Management Service Organizations (MSOs)
  • Quality Improvement Organizations (QIOs)
  • Utilization Review Organizations (UROs)
  • Accountable Care Organizations (ACOs)

Risk management services for qualified accounts can include:

  • Access to a web portal offering information on the latest in the managed care industry, such as current case law and emerging issues
  • Suggestions regarding daily business decisions, such as drafting contracts
  • Tailored risk management services through Robinson+Cole LLP, including policy and procedure review, and access to experienced managed care attorneys during critical situations in an organization

No one looks forward to being involved in a claim. However, we strive to be as prepared as possible should a claim occur. Our goal is to work with you and your defense counsel to develop and execute effective claim resolution strategies.  Our claims services include:

  • Experienced teams of in-house claims professionals which include clinicians, lawyers, investigators and IT experts that are dedicated to each account
  • A strong network of national reputable outside counsel, with preferred pricing negotiated with many of these firms and available to policyholders
  • A natural tenacity to fight for policyholders’ reputations
  • The ability to settle appropriately, but with policyholders’ best interests in mind, treating an insured’s money as if it was our own
Application

Managed Care Errors & Omissions Liability Application

For use in Rhode Island
HPA-41001-02-12
Application

Managed Care Errors & Omissions Liability Application

For use in Puerto Rico
HPA-41001-02-12
Application

Healthcare Consultants Liability Application

HPA-44001-10-11