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California Health Maintenance Organization Insurance Policy Information

CA Health Maintenance Organization Insurance

California Health Maintenance Organization Insurance. Health Maintenance Organizations - shortened to HMOs - are a type of health insurance provider using a unique business model. These health insurers partner with a network of physicians.

Subsequently, clients who opt to insure themselves through the Health Maintenance Organization may access covered medical care through this network. This model benefits physicians, as the HMO ensures an influx of patients. It also has marked advantages for patients, who obtain less costly health insurance.

Health maintenance organizations (HMOs) act as both a medical insurance carrier and as the coordinator of health services for its members, who pay a monthly fee to receive all the medical services needed at a reduced cost or co-payment to them.

The HMO contracts with doctors, hospitals, and other health care professionals to serve members 24 hours a day, seven days per week. Members may be required to select a primary care physician (PCP). Except for medical emergencies, this PCP determines the member's need for hospitalization or referrals for specialized services such as diagnostic tests or physical therapy.

Preventive care services are often offered free or at a reduced charge. The HMO is generally limited to a particular geographical area but may have reciprocal agreements with HMOs in different areas to provide service to customers outside their primary service location.

HMOs are regulated at both CA state and federal levels.

HMOs unquestionably provide an important service. While these insurance providers will do everything they can to run a smooth operation, however, they are subject to a range of risks, just like any other business.

Therefore, HMOs require excellent insurance coverage as well. What types of California health maintenance organization insurance coverage are crucial? Discover more in this brief guide.

California health maintenance organization insurance protects your HMO insurance and health services business from lawsuits with rates as low as $77/mo. Get a fast quote and your certificate of insurance now.

Why Do CA Health Maintenance Organizations Need Insurance?

As health insurance providers, HMOs will understand the fact that disaster can strike unexpectedly better than most businesses. Health Maintenance Organizations are vulnerable to some of the same risks as any other commercial venture, as well as facing hazards unique to this particular industry.

The office space of a CA Health Maintenance Organization may be impacted by large-scale acts of nature, such as earthquakes, hurricanes, or wildfires - leading to severe damage to the building, as well as the loss of important smaller assets.

Theft, cyber theft, vandalism, and accidents represent other important threats, along with the sudden breakdown of essential equipment.

Employees, or third parties present on the premises, may be injured for accidental reasons or those related to negligence. HMOs will, likewise, have to consider the costs associated with claims of professional misconduct, which can be astronomical even if the lawsuit is ultimately dismissed.

Any of these perils, alongside numerous others, can lead to such devastating financial consequences that the HMO may not be able to recover - however, protected by excellent insurance coverage, you no longer have to worry about this.

In addition to the fact that you will legally be required to carry certain types of California health maintenance organization insurance, this explains, in short, why the right commercial insurance is important.

Some of the largest HMOs in the US include; Aetna, Anthem, Blue Cross Blue Shield, Cigna, Humana, Kaiser Foundation and UnitedHealthcare.

What Type Of Insurance Do California Health Maintenance Organizations Need?

Each Health Maintenance Organization will have unique insurance needs. The types of coverage that will best protect your business depend, after all, on factors such as the size of your company, the jurisdiction in which your business is based, your number of employees, and the value of your assets.

Because of this, it is crucial to discuss your individual risk profile with a skilled commercial insurance broker who understands your industry. However, among the key types of California health maintenance organization insurance are:

  • Commercial Property - Should your commercial premises be impacted by unforeseen circumstances that include vandalism, theft, and acts of nature, this form of coverage serves the purpose of protecting your HMO from the financial consequences. Your building and its contents are both covered, up to a predefined limit. Flood insurance should be purchased additionally, as that does not fall under most commercial property policies.
  • Commercial General Liability - In the event that your business faces a third party personal injury or property damage claim, this kind of California health maintenance organization insurance covers many of the legal costs that arise. Attorney fees, medical bills, repair expenses, and settlement payments are examples of the types of expenses covered.
  • Errors and omissions - Also called E&O insurance, this type of professional liability coverage protects a HMO in the event that a client or a clinic within their network files a lawsuit alleging professional negligence or misconduct. This form of coverage is essential to any insurance provider or company within the financial sector.
  • Workers Compensation - Assuming that you have employees, your business will also need to carry workers' comp insurance in most states. This important form of coverage takes care of the medical expenses of employees who have been injured in the workplace under circumstances for which the company could be held responsible. In addition, it covers any wages the injured employee loses to related work absences.

While HMOs are likely to have further insurance needs - in the forms of commercial auto and cyber security insurance, for instance - these types of coverage will offer a large degree of protection.

To find out what other California health maintenance organization insurance policies you may benefit from, direct your questions to a commercial insurance broker.

CA Health Maintenance Organization's Risks & Exposures

Premises liability exposure is very limited because most member and insurer contact is done over the phone, electronically or by mail. If clients visit the premises, they must be confined to designated areas to prevent them from observing other clients' confidential information or overhearing private conversations.

To prevent slips, trips, or falls, all areas accessible to customers should be well lighted with floor coverings in good condition. The number of exits must be sufficient and well marked, with backup lighting in case of power failure. Parking lots and sidewalks need to be in good repair with snow and ice removed, and generally level and free of exposure to slips and falls.

Personal injury liability exposures include allegations of assault, breach of confidentiality, discrimination, and invasion of privacy.

Professional liability exposures are increasing in some states. The HMO does not technically diagnose illnesses or prescribe treatment but relies on the judgment of participating doctors and other health care service providers.

However, an HMO can deny certain types of services based on cost, the likelihood of a successful outcome, or status of the treatment as experimental or in a clinical testing environment. An HMO may also restrict the amount of time a recuperating patient may spend in a hospital, resulting in allegations of forced early discharge and subsequent worsening of a health condition.

As a result, some states now permit members to sue HMOs directly for medical malpractice. The exposure increases if the HMO fails to conduct thorough background checks to verify employees' credentials and education, if non-professional workers are allowed to make decisions that only professionals should make, or if error checking procedures are ignored or are inadequate.

Workers compensation exposures are primarily those of an office. Since office work is done on computers, potential injuries include eyestrain, neck strain, carpal tunnel syndrome, and similar cumulative trauma injuries that can be addressed through ergonomically designed workstations.

There may also be off-premises travel, which can result in injuries from slips and falls, assaults, or vehicular or aviation accidents.

Property exposure is limited to an office. Extensive phone and computer networks are in place for the handling of claims. Ignition sources include adequacy of electric wiring, heating and air conditioning systems, wear and overheating of equipment. Smoking must be prohibited.

There may be storage of client or medical staff information in paper form, although these are now often digital instead of paper format. Paper should be stored in fireproof cabinets.

Fire suppression systems can result in damage to computers and electronic systems. Computers and other electronic equipment may be targets for theft.

Inland marine exposures are from accounts receivable for credit payments, computers, and valuable papers and records for members' and carriers' information. Power failure and power surges are potentially severe hazards.

Backups of all records must be made regularly and stored off-site. Due to the confidentiality of medical records, adequate security features should be taken to prevent unauthorized access to paper or computerized information.

Crime exposure is from employee dishonesty, computer fraud, and forgery. Employees have access to members' personal medical information. Potential for theft, directly or through identity theft, is great. Background checks should be conducted on all employees.

Hazards increase without monitoring procedures and securing all records to prevent unauthorized access. There must be a separation of duties between persons handling deposits and disbursements and reconciling bank statements.

All activities must be carefully monitored with internal audit systems and checks and balances in place.

Business auto exposure is generally limited to hired and non-owned. If the company supplies vehicles to employees for sales or other types of calls, there should be written procedures in place regarding personal use by employees and their family members.

All drivers must have appropriate licenses and acceptable MVRs. Vehicles must be maintained and records kept in a central location.

California Health Maintenance Organization Insurance - The Bottom Line

To learn more about the exact types of California health maintenance organization insurance policies needed, what coverage limits you should carry and the associated premiums - consult with a reputable broker that is experienced in commercial insurance.

California Economic Data, Regulations & Limits On Commercial Insurance

If you are an entrepreneur and you considering having your operations located in California, it's essential that you have a full understanding about the economy of the state, as well as the regulations and limits that are in place for commercial insurance.

Made In California

If you are considering opening up a business in the Golden State, you first want to make sure that it is a sound location for your operations. That means that you should understand some key information related to the state's economy, as well as the types of insurance coverages that businesses are legally required to carry.

Economic Trends For Businesses In California

In terms of job creation, the state of California exceeds rate of job growth in the United States; however, as the state's metropolitan areas are reaching employment capacity, job growth is starting to slow. In 2017, the rate of growth was 2.1 percent, which is the slowest rate of growth since 2011; but it is still expected to increase by 1.8 percent by the end of 2018, and 1.2 percent by the end of 2022.

In the month of April, the unemployment rate in California dropped to 4.2 percent, which is a record low. This unemployment rate is expected to remain consistent for the rest of the calendar year; however, it's forecasted that the rate will start to increase in 2022.

The strongest labor market in the state is in the Bay Area, where the unemployment rate was 3.4 percent in 2017. Southern California follows, with an unemployment rate of 4.5 percent in 2017. In the Central Coast region, the rate was 5.4 percent and in the Central Valley, it was 6.6 percent. While the unemployment rate is considered high in these areas, they have decreased dramatically over the last 12 month period.

The industries that are expected to see the most growth in CA include:

  • Agriculture
  • Construction
  • Healthcare
  • Hospitality
  • Information Technology
CA Commercial Insurance Regulations And Limits

The California Department of Insurance regulates insurance in the Golden State. In the state of CA, commercial liability insurance is not required; however, since the state does not cap rewards for liability law suits, business owners are wise to invest in this type of coverage. The amount of coverage recommended varies depending on the size of the business and in the industry.

Workers' compensation insurance is the only type of coverage that business owners are required to have. This applies to any organization that employs a salaried or hourly staff, even if that staff only consists of one employee. Furthermore, if an employee is injured or becomes ill as a result of work, business owners must pay for CA workers' comp benefits.

Additional Resources For Medical Insurance

Discover small business insurance for medical and dental professionals. Medical malpractice insurance is a type of professional liability that protects health care professionals from liability causing in bodily injury, medical expenses and property damage.


Medical And Dental Insurance

Health care providers are the most trusted individuals in our society. Ironically, they are the same ones who can do the greatest harm. They actually have the right to invade our bodies with knives and to poison us with chemicals - all in the name of health care and with the goal of relieving our symptoms and hopefully bringing about a cure.

While the actions of these professionals normally benefit us, insurance coverage must be available for the times when mistakes happen and things go wrong. These professionals and their facilities have extensive property exposures that are becoming more and more intricate and whose values are increasing exponentially.

The 'one size fits all' approach that once could have applied to insurance for health care providers and their facilities no longer applies.

Professional liability offers protection against claims of malpractice for all sums that the medical professional becomes legally obligated to pay as damages because of rendering or failing to render professional services.

Professional and medical malpractice exposures are the most expensive and difficult of all exposures for health care providers. The commercial general liability policy excludes these exposures so separate coverage is needed. Most professional liability policies are written on a claims-made basis and, as a result, tail coverage and retroactive dates are important coverage issues to be aware of when evaluating the insured’s coverage needs and comparing coverages.

The coverage provided is often called medical malpractice. For decades, many involved in the health care field and insurance companies that provide insurance coverage to providers have stated that malpractice lawsuits have created an ongoing crisis of restricting insurance availability, due to loss of insurance companies that write the coverage and significant rate increases.

As a result, state legislatures have taken the following actions to address the situation:

Imposed a dollar limitation of liability for malpractice suits.

Modified statutes of limitation to limit the number of years that a suit may be brought against a physician following a negligent act.

Modified when the statute of limitations takes effect. An example is beginning from a negligent act's occurrence rather than from its discovery.

Passed laws to modify tort law procedures and doctrines that relate to malpractice.

Because of differences in law by state it is important to know the states in which the covered health care providers are licensed and regularly practice. Some health care providers may practice in multiple states because of their particular specialty, their reputation or the demand for their services. Some hospitals may have ownership in facilities or provide services to patients that are outside of their main location state.

Minimum recommended small business insurance coverage: Business Personal Property, Business Income and Extra Expense, Employee Dishonesty, Money and Securities, Accounts Receivable, Computers, Physicians and Surgeons Floater, Valuable Papers and Records, General Liability, Employee Benefits, Professional, Umbrella, Hired and Non-owned Auto & Workers Compensation.

Other commercial insurance policies to consider: Building, Earthquake, Equipment Breakdown, Flood, Leasehold Interest, Real Property Legal Liability, Computer Fraud, Forgery, Cyber Liability, Employment-related Practices, Business Automobile Liability and Physical Damage and Stop Gap Liability.


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