The combination of unrelenting financial pressure and healthcare reform has spurred tremendous change in the way healthcare providers and payors are organizing themselves in order to effectively deliver and finance care. Hospitals and physicians are increasingly coming together in one form or another. Formerly independent community hospitals are creating alliances, and larger hospitals are acquiring smaller ones, or merging with other like-size systems.
Through all of this change, healthcare providers are taking on more financial risk as they move from “fee-for-service” to “fee-for-performance” reimbursement methodologies. The integration of the healthcare delivery model and the resulting coordination of services is blurring the traditional boundaries between and among those who provide and those who administer care.
IronHealth, Ironshore's healthcare division, understands that integrated delivery means integrated risk and is in a unique position to address these emerging risks, with unparalleled product offerings and expertise in virtually all areas of healthcare liability, employer and provider stop loss and HMO reinsurance.
Medical Professional Liability
Hospital Professional Liability Insurance
IronHealth’s Hospital Professional Liability Insurance solutions include primary, lead excess, follow-form excess and umbrella capabilities as well as reinsurance for captives and the capability to participate on London line-slip programs. IronHealth has $50M in excess capacity and $1M/$3M or $2M/$4M in primary capacity and can offer individual physician limits on primary.
Our insureds are offered “risk management dollars" which can be allocated toward the purchase of risk management products and services from the providers of their choice. We don't require that "in-house" resources be used or that only select vendors can be utilized. Instead, we acknowledge that our insureds know best what their needs are and may already have existing vendor relationships in place to meet those needs. To help stretch these dollars, IronHealth has proactively established relationships with some of the industry's leading Healthcare Risk Management providers.
Currently, our preferred partners include (click for details on each):
- Healthcare Professional Liability Brochure
- HPL Pyramid
- Claims Services
- Malpractice Verdicts - Amputation Claims
- Malpractice Verdicts - Emergency Department
- Malpractice Verdicts - Increase in Frequency, Severity and Batch
- Risk Management and Healthcare IT Services
- “LeadingEdge” for Hospitals & Integrated Health Systems
Physician Group Practice Liability Insurance
As the business of healthcare delivery has evolved, physician group practices have developed significant exposures that are no longer adequately served by traditional Physician ProfessionalLiability (PPL) products. As a result, IronHealth has created an upgraded product - combining outstanding PPL coverage with enterprise risk management in the form of additional liability coverages that can help protect the assets of the group. Claims-made coverage is available for groups of 10 or more physicians. Primary and excess limits are available (including excess of captives or SIRs).We can also provide reinsurance of captives.
- Primary policy limits of $1M/$3M ($2M/$6M available upon request)
- Excess limits available up to $15M
- Stand-alone “tail” coverage is available for physicians who are changing carriers or employers
Long Term Care Professional Liability
IronHealth offers tailored coverage and effective risk management solutions for not-for-profit and for-profit long term care entities including independent, assisted and skilled nursing facilities in all states. Claims-made or occurrence coverage is available on a primary and/or excess basis.
- Primary policy limits $1M /$3M
- Excess limits available up to $10M
Miscellaneous Medical Facilities
IronHealth has a broad appetite for Miscellaneous Healthcare Facility business including more than 75 classes and sub-classes of business. Coverage is available on both an occurrence and a claims-made basis in all states and on a primary and/or excess basis.
- Primary policy limits of $1M/$3M or $2M/$4M
- Excess limits available up to $10M
Adverse Health Survey Reimbursement Policy
Nursing home operators are committed to providing the highest quality care possible for their patients, but at times there are lapses that create serious issues for all involved. The impact of an adverse Health Survey can be devastating not only in terms of a facility's reputation, but also the impact to the bottom line as the operator scrambles to develop a mandatory Plan of Correction in response to the survey. In today's economic environment, skilled nursing facility budgets often don't have the flexibility to absorb these added costs. IronHealth has developed the Adverse Survey Expense Reimbursement Policy which provides the resources needed to respond. This new product is available only as a companion policy to IronHealth's Professional and General Liability product and provides the following coverage features:
- Separate Limits for Adverse Health Survey Expenses - $25,000 per location
- First Dollar coverage
- Low minimum premiums starting at $1,825
- Assists Administrators in achieving Substantial Compliance in timely, professional manner
- Covers out of pocket costs associated with responding to adverse Health Surveys for Skilled Nursing facilities receiving deficiencies at Scope and Severity of G or higher, including tags related to sub standard care
- Covered costs may include Professional Consultation to prepare Plans of Correction, preparation for Informal Dispute Resolution, development of Letters of Removal for Immediate Jeopardy citations, Legal Counsel and Training Assistance
- All insureds receive a Survey Preparation and Response kit
- Professional Consultation services provided by Pendulum, LLC
Federally Qualified Healthcare Centers
Grant-Supported Federally Qualified Health Centers are public and private not-- for profit health care organizations that meet certain criteria under the Medicare and Medicaid Programs of the Social Security Act and receive grant monies under the Health Center Program (Section 330 of the Public Health Service Act). Under the Federally Supported Health Centers Assistance Act of 1992 and 1995, eligible health centers are afforded protection under the Federal Tort Claims Act (FTCA) for their alleged acts or omissions related to medical malpractice. Following an annual application process, "deemed" entities, their employees as well as certain other individuals identified by the statute, are covered under the FTCA. The intent of the Health Center Medical Malpractice Program is to increase the availability of funds for the Health Centers, expand access to quality health care and increase the number of patients served and at the same time eliminate the costs associated with buying malpractice insurance. All general liability exposures are excluded as well as any new services or activities that the health center has engaged in since the deeming application was submitted and approved. Until those activities and services have been deemed and therefore subject to FTCA coverage, private insurance should be purchased for the medical malpractice exposure created by the new services. In response to this need, IronHealth has developed a policy form to address the potential gaps in coverage with the following features:
- Professional Liability/General Liability "wrap around" coverage
- Coverage available for deemed and non deemed services and activities
- Occurence coverage available
- Primary and excess limits available
- Additional Insured and contractual coverage included for all Funding Sources
- $25K sub-limit for Personal Injury Information Reimbursement Coverage
- Separate limit
- Includes coverage for HIPPAA violations
- Worldwide coverage
- Separate limits available for employed medical practitioners
- Good Samaritan coverage
- Coverage provided for volunteers and part time dentists
- Risk Management dollars available
- Federally Qualified Healthcare Centers Highlight Sheet
- Risk Management Services for Federally Qualified Health Centers Highlight Sheet
IronHealth has combined their highly specialized institutional expertise with Medical Mutual Insurance Company of North Carolina’s (MMIC NC) highly regarded physician capabilities to develop IronMed, the first comprehensive risk transfer product of its kind in the nation. IronMed combines hospital professional liability and physicians professional liability coverage, tailoring protection for the main concerns of each constituency: for physicians, their reputations; for hospitals, their community persona and their balance sheet.
Hospital Professional Liability Insurance
- Primary limits up to $2M/$4M- additional excess limits available
- Lead excess limits up to $10M/$10M
- Additional Coverage Features:
- Public relations expense reimbursement up to $50,000
- Evacuation expense reimbursement up to $50,000
- Patient Loss of Property expense reimbursement up to $1,000 per claim, $3,000 aggregate
- "Risk Management Dollars" for insureds to use toward the purchase of risk management products and services from the providers of their choice
Physician Professional Liability
- Primary limits up to $2M/$4M- additional limits available
- Additional Coverage Features:
- Consent to Settle by the First Named Insured
- Risk Management products and services, tailored specifically for physicians, provided by MMIC NC and/or third party providers
Managed Care E&O and D&O Liability
IronHealth’s Managed Care E&O and D&O products cover the full range of managed care organizations. We understand and have expertise in underwriting not only the large traditional managed care organizations such as HMOs and PPOs, but also the myriad of other organizations which provide managed care services including IPAs, PHOs, ACO’s, UROs, MSOs, TPAs, PROs, QIOs, CVOs, care management and disease management companies, and healthcare consultants.
- Managed Care Errors & Omissions Liability limits available up to $50M
- Managed Care Directors & Officers Liability coverage is available with limits up to $10M for our E&O insureds
- Managed Care E&O Brochure
- Managed Care D&O Brochure
- IronHealth Managed Care Organization Professional Liability Coverage Brochure
Integrated Delivery Organization (IDO)
IronHealth’s Integrated Delivery Organization (“IDO”) policy specifically addresses the multi-line liability insurance exposures of healthcare organizations seeking to integrate care delivery and care management/financing vehicles. IronHealth’s IDO policy form allows healthcare organizations to consolidate the many separate liability programs an organization of this type would need into one insurance product offering integrated protection for sector-specific liability risk.
- Aggregate limits available up to $25M
- Limits may vary by coverage part
Benefit Plan Sponsor Liability Insurance
The world of employee benefits is rapidly changing. Employers are struggling to manage costs and deal with the mandates and issues surrounding health reform.
The ways employers choose to incent their employees to keep costs down, to design their health benefit plan choices, and the elements of the plan that they choose to administer in-house all have potential liability attached. IronHealth’s Benefit Plan Sponsor Liability Insurance offers insurance coverage to specifically address these various exposures for employers, unions and associations.
- Limits available up to $10M
Accountable Care Organization (ACO)
IronHealth’s ACO product was specifically designed to address the liability exposures of Accountable Care Organizations and to be flexible as these organizations grow and change over time.
The multi-line approach allows a start-up ACO to purchase Managed Care E&O and D&O to start but then add medical professional coverage down the line if they hire medical practitioners to provide hands-on care.
Employment Practices Liability coverage is included in the D&O and First and Third Party Privacy coverage, General Liability, Fiduciary Liability, and an Option for Government Billing E&O are available as well.
- Aggregate limits available up to $25M
- Limits may vary by coverage part
Custom Accounts and Asset Protection Solutions
Not every insured is looking for standard, traditional risk transfer options. Some may require a creative solution not easily found. Our Custom Account Facility specializes in non-traditional risk transfer solutions and in developing ways to address a specific need that other carriers cannot or won't consider. Examples of solutions include, but are not limited to:
- Options to purchase insurance coverage or additional limits at a later date at preset terms, including potential coverage for existing claims
- Swing-rated, or "loss sensitive" arrangements
- Stop loss coverage for an insured's self-insured retention
- Fronting arrangements
- Loss portfolio transfers
Loss Portfolio Transfer®
Hospital systems, long-term care facilities, physician groups and other healthcare organizations utilize a variety of methods to self-insure all or a portion of their own Professional Liability risk. Given the current economic climate, there may be a strong incentive for these organizations to free up capital through a "Loss Portfolio Transfer" (LPT®). An LPT® Plus is a simple financial mechanism that allows an organization to monetize excess reserves from prior years and return them to its bottom line or dividend them to its owners. Under an LPT® Plus, IronHealth will assume 100% of the organization's future liabilities of those past years, relieving the organization from those liabilities; this allows the organization to "clean up" its balance sheet, and improve its financial strength and stability.
- No LPT Plus is too small or too large to be considered - IronHealth has considered LPTs ranging from a single claim to many hundreds of claims.
- IronHealth and Transferor agree on acceptable aggregate cap on overall transferred liability.
- Flexibility in determining claims to be transferred or retained - Transferor may opt to retain one or more claims because it is more efficient to run the claim(s) off itself than transfer to IronHealth.
- Flexibility in who handles the transferred claims, IronHealth or existing TPA.
- Non-binding indications available with current comprehensive loss runs and detailed description of limits/policy years to be included in LPT Plus.
Pharmaceutical & Medical Devices (Life Sciences Practice)
IronHealth Products Liability Insurance and Commercial General Liability Insurance policies are available for established and emerging companies in the Life Sciences industry including those involved in pharmaceutical, biotechnological and medical device manufacturing. We offer flexible options, which allow us to adapt to this fast-paced and rapidly changing field.
- Limits available up to $20M
- True follow-form excess policy with drop down coverage enhancements
- Coverage available for human clinical trials
- True worldwide coverage
- Professional errors and omissions coverage for staff sales personnel and medical professionals
Provider Excess Insurance
Ironshore’s Provider Excess Insurance (PEI) product responds to the ongoing evolution in the healthcare sector as healthcare providers and Health Maintenance Organizations assume additional financial risk in connection with the cost of care for members. In addition, the healthcare reform environment has resulted in the creation of new types of managed care organizations and healthcare financing initiatives, including Accountable Care Organizations (ACOs), Consumer Operated and Oriented Plans (Co-Ops), Bundled Payments for Care Improvement (BPCI) and other demonstration programs sponsored by the Centers for Medicare and Medicaid Services (CMS).
- Commercial, Medicare and Medicaid membership classes
- Special expertise in start-up and emerging risks
- Access to IronHealth’s IronCARES program
Health Maintenance Organizations (HMOs) are assuming more and more financial risk in connection with the cost of care for their members. In addition, new types of managed care organizations are emerging. Standard HMO reinsurance products are often very complicated and unpredicatable and can present significant gaps in coverage. IronHealth has responded by developing an HMO Reinsurance product that is both simple and enormously effective.
- Insured is offered a menu of services from which to select to be included for coverage
- Special expertise in start-up HMOs
- Alternative risk transfer financing options including experience refunds, retained corridors, inner aggregates, and aggregating specific deductibles
- Access to IronHealth’s IronCARES program
IronCARES, a risk management program designed to complement its Provider Excess of Loss and HMO Reinsurance solutions, offers a flexible, yet disciplined approach that helps clients achieve optimal financial and clinical outcomes related to the management of catastrophic or specialty healthcare claims.
Through this multifaceted program, the IronHealth team, backed by a panel of Registered Nurses and physicians coordinated by CPR Risk Management, will respond to the needs of each client and provide expert support as preferred and designed in conjunction with the client. Our program is guided by five key attributes developed by surveying our clients and brokers to identify the most important elements of a successful risk management program.
Employer Stop Loss
Health Reform has had a significant impact not just on health care organizations but on all employers that offer health benefit programs. Many such employers self-fund these programs and many more are contemplating self-funding. However, with self-funding comes an increase in financial risk for these employers.
Excess Risk Reinsurance (ERR) is an Employer Stop Loss specialty company acquired by IronHealth in 2012. ERR is committed to excellence and works with self-funded employers to help reduce this increase in financial risk for self-funded employers by offering Specific Excess Loss coverage as well as Aggregating Excess Loss coverage.
BLISCare Complication Insurance Protection
BLIS, Inc. has created a new, one-of-a-kind product, ‘BLISCare’ surgical complication protection insurance, which is now is available exclusively to those surgeons who meet BLIS underwriting standards. Once approved, theBLIS surgeon is uniquely positioned in their market to provide their patients and/or payers with protection from complication-related medical bills. The BLIS surgeon is able to utilize the BLISCare insurance program to provide a range of complication protection options for their patients. This unique approach creates a solution that is well positioned in a healthcare market that is quickly evolving into an outcomes based environment.
- Customized coverage.
- Per Procedure paid limits up to $250,000
- Protection time periods up to 60 months
- First dollar paid claims
- No patient financial responsibility
- No co-pays or deductibles to patient
- Costs resulting from complication event during policy period are covered to 1 year after expiration of coverage period
- Blis. Inc. serves as Managing General Agent for BLISCare program
- BlisCare is underwritten by ISIC.
Healthcare Regulatory Liability Errors and Omissions
Ironshore’s Healthcare Regulatory Liability Errors and Omissions product offers coverage to mitigate the serious exposure presented by regulatory actions, investigations and audits involving the False Claims Act (including qui tam suits), Stark Law and Anti-kickback allegations, and voluntary disclosure of billing errors to the government or commercial payors.
- Limits up to $10M on a primary or excess basis
- Minimum Retention of $500,000
- Co-Insurance Required (10-25%)
- Optional retroactive coverage for up to 3 years
- Coverage includes: defense and investigative costs, civil fines and penalties including multiplied damages component
- Regulatory Risk Mitigation Consultation Services
- Non-admitted product, available in all 50 states
Representations and Warranties Insurance
During merger and acquisition negotiations, the buyer and seller often negotiate the scope and nature of therepresentations and warranties provided by the seller in the purchase and sale agreement. Contentious negotiations may result in deal delays or may entirely derail a transaction. Transferring risk to a third-party bridges the gap and allows parties to close deals with comfort and confidence. Representations and Warranties Insurance can protect the buyers and sellers involved in mergers and acquisitions from loss if inaccuracies in representations and warranties are made.
Healthcare is the most active M&A sector, comprising nearly 20% of all deals. However, until recently, Representations and Warranties Insurance has been largely unavailable in this space. Ironshore with its dedicated global team ofM&A experts, and its innovative and responsive healthcare product suite, can offer tailored coverage for M&A transactions in the healthcare field
- Customized coverage for transactions with values from $50 million to $1 billion
- Up to $50 million in coverage is available with additional capacity provided on a case-by-case basis
- Policies are non-cancellable; ensuring coverage remains intact for the duration of potential liabilities
- Policy periods can either match or extend beyond the survival period in the purchase agreement
- Robust coverage for all representations via two separate insuring agreements: A) All non-healthcare representations and B) Healthcare regulatory representations
- Healthcare regulatory representations premium is typically 2% of the amount of insurance purchased, and all non-healthcare representations premium range is typically 2.5% to 4% of the amount of insurance purchased
- Retentions for each insuring agreement are typically between 1% to 3% of the transaction value, subject to diligence with cross-erosion available
Medicare Readmissions Reduction Insurance
Underwritten by Ironshore and available exclusively through Marsh, our new MRR policy provides coverage to mitigate a hospital's risk of a potential reduction in Medicare reimbursements. The MRR Policy provides limits of up to 3% of annual inpatient Medicare revenue subject to HRRP.
In addition to the coverage, the policy also provides for one hour of complimentary risk mitigation consultation with CSK Healthcare Consulting LLC, plus access to additional services at discounted rates. These services can help hospitals better understand the financial impact of CMS readmission penalties, evaluate factors that can contribute to penalties, and gain insight into potential reduction strategies.
- Coverage for profit and nonprofit acute care hospitals operating in the US that are subject to CMS' HRRP requirements
- Limits of up to 3% of qualifying annual HRRP inpatient fiscal year Medicare revenue
- One hour of complimentary risk mitigation consultative services with CSK Healthcare Consulting LLC.
- No claim premium credit to be applied against any renewal policy purchased
MMSEA Exposure Solutions
A first of its kind policy providing protection from the complex requirements of MMSEA (The Medicare, Medicaid and SCHIP Extension Act) Section 111 and MSPA reporting and compliance. This customized product addresses the risk and penalties from failing to file, or negligent filing, as well as providing coverage for Medicare billing errors and certain other expenses incurred in connection with an insured's obligations under the MMSEA and MSPA.
- Liability for third-party bodily injury caused by a reporting error under Section 111
- Civil fines and penalties for failure to file, or improper filing, of reports under Section 111
- Medicare Secondary Payer Act liability
- Other policy features including coverage offered on a claims-made basis, broad definition of "insured" including Named Insured, Employees, Volunteers, Members of Board of Directors, Board of Trustees or Committee Members, defense expense included within limit of liability, primary policy limits of $1M per claim/$3M aggregate higher primary limits (up to $5M per claim and in the aggregate) are available.
Medicare Set-Aside Liability Insurance
Medicare Set-Aside Arrangements (MSAs) are often a significant cost driver in the settlement of Workers’ Compensation claims. There is no requirement that the Centers for Medicare and Medicaid Services (CMS) approve MSAs, but many Workers’ Compensation carriers and self insured employers do not want to take the risk that CMS might come back at some future time and allege that an MSA put in place without its approval was not sufficiently funded. So, in addition to satisfying state-specific requirements, these carriers and self-insured employers choose to submit MSA proposals to CMS for review and approval, which typically increases both the time required and costs involved.
IronHealth has developed a first-of-its kind Medicare Set-Aside Liability Insurance policy that allows the carrier or employer to bypass the voluntary review process by addressing the concern that CMS may question the adequacy of the MSA amount at a later date.
- Coverage is available for either an individual MSA or for all MSAs a Workers’ Compensation carrier or self-insured employer enters into in an annual period
- Occurrence coverage incepting the date of the Workers’ Compensation settlement
- Coverage includes defense of the adequacy of the MSA amount as well as indemnity coverage and a sublimit for medical expenses incurred during the dispute process.
The combination of unrelenting financial pressure and healthcare reform has spurred tremendous change in the way healthcare providers and payors are organizing themselves in order to effectively deliver and finance care. Hospitals and physicians are increasingly coming together in one form or another. Formerly independent communityhospitals are creating alliances, and larger hospitals are acquiring smaller ones, or merging with other like-size systems. Through all of this change, healthcare providers are taking on more financial risk as they move from"fee-for-service" to "fee-for-performance" reimbursement methodologies. The integration of the healthcare delivery model and the resulting coordination of services is blurring the traditional boundaries between and amongthose who provide and those who administer care. IronHealth understands that integrated delivery means integratedrisk and is in a unique position to address these emerging risks, with unparalleled product offerings and expertisein virtually all areas of healthcare liability, employer and provider stop loss and HMO reinsurance.
The experience with Ironshore claims was great, efficient and responsive, anything I asked for I received an answer to. Overall it was a pleasure working with Ironshore.