• How will the self-insurance trust save my organization money?

• Is there a sponsoring group or association?  Who are the Trustees?

• What are the qualifications for participating in the Trust?

• May I speak with participants in the Trust?

• How long has the Trust been in existence?  Is this a start-up program or does it have a long operating history?

• How is the contribution determined?

• Is the Trust flexible with alternative rating plans?  Do these plans adversely affect the strength of the Trust?

• Who is the Program Administrator?  Does this organization have experience in New York?

• What safeguards are in place to protect the Trust and my agency?  Does the Trust purchase excess insurance?

• How are medical claims handled?  What safeguards are in place to assure that a claim doesn't cost more than is necessary?

• What loss control services are provided?  Are there any additional costs for individualized attention by risk management experts?

• If a claim is suspected to be fraudulent, what can the Trust do?  Can providers help control costs by ensuring that only legitimate claims are paid?

• Do I really need workers' compensation coverage?  What if we only work with subcontractors?

• If I maintain workers' compensation coverage, why do I also need disability coverage?

• If you want to leave the Trust, what do you need to know?

How will the self-insurance trust save my organization money?
As a membership benefit program of the New York State Association of Health Care Providers, Inc. (NYSAHCP), the Health Care Providers Self-Insurance Trust is specifically designed for the members NYSAHCP serves -- home-care and community-based providers. The Trust uses data specific to home care to determine appropriate rates just for this industry and to assist participants with loss control and risk management based on claims statistics generated from our program. With data specific to your industry, loss control and claims management become specialized. This can lead to lower experience modification factors which will reduce your cost of coverage.

Go to the New York State Association of Health Care Providers, Inc. website or call 1-518-463-1118 for information on how to become an NYSAHCP member.
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Is there a sponsoring group or association?  Who are the Trustees?
NYSAHCP is the sponsoring organization of the Trust. NYSAHCP is a statewide trade association representing home-care and community-based providers through advocacy, information, and education. Offered as a membership benefit program, the Trust was developed exclusively for NYSAHCP members. Currently NYSAHCP represents approximately 600 offices of Licensed Home Care Services Agencies, Certified Home Health Agencies, Long Term Home Health Care Programs, Hospices, and related health organizations throughout New York State. The Board of Trustees for the Trust are all NYSAHCP members and are home-care and community-based providers.
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What are the qualifications for participating in the Trust?
To qualify for the Trust, participants must:

• Be a member in good standing of the New York State Association of Health Care Providers, Inc.
• Have been in business for at least three years.
• Have the financial strength to meet the minimum standards of the Trust.

• Have loss experience for the previous four years within the range established by the Board of Trustees with input from consulting actuaries.

May I speak with participants in the Trust?
Please speak with any of the participants in the Trust program. All members of the Board of Trustees are open to talking to any provider who may be considering the Trust. Hear from them firsthand about the savings they receive through the program.

Please see the HCP SIT Trustees List for a list of Trustees' names and telephone numbers.
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How long has the Trust been in existence?  Is this a start-up program or does it have a long operating history?
The Trust has been in existence since 1993 and has a solid operating history and strong database of experience from which to draw. Participants have saved $30 million since inception. The Trust has established adequate cash flow for paying claims and covering costs.
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How is the contribution determined?
Contributions are calculated using a traditional rating method. Rates are multiplied per $100 of remuneration and, if eligible, the experience modification factor is applied.
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Is the Trust flexible with alternative rating plans?  Do these plans adversely affect the strength of the Trust?
The Trust can be extremely flexible in accommodating provider needs for the lowest possible costs. Providers could be eligible for a retention plan. Eligibility for a retention plan is subject to an organization's contribution (premium) size, rate classification and Experience Modification.
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Who is the Program Administrator?  Does this organization have experience in New York?
The Program Administrator for the Trust is Program Risk Management, Inc. (PRM), an experienced company specializing in self-insurance programs in New York State.

Find out more About PRM.
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What safeguards are in place to protect the Trust and my agency?  Does the Trust purchase excess insurance?
By law, the Trust is required to purchase excess insurance. Claims are covered above the Self-Insured Retention level, up to the Statutory Limits of the Workers' Compensation Law.
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How are medical claims handled?  What safeguards are in place to assure that a claim doesn't cost more than is necessary?
The Trust is known for processing claims quickly, thoroughly, and inexpensively. We offer fast, easy online reporting via our WebClaim application and the Online C-2 Reporting Form. After registering for WebClaim, participants can enter their new claim information in a few simple steps, submit the claim, and receive a copy of the C-2 via e-mail in less than half the time paper reporting methods take.

The Trust also utilizes nurse care management on claims with more complicated medical issues. This can facilitate a prompt return to work. Claims are processed efficiently, injured employees are encouraged to see physicians quickly, and the Trust works with participants to ensure employees receive proper treatment which will enable them to return to work as soon as possible.

In New York State, workers' compensation medical costs must be billed by physicians according to a statutory fee schedule. The Trust audits medical bills to ensure that no overpayments are made and that cases are settled correctly and fairly. The Trust also works to get injured employees back to work quickly once they've fully recovered or have become well enough to work in a modified position.
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What loss control services are provided?  Are there any additional costs for individualized attention by risk management experts?
The Trust employs extensive loss control and risk management services. Experienced professionals work with each participant to design and implement proactive loss control programs for individual agencies. These experts work one-on-one with providers in their offices, and with their staffs, to thoroughly explain methods for reducing losses, to demonstrate risk management skills, and to teach claims management techniques. In addition, each year the Trust holds safety training seminars to educate participants.
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If a claim is suspected to be fraudulent, what can the Trust do?  Can providers help control costs by ensuring that only legitimate claims are paid?
Once participants join the Trust, they become actively involved in the claim process. Each month participants can access their loss reports online via WebReports. Participants are provided with written updates and status reports on any claim reserved at $25,000 or more. Participants are notified of Workers' Compensation Board hearings and are encouraged to send someone from the organization to attend. If participants suspect fraudulent claims, when economically feasible the Trust will investigate to the extent required in order to determine legitimacy. The Trust covers any costs incurred for surveillance or investigative activities and, by proactively combating fraud, saves money for individual agencies and for the entire Trust.
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Do I really need workers' compensation coverage?  What if we only work with subcontractors?
If your organization utilizes the services of individuals you consider "sub-contractors," the New York State Workers' Compensation Board will require evidence that they are protected by workers' compensation coverage to the same degree that your employees are protected. Therefore, when working with these individuals, you should obtain proof of workers' compensation coverage from them. If they are injured while working for you and are unable to provide evidence of coverage through another source, they may file a claim for workers' compensation benefits under your coverage. Unless proof of coverage is provided at the time of your payroll audit, the cost of covering these individuals will be chargeable to your organization.
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If I maintain workers' compensation coverage, why do I also need disability coverage?
Like workers' compensation, Short-Term Disability coverage is required by New York State law for all employees and any sub-contractors unable to provide evidence of coverage elsewhere. There is a distinct difference in the benefits paid under each type of coverage. Workers' compensation pays a portion of lost wages and all medical bills associated with a work-related injury. Disability coverage pays only lost wages resulting from a disabling injury or illness that is not work-related.
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If you want to leave the Trust, what do you need to know?
All participants in the Trust are jointly and severally liable for all assessments during the period in which they are a participant. Participants may choose to leave the plan at any time; however, they will be held responsible for any assessments for the period in which they were a participant until the Workers' Compensation Board releases that year or years.
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