General Liability
The foundation North Carolina hospitals and health systems expect, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
North Carolina Home Care Insurance
For agencies already operating in North Carolina. If a hospital, facility 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 North Carolina 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 actually deliver, an umbrella behind both, and certificates carrying the additional insured and waiver wording the contract specifies. We place that through exclusive carrier programs that write home care in North Carolina, and we do it mid-term when the contract will not wait.
North Carolina has one clause most brokers never mention, and it matters to an agency that already carries coverage: buying a workers compensation policy settles your status under the Act conclusively, whatever your headcount. Usually that is the outcome you want, but it should be a decision rather than something you back into.
An agency running seventy-five to a hundred caregivers across Charlotte, the Triangle or out to the coast and the mountains has a different problem from a startup, and this page is written for the former.
What North Carolina 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 skilled agencies for their clinical exposure. 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 chasing health system partnerships in Charlotte or the Triangle 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 advance notice of cancellation. Each is an endorsement rather than a sentence on a certificate.
In Charlotte and the Triangle those contracts come from large institutions with standard requirements attached, which cuts both ways. The wording is rarely negotiable, but it is predictable, and an agency that has met it once is better placed for the next one.
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 stacked over general liability, auto and employers liability get there quicker and for less than rebuilding the primary underneath.
The third is re-marketing, where a carrier will not extend or the wording sits outside what the form allows. That takes longer, which is the argument for sending contract language when it first appears rather than the week it has to 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 Charlotte or Raleigh 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 needs no 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 from personal care into skilled care under a plan of care.
- A new office, or counties you did not previously serve, particularly across the mountain or coastal divide.
- Agency-owned vehicles, which need commercial auto rather than a caregiver reimbursement arrangement.
- Caregivers regularly working over the South Carolina or Virginia line.
- Excluding or including a corporate officer, which changes what that person has if they are hurt on agency business.
- 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 North Carolina home care agencies carry
The full program, sized to your headcount, contracts, and driving. Each coverage has a page of its own.
Professional Liability
Clinical claims coverage for agencies running skilled care under a plan of care, weighted heavier than personal care and companion work.
Professional liability coverageWorkers Compensation
Required at three or more employees regularly in service, and a policy bought below that line conclusively brings you under the Act. Priced on payroll and your experience modifier.
Workers compensation coverageCommercial Auto
Coverage for agency-owned vehicles carrying caregivers through Charlotte and Triangle traffic and across coastal and mountain routes.
Commercial auto coverageHired and Non-Owned Auto
For caregivers driving their own cars for work, a short metro run or a long county route alike, an exposure most North Carolina agencies carry.
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 inside their homes.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked on your liability and auto, the efficient way to reach the totals Charlotte and Triangle health system 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, sized to the footprint you actually run.
Home care agency insuranceProvider types we insure in North Carolina
Home Care Agencies
Agencies holding a DHSR Home Care Agency license, delivering non-medical personal care and companion services.
Home care agency insuranceHome Health Agencies
Skilled providers delivering care under a plan of care, where documentation and professional liability carry more weight.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the work a Home Care Agency license covers.
Personal care services coverageSenior Care Providers
Agencies serving the roughly 1.9 million North Carolina residents aged 65 and older, weighted for wandering, falls, and abuse.
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 coverageNorth Carolina workers compensation for home care agencies
North Carolina is one of the minority of states that sets a genuine headcount threshold, and getting its shape right matters more here than in states where the answer is yes from day one.
Three or more, regularly in service
The North Carolina Industrial Commission administers the system under Chapter 97, with the exemptions at G.S. 97-13. The Commission states that employers with three or more employees on a regular basis are covered by the Act. The statute puts the same rule in the negative: the Article does not apply to any person, firm or private corporation that has regularly in service less than three employees in the same business within this State. Read how the coverage works on our workers compensation page.
G.S. 97-13 sets out other exclusions alongside the headcount rule: farm labour where fewer than 10 full-time nonseasonal farm laborers are regularly employed by the same employer, and federal government employees. The Commission also states that employers of one or more employees engaged in activities involving the use or presence of radiation are required to have coverage. That carve-in rarely touches home care, but it shows how the state thinks: three employees is the general rule rather than a universal floor.
The domestic servant exemption, and what it does not settle
G.S. 97-13 provides that the Article does not apply to domestic servants, nor to employees of such persons. There is no hours test and no earnings test attached to it, which is unusual. Several states bound their household exemption with a quarterly earnings figure or a weekly hours figure. North Carolina does not.
Read the phrasing carefully, because this is where we stop. The exemption is written around the servant and that servant's own employees. It is not written around an agency. Whether it reaches a caregiver employed by a licensed North Carolina agency is a question G.S. 97-13 does not settle, and we will not tell you it exempts your caregivers or that it captures them. Treating statutory silence as an exemption is a decision rather than a finding, tested at claim time rather than at renewal.
Buying the policy settles it, conclusively
This is the North Carolina clause worth reading twice, and it is the one most brokers never mention. G.S. 97-13 provides that any employer without regard to number of employees, including an employer of domestic servants, farm laborers, or one who previously had exempted himself, who has purchased workers compensation insurance to cover his compensation liability, shall be conclusively presumed subject to the Act.
There is no halfway position. The purchase settles coverage status, conclusively, even for an employer that had previously exempted itself. For most established agencies that is the outcome you want, because a covered employee with a statutory benefit schedule is a more predictable problem than an injured caregiver with no defined remedy. It should still be a deliberate decision rather than one you back into while shopping a certificate.
Officers, and what an exclusion actually does
The Commission states that corporate officers may specifically exclude themselves from coverage. That is a decision about the officer as an individual. It changes nothing about the caregivers on your schedule, and an excluded officer injured on agency business has no benefits under that policy. Owner-operators who still take shifts should think hard first.
North Carolina licensing and regulatory context
Short version, because you already hold your licence. It earns space for two reasons: your category is what a carrier underwrites against, and everything the state watches for in a survey is the same ground a liability or abuse claim gets fought on.
Home care is licensed by the Department of Health and Human Services through its Division of Health Service Regulation, specifically the Acute and Home Care Licensure and Certification Section. The licence is a Home Care Agency licence. The governing statutes run from G.S. 131E-135 through G.S. 131E-142, and the rules sit at 10A NCAC 13J.
One structural point: the North Carolina Medical Care Commission makes those rules, so the rules you are surveyed against and the division that inspects you come from different places. A Home Care Agency delivering personal care carries different clinical exposure than an operation running skilled care, and professional liability is weighted accordingly.
Medicare, Medicaid 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 sits on a different footing from personal care and companion work.
For most non-medical agencies the limits on your certificates are not set by statute at all. They are set by the hospitals, health systems, facilities and payers you contract with. That is why we ask to see the contract language rather than guessing at a number.
If you run skilled care, our home health agency insurance page covers that program. For the non-medical side, see personal care services.
The North Carolina home care market
North Carolina has about 11 million residents, roughly 1.9 million of them 65 or older, close to 17.8 percent of the civilian population. It is one of the larger home care markets in the country and one of the faster growing.
The state carries several substantial metros rather than one dominant city. Charlotte and its surrounding area holds about 2.88 million and runs across the line into South Carolina. The Virginia Beach and Norfolk region, about 1.79 million, reaches into the northeast corner. Raleigh and Cary hold about 1.56 million, with Greensboro, High Point and Winston-Salem behind them.
Beyond those markets the state is rural in two different ways. The coastal plain is flat and spread out. The western mountains are neither, and a twenty mile visit there is not a twenty minute drive. An agency running metro and mountain clients from one office is running two auto exposures, and pricing either as the other gets both wrong.
Agency-owned vehicles need commercial auto, and caregivers using their own cars create a hired and non-owned auto exposure a personal policy usually will not cover on a work trip. Two of the state's three largest metropolitan areas are shared with a neighbour, so working over a line is routine here. Operators working the borders can read our South Carolina, Virginia and Georgia pages, and the full list is on our coverage by state hub.
North Carolina resources for home care providers
These are the bodies that shape how home care operates in North Carolina, so you know where each requirement comes from.
- North Carolina Department of Health and Human Services, Division of Health Service Regulation, Acute and Home Care Licensure and Certification Section, which issues the Home Care Agency license under G.S. 131E-135 through 131E-142.
- North Carolina Medical Care Commission, the rulemaking body behind 10A NCAC 13J.
- North Carolina Industrial Commission, which administers workers compensation under Chapter 97.
- Association for Home & Hospice Care of North Carolina, the state home care and hospice industry body representing agencies through advocacy and education.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why North Carolina agencies choose HCBI
We work with agencies already running, and their problems are contract problems.
A health system raises its required 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 current form does not carry. A caregiver crash in Charlotte traffic or on a mountain road in winter 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 of it.
On North Carolina specifically, we read G.S. 97-13 properly rather than summarising it. We will tell you what the domestic servant exemption says and then refuse to say whether it reaches your caregivers, because the statute does not. We will also make sure you know what buying a policy does under the conclusive presumption clause, and what excluding an officer costs that officer, before either decision rather than after.
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 metro traffic, coastal distance and mountain roads 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 working relationships across the home care and healthcare industry, including CareerStaff Unlimited and Genesis Healthcare in staffing and healthcare services, HOMELINK in the medical equipment and home care network space, and Bright Horizons Family Solutions on the family care side.
North Carolina home care insurance FAQ
Answers for agencies operating under North Carolina 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, because the required wording matters as much as the number.
The certificate is quick. What takes time is anything it has to evidence that your policy does not yet do: additional insured status for a named health system, a waiver of subrogation, primary and non-contributory wording, or a notice of cancellation. Those are endorsements to a policy, 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 into skilled care, a new office or county, agency-owned vehicles, regular work over the South Carolina or Virginia line, or an acquisition.
At three or more employees regularly in service. The North Carolina Industrial Commission administers the system under Chapter 97, and states that employers with three or more employees on a regular basis are covered by the Act. The statute puts it in the negative: the Article does not apply to any person, firm or private corporation that has regularly in service less than three employees in the same business within this State.
Yes, conclusively, and this is the clause most brokers never mention. G.S. 97-13 provides that any employer without regard to number of employees, including an employer of domestic servants, farm laborers, or one who previously had exempted himself, who has purchased workers compensation insurance to cover his compensation liability, shall be conclusively presumed subject to the Act. There is no halfway position. For most established agencies that is the outcome you want, because a covered employee with a statutory benefit schedule is more predictable than an injured caregiver with no defined remedy. It should still be a deliberate decision.
We will not tell you either way, because G.S. 97-13 does not settle it. The Article does not apply to domestic servants, nor to employees of such persons, and unusually there is no hours test and no earnings test attached. But the exemption is written around the servant and that servant's own employees. It is not written around an agency. Treating statutory silence as an exemption is a decision rather than a finding, and it gets tested at claim time rather than at renewal.
Think hard about it first. The Commission states that corporate officers may specifically exclude themselves from coverage under a workers compensation policy. That is a decision about the officer as an individual, and it changes nothing about the caregivers on your schedule. The part that catches people is the other side: an excluded officer injured on agency business has no benefits under that policy, and in home care the owner often drives the most miles.
The Department of Health and Human Services, through its Division of Health Service Regulation and specifically the Acute and Home Care Licensure and Certification Section. The licence is a Home Care Agency licence, the governing statutes run from G.S. 131E-135 through G.S. 131E-142, and the rules sit at 10A NCAC 13J. The North Carolina Medical Care Commission makes those rules, so the rules you are surveyed against and the division that inspects you come from different places.
Loss runs for the last five years, current declarations pages for every line, payroll by class, caregiver headcount, the counties you serve, and the insurance exhibits from your largest contracts. Start sixty to ninety days out. A non-renewal shortens the list of carriers, and lead time buys the options back.
Send us the contract and we will build to it
Tell us your payroll and caregiver count, the counties you serve and how far your caregivers drive, whether any officer is excluded, 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 North Carolina. There is no obligation.