Insurance Marketplace Realities 2025 Spring Update – Managed Care E&O and D&O

Rate predictions: Managed Care E&O and D&O

	Trend	Range
Overall	No trend	Market rate conditions are easing but underwriting information, including exposure increases may drive premium increases
Public MCOs		E&O: Up to +5% D&O: Up to -5%
Blue plans		E&O: Up to +5% D&O: Up to +10%
Hybrid entities		E&O: Up to +10% D&O: Up to +10%
All other MCOs		E&O: Flat to +5% D&O: Up to +10%
Private company, others lines of business		E&O: Flat to +5% Fiduciary: Flat to +5% Crime: Flat to +5%
Cyber liability		MCOs with good cybersecurity controls and no adverse loss activity: 0% to +5% For less than optimal risks: Up to +15%

Key takeaway

E&O and D&O carriers continue to offer flat to minimal rate increases. Risks that attract limited primary markets, such as TPAs and PBMs, continue to see higher pricing and coverage restrictions. Systemic risks, unforeseen litigation, bodily injury claim values, behavioral health claims and regulatory risk are a concern for carriers and coverage restrictions continue to be applied especially for larger, complex organizations. Economic realities and federal and state health policy changes add additional pressure as well as climate, ESG, inflation and political considerations. Organizations that present as very good risks from an underwriting perspective receive better rates though terms and conditions are similar. 

Cyber liability pricing is still stable, but several notable cyber insurers are beginning to hold the line on flat and are no longer offering decreases for primary renewals. Cyber underwriters remain technically focused on ransomware controls and cybersecurity resilience and the Change Healthcare cyber event may impact future renewals.

Restrictions related to significant risk continue

• Some markets increase retentions, may apply coinsurance and sub-limit coverage related to antitrust and regulatory risk. We’re keeping an eye on regulatory retentions based on political and regulatory uncertainty at the federal and state level which is adding further complexity to the marketplace in this area.
• Related claim language has narrowed significantly as is manuscript exclusionary language applied to prior industry claims.
• Association and cyber exclusions continue to be applied.
• Rebate, opioid and other exclusions are being added to PBM policies.
• Coverage for Pharmacy Benefit Managers, those engaged in value-based contracting from the provider side, revenue cycle management, medical services management and other hybrid risks especially those exposed to bodily injury claims remain difficult to place due to limited capacity and restrictive terms and conditions.
• Some carriers require managed care E&O participation to write a D&O/management liability package, which creates anti-stacking coverage concerns, as well as issues related to rate and capacity in larger towers.
• Risk transfer programs must be managed and strategically planned across all lines of coverage to avoid gaps in coverage and limit restrictions.
• Reinsurance in this space continues to impact coverage and capacity.
• The use of captives and other alternative risk financing solutions has slowed as market conditions improve. Fronted programs can be negotiated as an alternative to captive programs.
• No new domestic Managed Care E&O carriers have entered the marketplace and no markets have exited.
• We haven’t seen any new offshore carriers enter this space.
• Non-core business diversification is driving risk and coverage limitations.

Download the full managed care E&O and D&O report below.

Disclaimer

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