General Liability
The layer Tennessee hospitals and health systems name first, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
Tennessee Home Care Insurance
For agencies already operating in Tennessee. 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 Tennessee 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 Tennessee, and we do it mid-term when the contract will not wait.
Most of what an established Tennessee agency needs from a broker is not education. You hold your licence, you carry coverage, and you know what caregiving costs. What you need is a program that keeps pace: limits that move when a contract moves, certificates that arrive the day they are asked for, and a renewal that does not surprise you.
An agency running seventy-five to a hundred caregivers across Nashville, Memphis or Knoxville has a different problem from a startup, and this page is written for the former.
What Tennessee contracts require, and what happens when yours falls short
No Tennessee 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 is delivered under a plan of care, and often at matching limits. Workers compensation at statutory limits with employers liability behind it. Auto liability covering both agency vehicles and caregivers driving their own. Abuse and molestation coverage, increasingly named specifically rather than assumed. And an umbrella to lift the total where the primary layers stop.
The wording usually matters as much as the number. Contracts routinely ask to be named as an additional insured, for a waiver of subrogation, for your cover to respond on a primary and non-contributory basis, and for advance notice if the policy is cancelled. Each of those is an endorsement on a policy rather than a sentence on a certificate.
When the contract asks for more than you carry
This is the situation that brings most established agencies to us, so it is worth being concrete about the routes out of it.
The first is endorsement. Sometimes the incumbent carrier will raise a limit or add the required wording mid-term for additional premium, and that is the fastest path when 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 usually get there quicker and for less than rebuilding the primary program underneath.
The third is re-marketing. Where the 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 us contract language when it first appears rather than the week it has to be signed.
What we ask for is the insurance exhibit itself. A summary loses the wording, and the wording is what an underwriter has to agree to.
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 worth getting right, because both are where a placement quietly fails.
Certificates
A certificate is evidence, not coverage. It can only state what the policy already does. If a Nashville 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 whether to add the endorsement, not paperwork.
So the habit that helps is simple: when a new client, facility or payer sends paperwork, send us the insurance requirements immediately. Renewals of 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 policy change each time, because the program is rated on payroll and headcount and trued up at audit. What does need reporting is a change in the shape of the agency.
- A new service line, particularly a move from personal care into skilled nursing or therapy.
- 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 Mississippi, Arkansas, Georgia, Kentucky, Alabama, Virginia, North Carolina or Missouri.
- 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 Tennessee home care agencies carry
The full program, sized to your payroll, territory and contracts. Each coverage has a page of its own.
Professional Liability
Clinical claims coverage for care delivered under a plan of care, usually required at limits matching your general liability.
Professional liability coverageWorkers Compensation
Required in Tennessee at five or more employees, counting full-time and part-time alike, with employers liability behind it.
Workers compensation coverageCommercial Auto
For agency-owned vehicles running Nashville and Memphis traffic and the long routes through the rural middle and the eastern mountains.
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, auto and employers liability, 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 Tennessee
Home Care Agencies
Non-medical agencies delivering personal care and companion work across the three metros and the rural counties between them.
Home care agency insuranceHome Health Agencies
Agencies licensed by the Health Facilities Commission delivering care under a plan of care.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the core of a Tennessee non-medical book.
Personal care services coverageSenior Care Providers
Agencies serving the roughly 1.24 million Tennessee 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 coverageTennessee workers compensation for home care agencies
Tennessee workers compensation is administered by the Department of Labor and Workforce Development, Bureau of Workers' Compensation, and its threshold is one of the higher ones in the country.
Five or more employees
The Bureau states that businesses engaged in the construction industry are required to have workers' compensation coverage for everyone including the business owners, and that other businesses need insurance if there are five or more employees. A home care agency is in the second group. Full-time and part-time employees both count toward the five, which matters here more than in most industries, because part-time scheduling is how home care staffs itself. Four full-time caregivers and two weekend part-timers is six employees, not four.
The rule most states do not have
Tennessee says something explicitly that almost every other state leaves unaddressed. The Bureau states that if an employer has five or more employees and its workforce drops below five, the employer may elect to drop its workers' compensation coverage.
That is genuinely useful to an operating agency, and it deserves one caution. The word is elect. It describes a choice rather than an automatic result, and the choice has consequences beyond the statute. Your contracts may require workers compensation whatever Tennessee permits, so a hospital or payer agreement can make the election unavailable in practice. Coming back onto cover later also means re-underwriting, at whatever your loss history looks like then.
The domestic servant exemption, and what Tennessee does not say
Tennessee lists domestic servants among its non-construction exemptions, described as household employees and their employers. Elsewhere the Bureau states that domestic help are exempt from the coverage requirements but may elect to purchase workers' compensation coverage anyway.
Read the wording rather than the label. It is written around a household and the people that household employs. It says nothing about a caregiver on a home care agency's payroll, and Tennessee does not resolve the point either way. Some states do: West Virginia's rule expressly removes agency employees from domestic services, and Oregon expressly names home health workers inside its definition. Tennessee is silent, so we will not tell you the exemption reaches your caregivers, and we will not tell you it captures them. Treating silence as an exemption is a decision rather than a finding.
The other exemptions, and the one that will not help
Tennessee's non-construction exemption list also covers casual employment, farm and agricultural laborers, government entities at state, county and municipal level, volunteer ski patrol, and interstate common carriers already regulated by federal law. Small employers with fewer than five regularly employed individuals sit outside the requirement as well, which is the same five-employee test stated from the other direction.
The casual employment exemption is the one agencies ask about, and in Tennessee it is defined by the nature of the task rather than its duration: individuals employed for tasks outside the employer's regular trade, business, profession, or occupation. Caregiving is squarely inside a home care agency's regular business, so this exemption should not be expected to apply however irregular the shift pattern is.
Tennessee licensing and regulatory context
Short version, because if you are reading this you already hold your licence. It earns space only because the category you hold is what a carrier underwrites against and what a contract counterparty thinks it is buying.
Home care in Tennessee is licensed by the Tennessee Health Facilities Commission, through its Division of Licensure and Regulation, under a Home Care Organization licence covering service categories. Current Commission rules sit in chapter 0720-27.
One thing worth knowing if you are checking your own paperwork against published guidance. Licensure moved to the Health Facilities Commission from the Department of Health, and older material still names the Department as the licensing body. Rules published under the Department's chapters may be superseded, so check the date on anything you rely on.
We could not establish to our own standard where Tennessee draws the line for purely non-medical personal support work, so this page does not claim to know. Confirm your own position with the Commission and tell us the answer, and we will build the program to the licence you actually hold rather than to a label.
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.
We are not going to describe Tennessee's Medicaid in-home programmes, because we could not confirm how they are structured or funded. Those details should come from the state.
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 Tennessee statute. That 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 Tennessee home care market
Tennessee has about 7.23 million residents, and roughly 1.24 million of them are 65 or older, about 17.5 percent of the civilian population.
Three large metros sit along a long, narrow state. Nashville and its surrounding counties hold about 2.15 million. The Memphis area holds about 1.34 million and spans Mississippi and Arkansas. Knoxville holds about 958,000. Chattanooga spans Georgia and Clarksville spans Kentucky, and the rural middle and the eastern mountains carry long drives between visits.
Tennessee borders eight states, more than almost anywhere in this set, and three of its metro areas cross a line. For an agency of any size that makes multi-state exposure ordinary rather than exceptional, and it is the single most common gap we find in an established Tennessee program: caregivers routinely working over a border on a policy that contemplates one state.
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 Kentucky, Arkansas, Missouri and North Carolina pages, and the full list is on our coverage by state hub.
Tennessee resources for home care providers
The sources behind everything above.
- Who must carry workers' compensation insurance, the Bureau of Workers' Compensation page the five-employee rule comes from.
- Non-construction requirements and exemptions, including the domestic servant listing.
- Insurance exemptions, where the election to purchase coverage anyway is stated.
- Health Facilities Commission, Division of Licensure and Regulation.
- Home Care Organization licensure applications.
- Health Facilities Commission rules, chapter 0720-27.
- Home Care Association of America, Tennessee chapter. A Tennessee-specific association domain is live but refused our automated checks, so we have not linked it unverified.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why Tennessee agencies choose HCBI
We work with agencies that are already running, and the problems they bring us are contract problems rather than startup 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 Knoxville route exposes how little a personal auto policy does on a work trip. Those are the calls, and they are the reason we ask for the insurance exhibit rather than a summary of it.
On the Tennessee facts we are careful and we say why. The five-employee threshold and the drop-below-five election come straight from the Bureau's own pages. The domestic servant exemption is quoted as Tennessee wrote it and left unresolved for agency caregivers, because Tennessee left it unresolved. Where we could not verify something, including where the state draws the line for purely non-medical personal support work, this page says so rather than filling the gap.
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 and mountain routes alike, umbrella limits to reach what your contracts demand, 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.
Tennessee home care insurance FAQ
Answers for agencies already operating under Tennessee rules.
Usually yes, and usually without waiting for renewal. There are three routes and the contract language decides which one fits. 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. Where the carrier will not go far enough, we re-market the program. Send us the insurance exhibit rather than a summary of it, because the required wording matters as much as the number.
A certificate itself is quick. What takes time is anything the certificate 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 provision. Those are endorsements to the policy, not lines typed onto a form. Send us the contract wording when you first see it, not on the day the certificate is due.
Not caregiver by caregiver. Home care programs are rated on payroll and headcount estimates and then trued up at audit, so hiring six people in Rutherford County does not require a policy change the day they start. What does need reporting is a change in what the agency does: a new service line, a new office, agency-owned vehicles, or a move into skilled work you did not do before. Those change the exposure rather than the volume.
At five or more employees. The Bureau of Workers' Compensation puts it plainly: businesses in the construction industry are required to have coverage for everyone including the business owners, and other businesses need insurance if there are five or more employees. Full-time and part-time employees both count toward the five, which matters in home care where part-time schedules are the norm.
Tennessee is unusually direct about this, and most states are silent on it. The Bureau states that if an employer has five or more employees and its workforce drops below five, the employer may elect to drop its workers' compensation coverage. Note the word elect. It is a choice rather than an automatic result, and it is worth thinking through before making it, because your contracts may require the coverage whatever the statute allows, and going back on cover later restarts the underwriting conversation.
Tennessee lists domestic servants among its non-construction exemptions, described as household employees and their employers, and adds that domestic help are exempt from the coverage requirements but may elect to purchase workers' compensation coverage anyway. We will not tell you it reaches your caregivers. The wording is built around a household and the person that household employs, and it says nothing about a caregiver on an agency payroll. Tennessee does not answer that question, so neither will we.
Tennessee borders eight states and three of its metros cross a line, so this comes up more here than almost anywhere. The answer depends on the line. Workers compensation is state-specific and needs the other state listed properly rather than assumed. Liability and auto usually travel, but a contract in the neighbouring state can demand wording your Tennessee policy does not carry. Tell us every state your caregivers actually work in, including the occasional ones.
The Tennessee Health Facilities Commission, through its Division of Licensure and Regulation, which issues the Home Care Organization licence. Licensure moved to the Commission from the Department of Health, so older guidance naming the Department as the licensing body may be out of date. Current Commission rules sit in chapter 0720-27. Tell us which licence you hold and which services sit under it, because that is what a carrier underwrites against.
Loss runs for the last five years, current declarations pages for every line, your 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 final fortnight. A non-renewal is not a verdict on the agency, but it does shorten the list of carriers, and time is the thing that buys back the options.
Send us the contract and we will build to it
Tell us your payroll and caregiver count, the states your caregivers actually work in, 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 Tennessee. There is no obligation.