New York’s Changing M alpractice I nsurance Marketplace

1. New York’s Changing Malpractice Insurance Marketplace Presented by Gabrielle Lamb, Vice President of Business Development at PriMed Consulting

2. Standard Market • MLMIC • PRI • MMIP • HIC • Academic

3. MLMIC • Medical Liability Mutual Insurance Company (MLMIC): MLMIC is the oldest and largest carrier in the State. MLMIC is an admitted carrier, hence physicians insured through MLMIC have the State Guaranty Fund to protect them in case of insolvency of the carrier. In addition, MLMIC insured physicians may be eligible for the Section 18 Excess Insurance program for $1/3 Million in coverage that is provided at no cost to physicians.

4. PRI Physicians Reciprocal Insurers is the 2nd largest medical malpractice insurance carrier in the state of New York. Like MLMIC, they offer the security of the guarantee fund and free excess to those who qualify

5. HIC • Hospitals Insurance Company, Inc. has a long standing relationship with the FOJP hospitals and will provide their attendings with coverage.

6. Standard Market Carriers • Pros • Free excess coverage • Guarantee fund protection • Cons • Slot rating • No flexibility on premiums/discounts

7. RRG What is a Risk Retention Group? A Risk Retention Group (RRG) operates under the auspices of the Federal Risk Retention Act (RRA) of 1986. Please keep in mind that the coverage being offered is through a risk retention group, which is not subject to all of the insurance laws and regulations of your state and as such is considered an un-admitted carrier.

8. Pros & Cons Pros • Significant savings for groups and hospitals • Hands on and customized risk management solutions • Aggressive claims handling

9. Pros & Cons Cons • No guarantee fund ★ Financial Stability is key • Excess limits must be purchased • Hospital acceptance

10. Carriers • MedPro RRG • AMS • Oceanus • Doctors & Surgeons • Care • Fairway

11. AMS Applied Medico-Legal Solutions: Since 2003, AMS RRG has been providing medical liability insurance to a growing number of physicians across a broad range of specialties, and today we are one of the nation’s premier physician risk retention groups. Our stable, flexible, cost-effective medical liability insurance options now protect over 2,500 members. The risk retention group model ensures our physician-owner interests are aligned with the company’s AMS RRG’s continued financial strength rewards shareholders with tangible benefits Our physician-led underwriting process delivers more accurate risk assessments and customized insurance programs All member claims assistance and defense is provided by a staff of attorney adjusters

12. MedPro RRG • Jonathan Lazar MBA, CPCU Marketing Manager • Overview of the Medical Protective RRG

13. MedPro

14. Medical Protective • Reinsurer of MedPro RRG • The nation’s oldest and strongest healthcare in malpractice • Currently insures more than 120,000 healthcare providers nationwide • Rated A++ (Superior) by A.M. Best • Owned by Berkshire Hathaway • www.MedPro.com

15. Princeton Insurance (NJ) • Service provider to MedPro RRG NY hospitals and physicians • Rated A++ (Superior) by A.M. Best • Owned by Berkshire/Medical Protective • Previously owned by MLMIC • 9,000+ physicians, 29 hospitals/health systems • Known for personalized customer service and customized risk programs

16. MedPro RRG Risk Retention Group • Rated A++ (Superior) by A.M. Best • No capitalization costs • No possibility of premium assessments • Full consent-to-settle provisions • Expert local defense counsel specializing in New York healthcare malpractice claims

17. Benefits of this approach • The right structure for New York, allowing risk-specific pricing and tailored coverage alternatives • The national expertise of Medical Protective, backed by Berkshire Hathaway’s unparalleled financial strength • The local support of Princeton Insurance, with past New York affiliation and knowledge of medical professional liability in our founding “DNA”

18. Claims Over 400,000 claims resolved Supplementing local defense lawyers with national reach and expertise for experts and other resources Past decade: 1. 90% trial win rate 2. 80% closed without payment 3. 99% overall customer satisfaction

19. Underwriting . •First Dollar Coverage • Excess Coverage • Deductibles and Self-Insured Retentions (SIRs) • Reinsurance • Performance-Based Risk Sharing • Loss Portfolio Transfers (LPTs) • Employed Physician Programs

20. Risk Management • Risk management philosophy: To recognize hospitals and health systems as their own first and best risk manager and to come alongside them as a seasoned expert, a resource and trusted partner in order to improve patient outcomes and reduce loss. • MedPro offers a data-driven, collaborative risk management services

21. Why PriMed • PriMed is an independent medical malpractice insurance agency. We work with all NY carriers and help our clients to find the best fit for their needs; along with those of their group and hospital.

22. Summary • Market is changing to meet the needs of the changing healthcare industry. • More options than in the past

23. Q&A • Questions???

24. Thank you NYSAMSS! Gabrielle Lamb PriMed Consulting www.primedconsulting.com