General Liability
The foundation Hawaii hospitals, health systems and payers expect, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
Hawaii Home Care Insurance
For agencies already operating in Hawaii. If a hospital, health system or payer has handed you a contract demanding limits your current policy cannot reach, that is a solvable problem, and it does not have to wait for your renewal date.
If you already run a Hawaii home care agency
Here is the short answer. When a contract demands limits your policy cannot reach, the fix is general liability at the limit the contract names, professional liability sized to the care you deliver, an umbrella behind both, and certificates carrying the additional insured and waiver wording specified. We place that through exclusive carriers writing home care in Hawaii, mid-term when the contract will not wait.
Two Hawaii details are worth a look on an established program. Home care agency licensure is waived rather than absent, a live position that can be revisited, so an agency planning three years out should treat it that way. And a multi-island book is a different risk from a single-island one of the same size, because staff and clients are separated by water rather than road.
An agency running seventy-five to a hundred caregivers across Oahu, Maui, the Big Island or Kauai has a different problem from a startup, and this page is written for the former.
What Hawaii contracts require, and what happens when yours falls short
On liability the numbers come from your contracts, and they ask more than the law does.
What the contracts typically ask for
Hospitals, health systems and payers usually require general liability at $1 million per occurrence and $2 million aggregate. Professional liability is expected of agencies delivering skilled care. Workers compensation at statutory limits with employers liability behind it. Auto liability for agency vehicles and caregivers driving their own. Abuse and molestation coverage, increasingly named rather than assumed. And an umbrella, which agencies working with the larger Honolulu institutions often need.
Wording matters as much as the number. Contracts routinely ask for additional insured status, a waiver of subrogation, primary and non-contributory response, and notice of cancellation. Each is an endorsement rather than a line on a certificate.
Where a licence is waived the numbers matter more, not less, because what a hospital or payer can actually check is the certificate you send.
When the contract asks for more than you carry
The first route is endorsement. The incumbent carrier will sometimes raise a limit or add required wording mid-term for extra premium, the fastest path where available.
The second is an umbrella. Where a contract wants a total your primary layers cannot reach, excess limits over general liability, auto and employers liability get there quicker and cheaper than rebuilding the primary.
The third is re-marketing, where a carrier will not extend or the wording sits outside the form. That takes longer, which is the argument for sending contract language when it appears rather than the week it must be signed.
Certificates of insurance and the rest of the operating year
For a running agency the broker relationship is mostly certificates and mid-term changes, and both are where a placement quietly fails.
Certificates
A certificate is evidence, not coverage; it states only what a policy does. If a Honolulu health system requires additional insured status and your policy carries no such endorsement, no certificate can create it. The delay agencies feel there is an underwriter deciding, not paperwork.
So the habit that helps: when a new client, facility or payer sends paperwork, send us the requirements immediately. Certificates on file should carry over rather than be rebuilt each year.
What to report during the year
Adding and removing caregivers does not need a policy change each time: the program is rated on payroll and headcount and trued up at audit. What needs reporting is a change in the agency's shape.
- A move onto the skilled home health track, which needs an approved Certificate of Need before you can apply for the licence.
- Adding an island, since a multi-island book is a different risk from a single-island one of the same size.
- Anyone travelling between islands for work, which changes how a caregiver reaches a client.
- A change in the waiver position, which the Office of Health Care Assurance publishes.
- Agency-owned vehicles, which need commercial auto rather than a caregiver reimbursement arrangement.
- An acquisition, a new entity or a change of ownership, and any incident that could become a claim, reported when it happens rather than when it is served.
The payroll audit at the end of the term is worth preparing for. Records split properly by class keep it from producing a surprise premium.
Coverages Hawaii home care agencies carry
The full program, sized to your islands and your services. Each coverage has a page of its own.
Professional Liability
Clinical claims coverage weighted for Hawaii home health agencies, the track that sits behind a Certificate of Need.
Professional liability coverageWorkers Compensation
Required from one employee, full-time or part-time, permanent or temporary, with a household exclusion that stops at $225 in cash per calendar quarter.
Workers compensation coverageCommercial Auto
Coverage for agency-owned vehicles carrying caregivers through Honolulu traffic and around the neighbour islands.
Commercial auto coverageHired and Non-Owned Auto
For caregivers driving their own cars for work, which a personal policy usually will not cover on a work trip.
Hired and non-owned autoAbuse and Molestation
Coverage of up to $1 million for allegations standard liability excludes, and where a licence is waived one of the clearest signals you can give a client.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked on your liability and auto, the efficient way to reach the totals larger Honolulu institutions require.
Umbrella liability coverageCyber Liability
Breach response for the protected health information your agency holds: notification, ransomware, regulatory defense.
Cyber liability coverageProperty and Business Owners Policy
Cover for the office, its contents, and business interruption after a loss.
Home care agency insuranceProvider types we insure in Hawaii
Home Care Agencies
Non-medical agencies operating under the current licensure waiver, delivering personal care and companion work.
Home care agency insuranceHome Health Agencies
Licensed skilled agencies that have cleared a Certificate of Need through SHPDA before applying to OHCA.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the core of a Hawaii non-medical book.
Personal care services coverageSenior Care Providers
Agencies serving a state where about 21.7 percent of residents are 65 or older, the second highest share we cover.
Senior care coveragePrivate Duty Nursing
Skilled, high-acuity care that drives professional liability limits higher, often with an umbrella behind it.
Private duty nursing coverageGroup Home Care
Residential group homes combining a facility with hands-on care, carrying premises and property exposure.
Group home care coverageHawaii workers compensation for home care agencies
Whatever the licensing position, the workers compensation position is not in doubt. The Disability Compensation Division states that any employer, other than those excluded under section 386-1, having one or more employees, full-time or part-time, permanent or temporary, is required to provide workers compensation coverage for its employees.
Four categories named in one sentence, and no headcount anywhere. Coverage runs under HRS Chapter 386, administered by the Department of Labor and Industrial Relations through the DCD.
The narrowest household exclusion we have found
Hawaii excludes domestic workers earning less than $225 in cash per calendar quarter, alongside domestic workers of public welfare recipients.
Sit with that figure. Two hundred and twenty-five dollars across three whole months. Several states set a household earnings test, and Hawaii's is the narrowest we have found by a wide margin. Almost any regular caregiving arrangement clears it inside a fortnight. Whether it could reach a caregiver employed by an agency rather than a household is a question the source does not answer, and we will not answer it either way, because on the numbers alone the argument is largely academic. Read how the coverage works on our workers compensation page.
The rest of the excluded list, and the election beside it
Hawaii publishes its exclusions as a closed list: voluntary or unpaid workers for a religious, charitable, education or nonprofit organization; student workers performing services for a school, university or college club in return for room, board or tuition; a duly ordained, commissioned or licensed minister, priest or rabbi; the domestic worker categories above; certain twenty-five percent stockholders and all fifty percent stockholders; and real estate salespersons and brokers paid solely on a commission basis.
Two things stand out. The owner exclusion runs by ownership percentage rather than title, so a minority shareholder with an impressive title may not be where they assume, which is worth checking against your current policy. And the Division adds that an employer may elect to cover the excluded employees, worth knowing where an exclusion applies but you would rather not rely on it.
What going without costs in Hawaii
The Division is specific. The penalty for failure to obtain workers compensation insurance is not less than $500.00, or $100.00 for each employee for every day of non-coverage.
Read the structure rather than the headline figure. The $500 is a floor, not a cap, and the alternative runs per employee per day. For an agency running a full roster, a lapse measured in weeks compounds into a number with nothing to do with $500.
Hawaii licensing and regulatory context
Two things are true at once here, and getting both of them right is the point of this section.
HRS section 321-14.8 establishes Department of Health authority to license home care agencies and enforce administrative rules, so the framework exists in statute. And the Office of Health Care Assurance, State Licensing Section, publishes a page titled Home Care Agency licensure waived pursuant to Act 091 SLH 2019, so the state's own licensing office is signalling that licensure is not currently being required.
Several states we cover simply never created a licence for non-medical home care. Hawaii built the framework, then waived it, and that is a different position to operate from. A category that was never regulated tends to stay that way until a legislature decides otherwise, usually slowly and visibly. A waiver is a live decision: it can be revisited, extended, narrowed or allowed to lapse, with the underlying authority already in statute. An agency planning three years out should treat Hawaii as a state where the position could change without a new regime being built from scratch.
We are not going to describe the scope, conditions or duration of Act 091 SLH 2019 here. We could not read the act itself, and the difference between a waiver that applies to your agency and one that does not is too consequential to guess at. The Office of Health Care Assurance publishes the notice and is the right place to ask what applies today. Do that before relying on any summary, including this one.
The skilled side has a hard gate instead. Licensure as a home health agency requires first obtaining an approved Certificate of Need from the State Health Planning and Development Agency, then applying to the Office of Health Care Assurance. The CON comes first and is a real barrier rather than a formality, so the two sides of home care here sit at very different heights.
Medicare, payers and what actually sets your limits
Hawaii Medicaid is administered by the Med-QUEST Division of the Department of Human Services. We will not characterise the programme structure or which authority funds in-home personal care, because we could not confirm either on an official page.
Medicare comes in separately, covering short-term skilled home health under a plan of care. In Hawaii that is the track behind a Certificate of Need, so the payer relationship and the entry barrier are connected: SHPDA, then licence, then certification. That work also carries the heavier professional liability weighting.
For a non-medical agency operating under the waiver, the limits on your certificates are not set by a statute at all. They are set by the hospitals, health systems and payers you contract with, and that is why we ask to see the contract language rather than guessing at a number. If your agency runs skilled care, our home health agency insurance page covers how that program is built. For the non-medical side, see personal care services.
The Hawaii home care market
Hawaii has about 1.45 million residents, roughly 303,000 of them 65 or older. At about 21.7 percent of the civilian population that is the second highest share of any state we cover, behind only Maine. The demand here is deep.
Urban Honolulu at about 999,000 is the dominant market, with Kahului and Wailuku at about 164,000, then Hilo and Kapaa. Most of the population sits on one island, the rest spread across several others.
That is what makes Hawaii unlike every mainland state we write. Elsewhere, serving a rural client means a longer drive. Here, staff and clients on different islands are separated by water rather than road. An agency covering more than one island is not running longer routes, it is running a business where reaching a client can involve a flight, a caregiver cannot be reassigned across a territory, and covering a call-out is an operational problem before a scheduling one.
So we ask directly: which islands do you serve, and does anyone travel between them for work? A single-island agency and a multi-island agency of the same size are different risks. Agency-owned vehicles still need commercial auto, and caregivers using their own cars create a hired and non-owned auto exposure a personal policy will not cover on a work trip. Hawaii borders no other state, so the multi-state question is about ownership and recruitment rather than caregivers crossing a line. The full list of states we cover is on our coverage by state hub.
Hawaii resources for home care providers
The sources behind everything above.
- Office of Health Care Assurance, the licensing office, and its home care agency licensing page.
- The OHCA waiver notice. Read this one yourself and ask OHCA what applies to your agency today.
- Opening a home health agency, which sets out the Certificate of Need route through SHPDA.
- Disability Compensation Division and its FAQ page, carrying the exclusions and the penalties.
- Med-QUEST Division, Hawaii Medicaid.
- Home Care Association of America, Hawaii chapter. We have not been able to confirm a separate Hawaii-specific home care association.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why Hawaii agencies choose HCBI
We work with agencies already running, and their problems are contract problems.
A health system raises its limits at renewal. A payer adds abuse and molestation as a named requirement. A facility wants additional insured status and primary and non-contributory wording your form does not carry. A caregiver injured on a flight between islands tests a program written for a single-island book. That is why we ask for the insurance exhibit rather than a summary.
On Hawaii specifically, we ask which islands you serve and whether anyone travels between them for work, because that answer separates two very different risks at the same headcount. We also treat the licensure waiver as live rather than settled: the authority sits in HRS section 321-14.8 and the waiver runs under Act 091 SLH 2019, so the position can change without a new regime being built.
We place coverage through exclusive carrier programs that write home care risks, and we coordinate the whole program: general liability, professional liability, workers compensation, commercial and hired and non-owned auto and travel cover reflecting island operations, umbrella limits to reach what your contracts demand, cyber, and abuse and molestation coverage of up to $1 million. That reach is backed by relationships across the home care and healthcare industry, including CareerStaff Unlimited and Genesis Healthcare in staffing, HOMELINK in medical equipment and home care networks, and Bright Horizons Family Solutions on the family care side.
Hawaii home care insurance FAQ
Answers for agencies operating under Hawaii rules.
Usually, and usually before renewal. The underlying general liability limit can sometimes be raised by endorsement. More often an umbrella stacked over general liability, auto and employers liability reaches the required total faster and for less than rebuilding the primary program. Where the carrier will not extend, the program is re-marketed. Send us the insurance exhibit rather than a summary; the wording matters as much as the number.
The certificate is quick. What takes time is anything it must evidence that your policy does not yet do: additional insured status, a waiver of subrogation, primary and non-contributory wording, or a notice of cancellation. Those are endorsements, not lines typed onto a form. Send us contract wording when it first arrives, not on the day the certificate is due.
Not person by person. The program is rated on payroll and headcount estimates and trued up at audit, so ordinary turnover needs no policy change. What does need reporting is a change in what the agency does: a move onto the skilled home health track, adding an island, anyone travelling between islands for work, agency-owned vehicles, or a change in the waiver position.
Yes, from the first employee, whatever the licensing position. The Disability Compensation Division states that any employer, other than those excluded under section 386-1, having one or more employees, full-time or part-time, permanent or temporary, is required to provide workers compensation coverage for its employees. Four categories of worker named in one sentence, and no headcount anywhere. Coverage runs under HRS Chapter 386, administered by the Department of Labor and Industrial Relations through the DCD.
Almost nothing, on the numbers alone. Hawaii excludes domestic workers earning less than $225 in cash per calendar quarter, alongside domestic workers of public welfare recipients. Two hundred and twenty-five dollars across three whole months is the narrowest household earnings test we have found by a wide margin, and almost any regular caregiving arrangement clears it inside a fortnight. Whether it could reach a caregiver employed by an agency rather than by a household is a question the source does not answer, and we are not going to answer it either way, because in Hawaii the argument is largely academic.
It runs by ownership percentage rather than title, which is worth checking against your current policy. Hawaii publishes its exclusions as a closed list covering voluntary or unpaid workers for a religious, charitable, education or nonprofit organization; student workers performing services for a school, university or college club in return for room, board or tuition; a duly ordained, commissioned or licensed minister, priest or rabbi; the domestic worker categories; certain twenty-five percent stockholders and all fifty percent stockholders; and real estate salespersons and brokers paid solely on commission. So a minority shareholder with an impressive title may not be where they assume. The Division also adds that an employer may elect to cover the excluded employees.
No, and the distinction matters if you are planning more than a year ahead. HRS section 321-14.8 establishes Department of Health authority to license home care agencies and enforce administrative rules, so the framework exists in statute, and the Office of Health Care Assurance publishes a page titled Home Care Agency licensure waived pursuant to Act 091 SLH 2019. A category never regulated tends to stay that way until a legislature decides otherwise. A waiver is a live decision that can be revisited, extended, narrowed or allowed to lapse, with the authority already in place. We could not read the act, so ask the Office of Health Care Assurance what applies today. The skilled side is different again: home health licensure requires an approved Certificate of Need from the State Health Planning and Development Agency first.
Loss runs for the last five years, declarations pages for every line, payroll by class, caregiver headcount, the counties you serve, and the exhibits from your largest contracts. Start sixty to ninety days out. A non-renewal shortens the carrier list, and lead time buys the options back.
Send us the contract and we will build to it
Tell us your payroll and caregiver count, which islands you serve and whether anyone travels between them for work, and what your largest contract requires. If a limit needs raising before your renewal date, say so and we will start there. A specialist will build the program through exclusive carriers that write home care in Hawaii. There is no obligation.