General Liability
The foundation New Hampshire hospitals and health systems expect, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
New Hampshire Home Care Insurance
For agencies already operating in New Hampshire. 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 New Hampshire 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 carrier programs writing home care in New Hampshire, mid-term when the contract will not wait.
One New Hampshire detail deserves a look on any established program, and it is unlike anything else we write. The statute puts agencies outside the domestic employer definition, then pulls live-in companions back into that category anyway, agency-employed or not, and domestic status here is not an exemption at all.
An agency running seventy-five to a hundred caregivers from Manchester and Nashua into the North Country has a different problem from a startup, and this page is for the former.
What New Hampshire 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 Boston area systems 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.
How your caregivers are deployed shapes what a carrier is pricing here more than in most states, because the live-in companion rule turns on the housekeeping share and on whether nurse level work is involved. Tell us the mix of hourly visits and live-in placements when you send the exhibit.
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 Manchester 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 shift between hourly visit work and live-in placements, which is unusually consequential under RSA 281-A.
- Adding clinical services requiring registered or licensed practical nurse level personnel.
- A new office, or clients further north where winter routes change the driving entirely.
- Caregivers regularly working over the Massachusetts, Vermont or Maine 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 New Hampshire home care agencies carry
The full program, sized to how your caregivers are deployed. Each coverage has a page of its own.
Professional Liability
Clinical claims coverage for work requiring registered or licensed practical nurse level personnel, which RSA 281-A:2 puts outside the domestic category.
Professional liability coverageWorkers Compensation
Secured under RSA 281-A:5 with a licensed carrier, and the policy that takes a placement outside the household-policy route in RSA 281-A:6.
Workers compensation coverageCommercial Auto
Coverage for agency-owned vehicles carrying caregivers through the southern corridor and across northern winter roads.
Commercial auto coverageHired and Non-Owned Auto
For caregivers driving their own cars for work, a short southern run or a long January route north.
Hired and non-owned autoAbuse and Molestation
Coverage of up to $1 million for allegations standard liability excludes, essential given caregivers work alone with vulnerable clients, more so in live-in placements.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked on your liability and auto, the efficient way to reach the totals Boston area contracts 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 New Hampshire
Home Care Agencies
Providers licensed under RSA 151, delivering non-medical personal care and companion work.
Home care agency insuranceHome Health Agencies
Home health care providers as defined in RSA 151:2-b, delivering care under a plan of care.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the core of most non-medical books here.
Personal care services coverageSenior Care Providers
Agencies serving a state where about 20.8 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 coverageNew Hampshire workers compensation and the live-in companion rule
Workers compensation runs under RSA Chapter 281-A, administered by the New Hampshire Department of Labor. RSA 281-A:5 sets out how an employer discharges the duty, the first route being by insuring and keeping insured the payment of such compensation with a company licensed to write workers compensation insurance in this state, which for an agency employing caregivers is the ordinary answer. The interesting part of New Hampshire is not how you buy the policy, it is who the statute says is a domestic worker.
An agency is not a domestic employer
RSA 281-A:2, V-a defines domestic, domestic employee, or domestic worker as a person performing domestic services in a private residence of the employer, where the employer is an individual, family, local college club, or local chapter of a college fraternity or sorority and not an agency or other entity engaged in the business of providing domestic workers to the public.
Read the closing clause. An agency in the business of providing domestic workers to the public is expressly outside the definition of a domestic employer. In most states you argue that from silence; here the legislature wrote it down, though that is not the end of it.
But live-in companions are reached anyway, agency or not
RSA 281-A:2, V-b(b) provides that domestic labor or domestic services shall also include the services rendered by paid roommates or live-in companions who provide fellowship, care, and protection for persons who because of advanced age, or physical or mental infirmity cannot care for their own needs, regardless of whether the paid roommate or companion is employed by an agency or entity other than the person using such services.
That final clause is deliberate. Having put agencies outside the domestic employer definition, the legislature pulled a kind of agency-employed worker back into the domestic category. Two limits attach, and both must hold.
- The services may encompass housekeeping duties provided such services do not exceed 20 percent of the total hours worked.
- The services do not include those relating to the care and protection of the aged and infirm that require and are performed by specially trained personnel such as registered or licensed practical nurses or similarly trained personnel.
So a live-in companion placed by a New Hampshire agency can fall inside the domestic category, while an hourly aide making scheduled visits, or a live-in doing substantial housekeeping or nurse level work, does not. That is a fact-specific test, and whether a particular staffing model falls inside it is one for counsel rather than a broker page. What we will not do is pretend New Hampshire is silent on it, because it is one of the very few states that is not.
Domestic status is not an exemption here
This is the part that surprises people who have worked in other states. RSA 281-A:6 provides that notwithstanding any other provision, all insurance companies authorized to provide comprehensive personal liability, tenant's or homeowner's insurance in this state shall, in connection with such insurance, provide workers compensation insurance covering domestics unless the employer has a separate policy of workers compensation insurance covering domestics.
New Hampshire does not exempt domestics from workers compensation. It routes their coverage onto the household's homeowners, tenant's or personal liability policy, unless the employer carries a separate policy covering domestics. No other state in our research uses this mechanism.
The consequence is worth sitting with. If a caregiver falls inside the domestic definition and the employer has no separate policy covering domestics, the cover sits with the client's home policy rather than the agency. That is not a gap, it is a different place to look. It cuts the other way too: an agency carrying its own workers compensation for that work sits inside the exception the section names. Read how the coverage works on our workers compensation page.
New Hampshire licensing and regulatory context
Short version, because you already hold your licence. It earns space because New Hampshire regulates the people as well as the agency.
Licensing runs through the New Hampshire Department of Health and Human Services, Health Facilities Administration, under RSA Chapter 151, Residential Care and Health Facility Licensing, whose list of licensed facilities includes home health care providers as defined in RSA 151:2-b. The rules sit in two series: He-P 809 for home health care providers and He-P 820 for individual home care service providers.
Most states write rules for the agency and stop there. New Hampshire addresses individual home care service providers in a series of their own. We are not going to describe that pathway: the rule text lives on a state site that does not serve automated requests, and we would rather send you to the Department than paraphrase something we have not read. Confirm it with DHHS directly.
Medicare, payers and what actually sets your limits
Medicare covers short-term skilled home health under a plan of care. That work raises the stakes on documentation and on professional liability, and it sits on a different footing from companion work.
It also intersects with the domestic analysis above. RSA 281-A:2, V-b(b) excludes from the domestic category work requiring registered or licensed practical nurse level personnel, so the more clinical your book becomes, the further it moves from the live-in companion category.
For most providers the limits on your certificates are set by the hospitals, health systems and payers you contract with rather than by statute, which is why we ask to see the contract language. 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 New Hampshire home care market
New Hampshire has about 1.41 million residents, roughly 292,000 of them 65 or older. At about 20.8 percent of the civilian population that puts it among the older states, and an older client base is a deeper home care market.
The state divides cleanly in two. The southern tier is urban and faces Massachusetts: the largest metropolitan area is Boston's, at about 5.03 million and centred over the state line, with Manchester and Nashua at about 430,000 the largest market wholly inside New Hampshire.
The North Country is the other half: sparsely settled, with long drives that winter makes longer. A caregiver in the southern corridor makes short trips through steady traffic; one covering the north drives long stretches on roads that ice, in the dark for much of the winter. An agency working Nashua and one working Coos County run the same business under two different road conditions, and a program built for one will misprice the other.
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. Cross-border work is ordinary here, since the largest metropolitan area is centred in Massachusetts and the Vermont line is a short drive from the west. Operators there can read our Vermont page, and the full list is on our coverage by state hub.
New Hampshire resources for home care providers
These are the sources that shape how home care operates in New Hampshire.
- New Hampshire DHHS, Health Facilities Administration, which licenses under RSA Chapter 151 and publishes the He-P 809 and He-P 820 rule series.
- New Hampshire Department of Labor, which administers RSA Chapter 281-A.
- RSA 281-A:2, the definitions section carrying the domestic and live-in companion rules at V-a and V-b.
- RSA 281-A:5, which sets out how an employer secures compensation.
- RSA 281-A:6, which routes compensation for domestics onto personal liability, tenant\'s and homeowner\'s policies.
- Home Care Association of America, New Hampshire chapter, the state chapter of the national private duty home care association.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why New Hampshire 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 an iced northern 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 New Hampshire specifically, we ask how your caregivers are deployed before anything else, because few states make that this consequential. RSA 281-A puts agencies outside the domestic employer definition, then reaches live-in companions anyway subject to a 20 percent housekeeping limit and a nurse level carve-out, and RSA 281-A:6 routes domestic coverage onto a household policy rather than removing it.
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 for the southern corridor and long northern winter routes alike, 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.
New Hampshire home care insurance FAQ
Answers for agencies under New Hampshire 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 shift between hourly visits and live-in placements, adding nurse level services, a new office or territory, agency-owned vehicles, or regular work over a state line.
No, and the statute says so directly. RSA 281-A:2, V-a defines a domestic employer as an individual, family, local college club, or local chapter of a college fraternity or sorority and not an agency or other entity engaged in the business of providing domestic workers to the public. In most states you argue that point from silence; here the legislature wrote it down. That is not the end of the analysis, though, because a second limb reaches back in.
They can be, and few states make deployment model this consequential. RSA 281-A:2, V-b(b) provides that domestic services shall also include services rendered by paid roommates or live-in companions who provide fellowship, care, and protection for persons who because of advanced age, or physical or mental infirmity cannot care for their own needs, regardless of whether the companion is employed by an agency. Two limits attach and both must hold: housekeeping may not exceed 20 percent of the total hours worked, and the services must not include care of the aged and infirm requiring registered or licensed practical nurses or similarly trained personnel. So a live-in companion can fall inside the category while an hourly aide on scheduled visits does not. Whether a particular staffing model falls inside it is a question for counsel rather than a broker.
No, and this is what surprises people who have worked in other states. RSA 281-A:6 provides that all insurance companies authorized to write comprehensive personal liability, tenant's or homeowner's insurance in this state shall provide workers compensation insurance covering domestics, unless the employer has a separate policy of workers compensation insurance covering domestics. New Hampshire does not exempt domestics, it routes their coverage onto the household policy. No other state in our research uses this mechanism. It cuts both ways: an agency carrying its own workers compensation for that work is squarely inside the exception the section names.
Licensing runs through the New Hampshire Department of Health and Human Services, Health Facilities Administration, under RSA Chapter 151, Residential Care and Health Facility Licensing, whose list of licensed facilities includes home health care providers as defined in RSA 151:2-b. The administrative rules sit in two series, He-P 809 for home health care providers and He-P 820 for individual home care service providers. That second series is unusual: most states write rules for the agency and stop there, so it is worth confirming with DHHS directly what applies to the people working under your licence.
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, your mix of hourly visits and live-in placements, how far north 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 New Hampshire. There is no obligation.