Joint Underwriting Associations (JUAs) are state-sponsored insurance mechanisms for physicians who do not have access to other sources of professional liability insurance. They are normally highly regulated and are backed by licensed property and casualty carriers operating in the state.

Syndicates – A less common alternative is a "syndicate." This is not an insurance company, but a group of individuals who agree to share liability and profits in making contracts of insurance. Syndicates tend to specialize in unique and/or high value coverages. The best known is Lloyd's of London which is an association of syndicates.

Risk Retention Groups - The federal Risk Retention Act of 1986 permits the formation of Risk Retention Groups. These must follow the insurance laws of at least one state. There have been Risk Retention Group insolvencies but they can be a viable insurance alternative if they are adequately capitalized and are charging proper premiums. Those considering joining an RRG should review the annual financial statement groups are required to file with all states in which it operates. You should carefully investigate all aspects of the policy, rules regarding accessibility, tail coverage requirements, and the financial solvency of the organization.

Risk Purchasing Groups – An association of insurance buyers with a common identity (e.g., a medical specialty society) who form an organization to purchase liability insurance on a group basis from an insurance company. No capital contributions are required in order to join but you should carefully investigate the strength of the insurance company that provides coverage to the group. You should carefully investigate all aspects of the policy, rules regarding accessibility, tail coverage requirements, and the financial solvency of the organization.

Trusts - Trusts are not insurance companies and are not regulated by state insurance departments, nor are they protected by state guarantee funds in the event of insolvency. To "join" a trust you will normally be required to contribute a certain amount of capital. In addition, members are retroactively assessable if assets prove insufficient to pay losses. You should carefully investigate all aspects of the policy, rules regarding accessibility, tail coverage requirements, and the financial solvency of the organization.