General Liability
The foundation Pennsylvania hospitals and facilities expect, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
Pennsylvania Home Care Insurance
For agencies already operating in Pennsylvania. 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 Pennsylvania 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 Pennsylvania, and we do it mid-term when the contract will not wait.
Two Pennsylvania facts shape an established agency's program more than anything else. Workers compensation attaches from the first employee and reaches family members working in the business, and every location needs its own licence because the state does not recognise branch offices. Both are easy to drift out of step with.
An agency running seventy-five to a hundred caregivers across Philadelphia, Pittsburgh or Harrisburg has a different problem from a startup, and this page is written for the former.
What Pennsylvania contracts require, and what happens when yours falls short
On liability the numbers come from your contracts rather than a statute, and they ask more than the law does.
What the contracts typically ask for
Hospitals, facilities 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 where hospital partnerships demand higher totals.
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.
One Pennsylvania wrinkle is worth raising early. Because each location is separately licensed, a counterparty contracting with a second office is contracting with a separately licensed entity. Make sure the certificate names the right one, and tell us when a location opens.
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, 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, 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 already does. If a Philadelphia or Pittsburgh 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 already on file should carry over rather than be rebuilt each year.
What to report during the year
Adding and removing caregivers does not require a policy change each time, because 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 new location, which in Pennsylvania is a separate licence rather than a branch, with its own inspection and renewal cycle.
- A move from non-medical work under Chapter 611 into skilled care under Chapter 601.
- Agency-owned vehicles, which need commercial auto rather than a caregiver reimbursement arrangement.
- A family member joining the payroll, because Pennsylvania treats them as employees for workers compensation.
- 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.
Your renewal inspection is worth tracking alongside your policy dates. The Department inspects before each renewal and deficiencies need an accepted plan of correction before the licence issues, so it is not a date to discover late.
Coverages Pennsylvania home care agencies carry
The full program, sized to your license model, contracts, and driving. Each coverage has a page of its own.
Professional Liability
Clinical claims coverage for Pennsylvania skilled agencies licensed under Chapter 601, weighted for the exposure Medicare-certified home health carries.
Professional liability coverageWorkers Compensation
Required from your very first employee with no payroll floor, family members counted, and a 1099 label carrying no weight. Priced on payroll and your experience modifier.
Workers compensation coverageCommercial Auto
Coverage for agency-owned vehicles carrying caregivers through Philadelphia and Pittsburgh traffic and across long rural routes, where a personal policy will not respond.
Commercial auto coverageHired and Non-Owned Auto
For caregivers driving their own cars for work, a short city run or a long rural route alike, an exposure most Pennsylvania 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 and the state requires Older Adults Protective Services Act background checks before service starts.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked on your liability and auto, the efficient way to reach the totals Pennsylvania hospital 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. Size it carefully where each location holds its own license.
Home care agency insuranceProvider types we insure in Pennsylvania
Home Care Agencies
Agencies licensed under 28 Pa. Code Chapter 611 that directly employ their caregivers, delivering non-medical personal care and companion services.
Home care agency insuranceHome Health Agencies
Skilled agencies licensed separately under 28 Pa. Code Chapter 601, delivering care under a plan of care and able to pursue Medicare certification.
Home health agency insurancePersonal Care Services
Bathing, dressing, and daily living support, the work Chapter 611 licenses and Pennsylvania's Medicaid program helps fund.
Personal care services coverageSenior Care Providers
Agencies serving one of the country's oldest populations by share of residents 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 coveragePennsylvania workers compensation for home care agencies
Pennsylvania's hardest insurance rule has no number attached to it, which is what makes it easy to miss.
From the very first employee
Workers compensation is required from the very first employee. No minimum employee threshold, no payroll floor, no grace period while you are small. Coverage is governed by the Pennsylvania Workers' Compensation Act and administered by the Pennsylvania Department of Labor and Industry, and full-time, part-time and seasonal workers all count. That is among the strictest positions in the country. Read how the coverage works on our workers compensation page.
Family members count as employees
This is the Pennsylvania point worth reading twice, and it catches established agencies as often as new ones. Pennsylvania is unusual in that family members who work for the business are treated as employees and must be covered.
Plenty of agencies grow the way you would expect: an owner, a spouse handling scheduling, an adult child on weekend shifts. Owners assume family sits outside the requirement. Here it does not. If a family member works for the business they belong on the policy, and that gap stays quiet until one of them is the person who gets hurt.
A 1099 does not solve it
Paying a caregiver on a 1099 does not by itself remove the obligation. Pennsylvania's definition of employee for workers compensation purposes is broad and looks past the W-2 versus 1099 label. A Home Care Registry that genuinely refers independent contractors runs a licensed model. An agency that schedules, trains and supervises its caregivers but writes them 1099s to stay outside the requirement is doing something else, and here that is a serious risk rather than a gray area.
What going uninsured costs
Failing to carry required coverage is a misdemeanor. A conviction can bring a fine of up to $2,500 and up to one year in prison, with each day uninsured counted as a separate offense, which compounds fast for an agency that went a season without coverage. If a court finds the violation intentional it becomes a felony, with a fine up to $15,000 and up to seven years in prison.
An uninsured employer must also reimburse the state's Uninsured Employers Guaranty Fund for anything it pays out, plus interest, fees and attorney fees, so the agency pays the claim anyway on top of the penalty. High-risk businesses unable to buy private coverage can access the State Workers' Insurance Fund, so going without is never the only option.
How it is priced
Workers compensation is priced per $100 of payroll rather than as a flat premium, and your experience modifier adjusts it up or down based on your claims history. A clean claims record is the single best lever you control, and it improves how carriers underwrite the rest of your program.
Pennsylvania licensing and regulatory context
Short version, because you already hold your licence. It earns space because which of Pennsylvania's two models you hold changes the whole insurance picture.
Non-medical home care is licensed by the Pennsylvania Department of Health, through its Division of Home Health, under 28 Pa. Code Chapter 611. Skilled home health agencies are licensed separately under 28 Pa. Code Chapter 601. Chapter 611 licenses two models: a Home Care Agency directly employs its caregivers, while a Home Care Registry refers independent contractors to clients. An agency that employs caregivers carries workers compensation for them and direct liability for their work. A registry's exposure is shaped differently, so tell us which licence you hold.
Three operating details matter at renewal. Each physical location must be separately licensed, because Pennsylvania does not recognise branch offices in home care. The Department inspects before the initial licence and again before each renewal, with deficiencies requiring an accepted plan of correction first. And direct care workers require competency testing or approved training, criminal background checks under the Older Adults Protective Services Act including an FBI check for recent out-of-state residents, and TB screening before service starts.
Medicare, Medicaid and what actually sets your limits
Pennsylvania funds home and community-based long-term care through its Medicaid program. For an agency, that funding is what turns an aging population into an actual client pipeline.
Medicare comes in separately, covering short-term skilled home health for agencies certified under Chapter 601. Those clinical services raise the stakes on documentation and on professional liability. The two sides carry different exposures and often different licence chapters, so a program treating them as one thing tends to be wrong about both.
What sets your limits is neither programme. It is the hospitals, facilities and payers you contract with, which 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 Pennsylvania home care market
Pennsylvania has about 13 million residents and one of the oldest populations in the country by share of residents 65 and older. That is the population home care serves, and here it is a larger slice than in most states. Demand is large, aging and durable.
It is also spread across two very different kinds of territory. The largest markets are Philadelphia, Pittsburgh, Allentown and Harrisburg. Outside those metros, substantial demand runs across rural Pennsylvania, where seniors age in place with fewer agencies nearby.
That split is the practical fact for an established operator, because most run both books at once. Philadelphia means dense traffic and short trips stacked back to back, where the exposure is accident frequency. Rural counties mean long drives and hours on the road. Pricing either as though it were the other gets the auto exposure wrong in both directions. And because Pennsylvania does not recognise branch offices, an agency covering wide territory often runs it from one licensed location, which means more road time per caregiver rather than less.
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. If your caregivers work beyond Pennsylvania, the program has to satisfy each state they enter. Operators working the eastern border can read our New Jersey and New York pages, and the full list is on our coverage by state hub.
Pennsylvania resources for home care providers
These are the Pennsylvania bodies that shape how home care operates. We name them so you know where each requirement comes from.
- Pennsylvania Department of Health, Division of Home Health, which licenses non-medical home care under 28 Pa. Code Chapter 611 as a Home Care Agency or a Home Care Registry, and skilled home health under Chapter 601.
- Pennsylvania Department of Labor and Industry, which administers workers compensation under the Pennsylvania Workers' Compensation Act.
- State Workers' Insurance Fund, the route to coverage for high-risk businesses unable to buy private coverage.
- Uninsured Employers Guaranty Fund, which pays claims against uninsured employers and seeks reimbursement with interest, fees, and attorney fees.
- Pennsylvania Homecare Association, the state home care industry body representing agencies through advocacy.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why Pennsylvania 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 on a Philadelphia commute or a long rural 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 of it.
On Pennsylvania specifically, the first question we ask is which Chapter 611 model you hold, because a program built for an agency that employs caregivers rests on different assumptions from one built for a registry. We also know the two things that quietly go out of step as an agency grows: family members on the payroll who belong on the workers compensation policy, and a second location that is a separate licence rather than a branch office.
We place coverage through exclusive carrier programs that write home care risks, and we coordinate the whole program: general liability, professional liability, workers compensation from the first employee, commercial and hired and non-owned auto for metro traffic and long rural drives alike, umbrella limits to reach what your contracts demand, cyber, and abuse and molestation coverage of up to $1 million. Given the state's own background-check and screening rules, we treat that limit as essential rather than an afterthought. 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.
Pennsylvania home care insurance FAQ
Answers for agencies operating under Pennsylvania 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 does not require a policy change. What does need reporting is a change in what the agency does: a new licensed location, a move into skilled care under Chapter 601, agency-owned vehicles, an acquisition, or a family member joining the payroll.
From the very first employee. There is no minimum employee threshold, no payroll floor and no grace period while you are small. Coverage is governed by the Pennsylvania Workers' Compensation Act and administered by the Department of Labor and Industry, and full-time, part-time and seasonal workers all count. That is among the strictest positions in the country.
Yes, and this is the Pennsylvania point that catches established agencies most often. Pennsylvania is unusual in treating family members who work for the business as employees who must be covered. A spouse handling scheduling or an adult child picking up weekend shifts counts. Owners routinely assume family sits outside the requirement, and here it does not. The gap stays quiet until one of them is the person who gets hurt.
No. Each physical location must be separately licensed, because Pennsylvania does not recognise branch offices in home care. A second office means a second licence rather than an extension of the first, and each location brings its own inspection and renewal cycle. Operators who plan expansion around one licence and a satellite office tend to find out late, usually after signing a lease, so tell us and the Department early.
Failing to carry required coverage is a misdemeanor. A conviction can bring a fine of up to $2,500 and up to one year in prison, with each day uninsured counted as a separate offense, which compounds fast. If a court finds the violation intentional it becomes a felony, with a fine up to $15,000 and up to seven years in prison. An uninsured employer must also reimburse the state's Uninsured Employers Guaranty Fund for anything it pays out, plus interest, fees and attorney fees. High-risk businesses unable to buy private coverage can access the State Workers' Insurance Fund.
Non-medical home care is licensed by the Pennsylvania Department of Health, through its Division of Home Health, under 28 Pa. Code Chapter 611. Skilled home health agencies are licensed separately under 28 Pa. Code Chapter 601. Chapter 611 covers two models: a Home Care Agency directly employs its caregivers, and a Home Care Registry refers independent contractors to clients. Which one you hold changes the insurance picture, so it is the first thing we ask.
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, which Chapter 611 model you hold, how many licensed locations you 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 Pennsylvania. There is no obligation.