Managed Care E&O Liability Insurance

HMOs, PPOs, IPAs, PHOs... a virtual alphabet soup of managed care acronyms. Although highly varied in terms of duties and functions, Managed Care Organizations (MCOs) all need one thing -- a formula for protection.

Chubb's tailored coverage is based on the services each MCO provides. Our Managed Care E&O policy offers coverage to protect against exposures such as credentialing and peer review claims or claims arising out of utilization review activities. With up to $20 million of limits available, we offer MCOs the broad protection and stability they need.

It's better to evaluate your coverage in the boardroom than in the courtroom. Consider the following protection features:

Broad definition of covered managed care activities, including administration, management and marketing of health care or workers compensation plans, provider selection (peer review, credentialing, and contracting), utilization review, case management, disease management, claims administration, establishment of provider networks, and reviewing the quality of medical services or providing quality assurance.

In addition to the activities listed above, the following activities are also included: design and/or implementation of financial incentive plans, wellness or health promotion education, development or implementation of clinical guidelines, practice parameters or protocols, and triage for payment of medical services.

• Coverage for medical malpractice allegations involving managed care activities.

• Specific coverage for medical information protection (including breach of confidentiality or improper disclosure).

• Vicarious liability coverage. This feature provides true coverage for claims against MCOs arising from allegations of medical malpractice by contracted providers for which the MCOs are vicariously liable.

• Broad provider selection coverage for claims by enrollees alleging negligent selection of a provider, claims by denied/terminated providers (including antitrust), and claims related to credentialing for all providers, not just physicians.

• Broad definition of insured, including past and present directors, officers, employees, medical directors, members of the MCO's committees, and other volunteers.

• No ERISA exclusion.

• Defense coverage for contract claims.

• Automatic coverage for 90 days in the event of a merger or acquisition.

• "Velvet" hammer clause. In the event an insured does not consent to settlement, and Chubb would prefer to settle, the policy has an enhanced settlement clause providing payment of up to 50% of any loss and/or defense expense in excess of the first offered settlement amount.

• Broad definition of claim to include any written notice evidencing an intent to hold an Insured responsible for a wrongful act including, arbitration, mediation, judicial, declaratory, or injunctive proceedings.

• Vicarious liability coverage for sexual misconduct of contracted practitioners.

• Duty to defend. Highly qualified and experienced counsel is appointed by Chubb to defend covered claims.

• No prior acts date. The policy includes coverage for unknown acts occurring before the inception date of the policy.

• No mid-term audit or mid-policy premium adjustments.

• Noncancelable policy once the premium is paid.

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