General Liability
The centre of an Ohio program. It carries the limits contracts name and the additional insured status a BWC account cannot provide.
General liability coverage
Coverage by State
Ohio Home Care Insurance
For agencies already operating in Ohio. If a health system contract just demanded limits or additional insured wording your policy cannot reach, that is a solvable problem, and it does not have to wait for your renewal date.
If you already run an Ohio home care agency
Here is the short answer. When a contract demands limits your policy cannot reach, the fix is general liability written at the limit the contract names, professional liability sized to the care you actually deliver, an umbrella stacked behind both, and certificates issued with the additional insured and waiver wording the contract specifies. We place that through exclusive carrier programs that write home care in Ohio, and we do it mid-term when the contract will not wait.
One thing about Ohio shapes everything else. Workers compensation here comes from the Bureau of Workers' Compensation state insurance fund rather than from a private carrier, so we do not place that line in this state and we will not suggest otherwise. What follows from that matters more than it sounds: every contractual requirement a hospital or facility writes down has to be satisfied on the private side of your program, because there is no private workers compensation policy to carry any of it.
An agency running seventy-five to a hundred caregivers across Columbus, Cleveland, Cincinnati or the Dayton and Akron corridors has a different problem from a startup, and this page is written for the former.
What Ohio contracts require, and what happens when yours falls short
No Ohio statute sets your liability limits. Your contracts do, and they ask for more than the law.
What the contracts typically ask for
Hospitals, health systems, skilled nursing facilities, managed care payers and government contracts converge on a familiar list. General liability at $1 million per occurrence and $2 million aggregate is the common floor. Professional liability is expected wherever care runs under a plan of care, often at matching limits. Auto liability covering agency vehicles and caregivers driving their own. Abuse and molestation coverage, increasingly named specifically rather than assumed. Evidence of workers compensation, which here means your BWC account. And an umbrella to lift the total where the primary layers stop.
Wording usually matters as much as the number. Contracts routinely ask to be named as an additional insured, for a waiver of subrogation, for cover to respond on a primary and non-contributory basis, and for advance notice if a policy is cancelled. Each of those is an endorsement on a policy rather than a sentence on a certificate.
Why the private lines carry more weight here
In an ordinary state those requirements spread across the whole program. In Ohio they cannot. Your BWC coverage is an account with a state agency rather than a policy a broker can endorse, so contractual requests for additional insured status, waivers and policy documentation land on general liability, professional liability, auto and umbrella or nowhere at all. That is a reason to build the private lines deliberately rather than treat them as the smaller half of the file.
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 additional premium, and that is the fastest path where it is available.
The second is an umbrella. Where a contract wants a total your primary layers cannot reach, excess limits stacked over general liability and auto usually get there quicker and for less than rebuilding the primary program underneath.
The third is re-marketing. Where a carrier will not extend, or the required wording sits outside what the form allows, the program moves. 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. Both are where a placement quietly fails.
Certificates
A certificate is evidence, not coverage. It can only state what a policy already does. If a Cleveland or Columbus health system requires additional insured status and your general liability carries no such endorsement, no certificate can create it. The delay agencies feel there is an underwriter deciding whether to add it, not paperwork.
So the habit that helps is simple: when a new client, facility or payer sends paperwork, send us the insurance requirements immediately. Certificates already on file should carry over rather than being rebuilt each year.
What to report during the year
Adding and removing caregivers does not require a change to your private lines each time, because they are rated on payroll and headcount and trued up at audit. What needs reporting is a change in the shape of the agency.
- A move from a nonmedical licence into skilled home health services, which changes the exposure as well as the paperwork.
- A new office, or a move into counties you did not previously serve.
- Agency-owned vehicles, which need commercial auto rather than a caregiver reimbursement arrangement.
- Caregivers regularly crossing into Kentucky, Indiana, Michigan, Pennsylvania or West Virginia.
- An acquisition, a new entity, or a change of ownership.
- 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 rather than reacting to. Payroll records split properly by class are what keep an audit from producing an unwelcome additional premium.
Coverages Ohio home care agencies carry
The private program, sized to your payroll, territory and contracts. Workers compensation is not on this list because it comes from BWC rather than from any carrier.
Professional Liability
Clinical claims coverage for skilled home health services delivered under a plan of care, usually at limits matching your general liability.
Professional liability coverageCommercial Auto
For agency-owned vehicles across the metro corridors and the long routes through Appalachian southeast Ohio.
Commercial auto coverageHired and Non-Owned Auto
The line most established agencies are short on, covering caregivers who drive their own cars between visits.
Hired and non-owned autoAbuse and Molestation
Coverage of up to $1 million for allegations standard liability excludes, and increasingly named in contracts rather than assumed.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked over liability and auto, usually the fastest way to reach a total a contract has just raised.
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 Ohio
Home Care Agencies
Agencies holding a nonmedical home health services licence under ORC chapter 3740.
Home care agency insuranceHome Health Agencies
Agencies holding a skilled home health services licence, which also authorises nonmedical work.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the core of an Ohio nonmedical book.
Personal care services coverageSenior Care Providers
Agencies serving the roughly 2.21 million Ohio residents aged 65 and older.
Senior care coveragePrivate Duty Nursing
Skilled, high-acuity care that drives professional liability limits higher, usually 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 coverageOhio workers compensation and what the state fund means for you
Ohio runs an exclusive state fund, and it is worth being exact about what that means for an operating agency.
BWC or self-insurance, and nothing else
Ohio workers compensation runs under ORC chapter 4123 and is administered by the Bureau of Workers' Compensation. Section 4123.35 is titled for payment of premiums by employers and self-insurance, and it requires private employers to pay into the state insurance fund. The alternative is qualifying as a self-insuring employer, which is realistically a route for very large employers rather than for a home care agency.
We would rather be plain than vague. We do not place your Ohio workers compensation. It comes from BWC, and any page suggesting a broker can write it here is wrong.
What that changes for your contracts
A BWC account is not a policy a broker can endorse, so a hospital asking to be named as an additional insured, a payer asking for a waiver of subrogation, or a facility asking for policy documentation cannot be satisfied on the employment-injury side. Those requirements move onto general liability, professional liability, auto and umbrella, which is where our work is. The private program carries more contractual weight here, and it should be built accordingly.
Working across five borders
Ohio borders five states and Cincinnati reaches into two of them, so caregivers crossing a line is routine here. BWC references out-of-state employee coverage, out-of-state employers, and coverage arranged through the administrator or an other-states insurer. We have not set out how those arrangements work, because we could not verify the detail. Take it to BWC directly, and tell us every state your caregivers work in so the private lines are built for the same footprint.
What this page does not say, and why
The BWC pages we read state no headcount threshold, and ORC 4123.35 speaks of private employers without one, but we could not confirm a clean statement either way, so this page asserts none. It describes no domestic or household treatment, no owner or officer rules, no penalty figures and no reporting deadline, for the same reason.
Ohio licensing and regulatory context
Short version, because you already hold your licence. It earns space because the category you hold is what a carrier underwrites against, and because Ohio's regime is newer than most and still commonly misdescribed.
Non-medical home care in Ohio is licensed. Licensing runs through the Ohio Department of Health under ORC chapter 3740, with rules at OAC 3701-60. ORC 3740.02 carries an effective date of 30 September 2021 under House Bill 110 of the 134th General Assembly, and the chapter has been amended since, with ORC 3740.01 effective 3 October 2023 under House Bill 33. Guidance published before autumn 2021 saying Ohio requires no licence for non-medical work is out of date.
There are two licence types, nonmedical home health services and skilled home health services. A skilled licence also authorises nonmedical services; a nonmedical licence does not authorise skilled. ORC 3740.02 also bars an unlicensed agency from holding the agency, or any employee of the agency, out as a provider of services it is not licensed for, which is a marketing restriction as well as an operational one.
Two application requirements are worth knowing because both touch insurance and neither is common elsewhere. The Department requires the primary owner of an agency seeking a nonmedical licence to provide a fingerprint impression card rather than a criminal record check. And applicants whose business was not providing direct care on or immediately prior to 30 September 2021 must obtain a surety bond issued by a company licensed to do business in this state.
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 it sits on a different footing from personal care and companion work.
Ohio's licensure chapter is wired into the aging-services framework: ORC 3740.01 defines community-based long-term care provider and subcontractor by reference to Department of Aging provisions at ORC 173.39 and 173.38. Beyond that we will not describe Ohio Medicaid's in-home programmes, because we could not confirm how they are structured or funded.
What matters commercially is the point this page opened with: your limits are set by the hospitals, health systems and payers you contract with, not by any Ohio statute. That is why we ask to see the contract language rather than guessing at a number. If your agency holds a skilled licence, our home health agency insurance page covers how that program is built. For the nonmedical side, see personal care services.
The Ohio home care market
Ohio has about 11.88 million residents, and roughly 2.21 million of them are 65 or older, close to 18.8 percent of the civilian population.
Ohio has no single dominant city. Cincinnati holds about 2.30 million and spans into Kentucky and Indiana, Columbus about 2.23 million, and Cleveland about 2.17 million, with Dayton and Akron behind them. Appalachian southeast Ohio is rural, with lower density and long drives between visits.
For an operating agency that shape means two things. A statewide book is really three or four metro books plus a rural one, each with its own referral relationships and driving profile. And with five borders and a metro reaching into two of them, caregivers working over a line is ordinary, which is the most common gap we find in an established Ohio program.
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. Read our Pennsylvania, Michigan, Indiana, Kentucky and West Virginia pages, and the full list is on our coverage by state hub.
Ohio resources for home care providers
The sources behind everything above.
- Home health agency licensure, Ohio Department of Health, where the fingerprint card and surety bond requirements are stated.
- Non-medical home health services licence application.
- ORC chapter 3740, the home health agency licensure chapter.
- ORC 3740.02, the licence requirement, carrying its 30 September 2021 effective date and House Bill 110 origin.
- ORC 4123.35, payment of premiums into the state insurance fund and self-insurance.
- Getting coverage, Ohio Bureau of Workers' Compensation.
- Ohio Council for Home Care & Hospice, the state association.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why Ohio agencies choose HCBI
We are straightforward about the one thing we do not do here. Your workers compensation comes from BWC, we do not place it, and we will not pretend otherwise to win a conversation.
What we do is everything BWC leaves on your side of the line, and in Ohio that is more than it is elsewhere. A health system requires additional insured status a state fund account cannot carry. A payer wants a waiver of subrogation. A facility asks for policy documentation. A caregiver crash on a Columbus commute or a southeast Ohio route exposes how little a personal auto policy does on a work trip. Each of those lands on the private program, which is ours to build and endorse.
On the Ohio facts we are careful with dates, because this is a state where they are commonly got wrong. ORC 3740.02 carries an effective date of 30 September 2021 under House Bill 110 in its own published metadata, and the surety bond requirement keys off that same date. Another operative date circulates widely; we could not confirm it on the Department's own page, so it does not appear here.
We place coverage through exclusive carrier programs that write home care risks, and we coordinate the private side of the program end to end: general liability with the additional insured wording your contracts demand, professional liability, commercial and hired and non-owned auto, umbrella limits to reach what your contracts require, cyber, and abuse and molestation coverage of up to $1 million. That reach is backed by working relationships across the wider 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.
Ohio home care insurance FAQ
Answers for agencies already operating under Ohio 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 and auto 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 wording matters as much as the number.
On your general liability, and it has to, because your BWC coverage is a state fund account rather than a private policy a broker can endorse. That is the practical shape of operating in a monopolistic state: the requirements a hospital or facility writes into a contract land on the private lines of your program. Send us the wording as soon as it arrives, because additional insured status, a waiver of subrogation and primary and non-contributory language are endorsements rather than certificate text.
No. Ohio is a monopolistic state and we do not place the line here. Ohio employers pay premiums into the state insurance fund administered by the Bureau of Workers' Compensation, and ORC 4123.35 is titled for payment of premiums by employers and self-insurance. The alternative to the fund is qualifying as a self-insuring employer, not buying from a carrier. Everything else in your program is ordinary private-market business and is ours to build.
Not person by person. Your private lines are rated on payroll and headcount estimates and trued up at audit, so ordinary hiring and turnover does not require a policy change. What does need reporting is a change in what the agency does: a move from a nonmedical licence into skilled services, a new office, agency-owned vehicles, an acquisition, or regular work over a state line. Your BWC account is administered separately.
It depends on the line, and Ohio raises this more than most states because it borders five and the Cincinnati metro reaches into both Kentucky and Indiana. Liability and auto usually travel, but a contract over the line can demand wording your Ohio policy does not carry. On the employment-injury side, BWC references out-of-state employee coverage and coverage arranged through an other-states insurer. We could not verify the mechanics, so confirm that with BWC and tell us every state your caregivers actually work in.
Keep payroll records split properly by class through the year rather than reconstructing them at the end of it. Separate office staff from caregivers, keep hours and wages clean for anyone who moved between roles, and tell us mid-term when a new service line or a new county changes the picture. Most unwelcome audit results are not pricing decisions, they are records that did not match what the policy was rated on.
Rarely. The route exists, and ORC 4123.35 addresses payment of premiums by employers and self-insurance together, so an employer can qualify as a self-insuring employer instead of paying into the state insurance fund. In practice that is built for very large employers with the balance sheet and claims administration to carry it. For a home care agency the state fund is normally the answer, and either way it is not a line a broker places.
Ohio runs two licence types under ORC chapter 3740, nonmedical home health services and skilled home health services. A skilled licence also authorises nonmedical services; a nonmedical licence does not authorise skilled work. Note that ORC 3740.02 bars an unlicensed agency not only from providing skilled services but from holding the agency, or any employee of the agency, out as a provider of them. That is a marketing restriction as well as an operational one, so check your own website and proposals against the licence you hold.
Loss runs for the last five years, current declarations pages for every private line, payroll by class, caregiver headcount, the counties you serve, and the insurance exhibits from your largest contracts. Start sixty to ninety days out rather than in the last fortnight. A non-renewal shortens the list of carriers, and lead time is what buys the options back.
Send us the contract and we will build to it
Tell us your payroll and caregiver count, which licence you hold, the states your caregivers actually work in, and what your largest contract requires. If a health system wants wording your current policy does not carry, start there. A specialist will place the private side of your program through exclusive carriers that write home care in Ohio. There is no obligation.