General Liability
The foundation Montana hospitals, tribal health organisations and payers expect, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
Montana Home Care Insurance
For agencies already operating in Montana. 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 Montana 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 Montana, mid-term if the contract will not wait.
Two Montana details are worth a look on an established program. Montana is not a monopolistic state, so the whole program including workers compensation can be placed together. And the household exemption here is elective rather than automatic, which gives you a way to buy certainty instead of arguing about a category.
An agency running seventy-five to a hundred caregivers out of Billings, Missoula, Bozeman or Great Falls has a different problem from a startup, and this page is for the former.
What Montana 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, tribal health organisations 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 Billings and Missoula 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 state licence exists it tells a family, a discharge planner and a payer that somebody has inspected the operation. Where an agency does not hold one, the certificate itself becomes the credential a counterparty can check.
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 Billings 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 change in your licence position, since no DPHHS category for purely non-medical in-home personal care could be identified.
- A new office, or clients further out where the next visit can be an hour away.
- Work with a tribal entity or inside reservation boundaries, raising the MCA 39-71-401(2)(m) question.
- Caregivers regularly working over the Idaho, Wyoming, North Dakota or South Dakota line.
- 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 Montana home care agencies carry
The full program, sized to your payroll and your distances. Each coverage has a page of its own.
Professional Liability
Clinical claims coverage weighted for DPHHS licensed home health agencies delivering care under a plan of care.
Professional liability coverageWorkers Compensation
Required of all employers for all employees with no threshold, placed under compensation plan No. 2 with a private carrier.
Workers compensation coverageCommercial Auto
Coverage for agency-owned vehicles on routes that are long by default and severe for months of the year.
Commercial auto coverageHired and Non-Owned Auto
For caregivers driving their own cars for work, which in Montana is most of the working day.
Hired and non-owned autoAbuse and Molestation
Coverage of up to $1 million for allegations standard liability excludes, essential given caregivers work alone and often far from support.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked on your liability and auto, the efficient way to reach the totals larger Montana 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 Montana
Home Care Agencies
Non-medical agencies delivering personal care and companion work across very long rural territories.
Home care agency insuranceHome Health Agencies
Agencies licensed by the DPHHS Licensure Bureau, delivering care under a plan of care.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the work the Community Services Bureau programmes fund.
Personal care services coverageSenior Care Providers
Agencies serving a state where about 20.5 percent of residents are 65 or older.
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 coverageMontana workers compensation for home care agencies
Montana's rule contains no arithmetic at all, and is worth reading in the statute's own words.
Any employee, under any contract of hire
MCA 39-71-401 provides that except as provided in subsection (2), the Workers' Compensation Act applies to all employers and to all employees, and that an employer who has any employee in service under any appointment or contract of hire, expressed or implied, oral or written, shall elect to be bound by the provisions of compensation plan No. 1, 2, or 3. No headcount. No payroll floor. No hours test. Coverage is administered by the Department of Labor and Industry through its Employment Relations Division. Read how the coverage works on our workers compensation page.
Three plans, and why Montana can be placed as a whole
Montana does not tell you to buy a policy, it tells you to elect a plan: No. 1 self-insurance, No. 2 a private insurer, No. 3 the Montana State Fund.
The point worth drawing out is what that is not. Montana is not a monopolistic state. In Ohio, North Dakota and Washington the state fund is the route and a broker cannot place the line at all. Montana has a state fund alongside private carriers, not instead of them, so a program here can be built and placed as a whole, which matters when a contract needs employers liability under an umbrella.
Every exemption here is elective
Subsection (2) opens with a condition applying to everything under it: unless the employer elects coverage for these employments under this chapter and an insurer allows an election. So every exemption in the list is elective, and an employer can bring an otherwise exempt employment inside the Act where an insurer agrees.
First on the list is household or domestic employment, stated open-ended, with no hours or earnings test. The rest is long and specific: casual employment; a dependent member of an employer's family for whom an exemption may be claimed under the federal Internal Revenue Code; sole proprietors, working members of a partnership or limited liability partnership, and working members of a member-managed LLC; commission-only real estate, securities and insurance salespeople; direct sellers; employment under a rule of liability provided by the laws of the United States; services performed in return for aid or sustenance only; interstate railroad work; officials at amateur athletic events; newspaper carriers and freelance correspondents; cosmetologist and barber services; tribal employment; and jockeys.
The tribal employment exemption
Subsection (2)(m) is the one Montana operators should read carefully, because it has no real equivalent in most states. It exempts a person employed by an enrolled tribal member or a majority tribal-owned entity whose business is conducted solely within the exterior boundaries of an Indian reservation. Two conditions do the work: who the employer is, and where the business is conducted. Solely within the exterior boundaries is a specific test. With seven reservations inside Montana, an agency serving those communities, staffing from them, or working with a tribal entity should treat this as a live question rather than background, and one for counsel rather than a broker page.
What the household exemption does not settle, and how to remove the doubt
Here is where we stop on the point that matters most. The household or domestic employment exemption is stated as a category, and nothing in MCA 39-71-401 addresses whether a caregiver employed by an agency and assigned to a client falls inside it, so we will not tell you it exempts your caregivers or that it captures them.
What Montana gives you is a way to remove the ambiguity. The election route at the top of subsection (2) lets an employer bring an employment inside the Act where an insurer allows it. Where the exemption is open-ended and the question unsettled, electing coverage buys a certainty arguing about a category does not, and on an established book that is worth more than the premium.
Montana licensing and regulatory context
Short version, and here it includes an honest gap. Home health agencies are licensed by the Department of Public Health and Human Services, through its Licensure Bureau within Health Care Facility Licensure, with rules for healthcare facilities at ARM Title 37, chapter 100.
We could not identify a DPHHS licence category for purely non-medical in-home personal care, and will not assert a position we could not verify. Confirm yours with the Licensure Bureau directly, because the answer decides how your operation should be described to a carrier.
That gap is commercial as well as compliance. A state licence tells a family, a discharge planner and a payer that somebody has inspected the operation. Where an agency does not hold one, the documents become the credential a counterparty can check.
Medicaid, Medicare and what actually sets your limits
Montana Medicaid's in-home programmes run through DPHHS, in the Senior and Long Term Care Division, via its Community Services Bureau. The two relevant ones are Community First Choice and Personal Assistance Services.
One practical note. Those programmes are being renamed Community First Choice Services and Personal Care Services, shortened to CFCS and PCS, to align with federal naming, so older material and older contracts use the previous names for the same things. Expect both sets of terms in circulation, and check which your own paperwork uses. We are not going to characterise how they are funded or whether eligible residents are entitled to the service, because we could not confirm it at source. Get that from the Community Services Bureau directly.
Medicare comes in separately, covering short-term skilled home health under a plan of care, which raises the stakes on documentation and on professional liability. What sets your limits is neither: it is the hospitals, health systems, tribal health organisations and payers you contract with. 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 Montana home care market
Montana has about 1.14 million residents, roughly 232,000 of them 65 or older. At about 20.5 percent of the civilian population that is one of the older profiles we cover, so the demand is real. Reaching it is the difficulty.
Billings at about 193,000, Missoula at about 128,000 and Bozeman at about 127,000 are the largest markets, with Great Falls alongside them, and no Montana metro reaches 200,000. Set that against the fourth-largest land area in the country: barely over a million people across an enormous state, with no dominant centre to anchor a book.
Driving distance is therefore the defining operational fact, more than in any state except Alaska. Long routes are the default rather than the rural exception, winter conditions are severe for months, and a single rural visit can consume most of a shift. Seven Indian reservations also sit within the state, which is why the tribal exemption above is live rather than background.
Agency-owned vehicles 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, often the largest single exposure after payroll. Montana borders four states and a national boundary, so agencies in the west and southeast sometimes recruit or serve across a line. Read our Idaho and South Dakota pages, and the full list is on our coverage by state hub.
Montana resources for home care providers
The sources behind everything above.
- DPHHS home health agency licensure, through the Licensure Bureau.
- Health care facility licensure, for the categories DPHHS does license.
- MCA 39-71-401, the section carrying the coverage rule, the three plans and the full exemption list.
- Employment Relations Division workers compensation regulation.
- Community Services Bureau, which runs the in-home programmes.
- Home Care Association of America, Montana chapter. We checked for a Montana-specific home care association and could not find one that resolves.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why Montana 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 crash on a long winter route exposes how little a personal auto policy does on a work trip. That is why we ask for the insurance exhibit rather than a summary.
On Montana specifically, we treat the driving as the largest exposure after payroll rather than a rural footnote, because with no metro above 200,000 in the fourth-largest state by land area, long winter routes are the default. We also point to the election route at MCA 39-71-401(2): where an exemption is open-ended and the question unsettled, electing coverage buys certainty that arguing about a category does not.
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 built for very long winter routes, 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.
Montana home care insurance FAQ
Answers for agencies operating under Montana 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 change in your licence position, a new office or territory, work with a tribal entity or inside reservation boundaries, agency-owned vehicles, or work over a state line.
Yes, with no arithmetic in the rule at all. MCA 39-71-401 provides that except as provided in subsection (2), the Act applies to all employers and to all employees, and that an employer who has any employee in service under any appointment or contract of hire, expressed or implied, oral or written, shall elect to be bound by compensation plan No. 1, 2, or 3. No headcount, no payroll floor, no hours test. It is administered by the Department of Labor and Industry through its Employment Relations Division.
No, and the difference matters when a contract needs employers liability under an umbrella. Montana tells you to elect a plan rather than buy a policy: plan No. 1 is self-insurance, plan No. 2 a private insurer, plan No. 3 the Montana State Fund. In Ohio, North Dakota and Washington the state fund is the route and a broker cannot place the line at all. Montana has a state fund alongside private carriers rather than instead of them, so a program here can be built and placed as a whole.
The statute does not settle it, but Montana gives you a way to remove the doubt. The household or domestic employment exemption is stated as an open-ended category, with no hours or earnings test, and nothing in MCA 39-71-401 addresses whether a caregiver employed by an agency and assigned to a client falls inside it. The useful part is the condition at the top of subsection (2): unless the employer elects coverage for these employments under this chapter and an insurer allows an election. Every exemption in the list is elective, so an employer can bring an otherwise exempt employment inside the Act where an insurer agrees, which buys a certainty that arguing about a category does not.
It raises a question with no real equivalent in most states, and one for counsel rather than a broker page. MCA 39-71-401(2)(m) exempts a person employed by an enrolled tribal member or a majority tribal-owned entity whose business is conducted solely within the exterior boundaries of an Indian reservation. Two conditions do the work there, who the employer is and where the business is conducted, and solely within the exterior boundaries is a specific test. With seven reservations inside Montana, an agency serving those communities, staffing from them, or working with a tribal entity should treat this as live rather than background.
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, where your licence position sits, how long your routes run, 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 Montana. There is no obligation.