Just as each MCO and related entity has a unique risk profile, standard coverages and appetites vary between insurance carriers. Most coverage for this industry is excess & surplus lines (E&S) and not admitted, with offshore markets providing limited capacity. As an MCO, your organization has several vulnerabilities that require a tailored risk management approach, but not every insurance solution will address your specific risk profile and tolerance. Navigating through complex coverage options requires specialized expertise to align insurance solutions and strategies with your specific needs and objectives.

As the leading specialty insurance broker in the managed care industry, Alliant begins with a thorough review of your unique risks and exposures and compares them to available commercial coverage, with consideration of endorsements and different program structures. We investigate non-traditional approaches including captives and alternative risk transfer to achieve the most effective and efficient risk program possible.

To provide MCOs and related entities with the necessary guidance to build an effective risk program, your insurance broker must have a detailed understanding of the managed care industry and the unique operations of the different entities.

For example, many managed care entities have complicated legal structures. Managed care errors and omissions (E&O) policies do not provide blanket named insured coverage. This can expose your organization to substantial risks, including vertical and horizontal business structure risk as well as financial losses, regulatory violations or risk of bodily harm related to vendors and non-owned/controlled risk from joint ventures. This coverage issue is often coupled with exclusionary language in policies that further limit recovery, such as the insured versus insured clauses found in most policies. This is why it is critical to work with an experienced, industry specialized insurance brokerage like Alliant.

Alliant is well positioned to support your organization through today’s greatest threats by drawing from our interdisciplinary team of insurance specialists and risk advisors. For instance, cyber attacks pose significant risks to MCOs and related entities, with many foreign, federal and state legislative enactments and regulations that make the managed care industry susceptible to first and third-party exposure. Our team of cyber specialists with security, control and brokerage expertise can support your MCO in developing a holistic risk management program that meets your entity’s cyber risk and transference objectives.

Managed care policies (especially E&O, D&O and cyber) must include coverage with endorsements customized to the risks and exposures of the managed care industry and each entity. For E&O policies, this includes coverage for antitrust, regulatory and class action claims. Insurance policies for managed care can also include the following:

• 100% defense cost allocation
• Coverage for multiplied or punitive damages
• Derivative liability
• Coverage for lawyers, agents, licensed medical personnel and foreign exposures
• Coverage for corporate negligence claims related to non-core revenue streams

Given every entity is different, what coverage is required, and what coverage can be achieved via commercial carriers, requires significant market knowledge and relationships with A-rated insurers. As an industry leader with a robust network comprised of the leading insurance carriers, Alliant has every advantage to negotiate the best coverage terms and secure favorable rates.

Alliant reviews all contracts and master service agreements (MSAs) as they relate to insurance obligations, limitation of liability and indemnity obligations to help avoid compliance and contract disputes between our clients and their vendors. This additionally ensures that the contract clauses do not limit or eliminate coverage for the client. Understanding any potential issues puts you in a better position to manage the risk and finance for it. Having an industry specialized team like Alliant with decades of combined experience in healthcare and managed care provides the backbone for this service.

Alliant is also well-versed in M&A due diligence. In today’s healthcare industry, M&A activity is a business strategy of significance. Whether your entity is the acquiring entity, the divesting entity or one of a group involved in startups, joint ventures or PC model practice management, having a specialty insurance broker with a large M&A team with significant healthcare experience is critical. Alliant can assist you in evaluating the risk and solutions to finance the risk of an acquisition, a divestiture or the creation of a startup.

Alliant has decades of experience working with MCOs and related entities in determining whether a captive is feasible and cost effective. We support clients in establishing goals and strategies, forming captives and leveraging these risk financing vehicles for success. We have formed many captives in the managed care space and have worked hand in hand with our clients on the use of their captives, including:

• Compliance
• Risk financing
• Revenue
• Risk-based capital
• Tax benefits
• Stop loss

We additionally provide guidance on the following:

• Capital needs
• Actuarial services
• Analytics
• Coverage
• Policy creation
• Internal and external program building around a captive
• Claims advocacy
• Reinsurance
• Fronting

Alliant has multiple dedicated groups that address specific challenges related to captive insurance.