General Liability
The contract-driven coverage Texas hospitals and facilities expect to see, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
Texas Home Care Insurance
For agencies already operating in Texas. If a hospital or facility contract has just demanded limits or 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 a Texas 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 Texas, and we do it mid-term when the contract will not wait.
Texas adds one decision no other state asks you to make. Workers compensation is optional here, so every operating agency in the state is either a subscriber or a nonsubscriber, and many made that choice years ago and have not looked at it since. It is worth looking at, because it changes both what you are exposed to and what you can evidence to a counterparty.
An agency running seventy-five to a hundred caregivers across Houston, Dallas and Fort Worth, San Antonio or Austin has a different problem from a startup, and this page is written for the former.
What Texas contracts require, and what happens when yours falls short
Texas sets no universal statutory dollar minimum for general liability or professional liability simply to hold a basic HCSSA licence. That does not mean you can operate thin. The real requirements come from your contracts.
What the contracts typically ask for
Hospitals, facilities, managed care payers and referral partners across the Houston, Dallas and Fort Worth, San Antonio and Austin markets 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 skilled care runs under a plan of care, often at matching limits. Evidence of workers compensation, which in Texas is its own conversation. Auto liability covering agency vehicles and caregivers driving their own. Abuse and molestation coverage, increasingly named rather than assumed. And an umbrella to lift the total where the primary layers stop.
Wording 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 of cancellation. Each is an endorsement on a policy rather than a sentence on a certificate.
The workers compensation line is where Texas agencies most often get caught. A nonsubscriber has nothing to put on a certificate under that heading, and a hospital or facility that requires evidence of coverage will not treat nonsubscriber status as an equivalent. That is a contracting consequence of the opt-out, separate from the liability consequence, and it is the one that tends to surface at the worst moment.
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 underneath.
The third is re-marketing, where a carrier will not extend or the required 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. Both are where a placement quietly fails.
Certificates
A certificate is evidence, not coverage. It states only what a policy already does. If a Houston or Dallas 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 insurance 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 HCSSA category, particularly a move from personal assistance services into skilled home health.
- A new branch, 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 Louisiana, Oklahoma, New Mexico or Arkansas.
- A change in your subscriber or nonsubscriber position, which changes what you can evidence as well as what you are exposed to.
- 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.
Your HCSSA renewal runs on a three-year cycle, which is long enough that it is easy to forget until operations and billing are disrupted. It is worth carrying that date in the same place you carry your policy dates.
Coverages Texas 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 skilled Texas agencies, weighed against the state's damages caps.
Professional liability coverageWorkers Compensation
Optional in Texas and nowhere else. The opt-out decision, and the nonsubscriber liability that comes with it, explained in full.
Texas workers comp coverageCommercial Auto
For agency-owned vehicles across the metros and the long routes through West Texas, the Panhandle and the Valley.
Commercial auto coverageHired and Non-Owned Auto
The line most established Texas agencies are short on, covering caregivers who drive their own cars long distances 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, and the usual answer where economic damages are uncapped.
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 Texas
Home Care Agencies
Non-medical Texas agencies, often holding the Personal Assistance Services category.
Home care agency insuranceHome Health Agencies
Skilled, Medicare-certified agencies operating under Chapter 558 in Texas.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the core of a Texas personal assistance book.
Personal care services coverageSenior Care Providers
Agencies serving the roughly 4.4 million Texans 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 and adult family homes operating in Texas.
Group home care coverageTexas workers compensation for home care agencies
This is the section that makes Texas different from every other state on this site, and for an operating agency it is a decision to review rather than a rule to comply with.
Optional, and only here
Texas is the only state where workers compensation is optional for private employers, with no employee-count threshold that triggers a requirement. A Texas home care agency can legally operate as a nonsubscriber, carrying no workers compensation at all.
That option is unique to Texas, and it is also a trap for the unwary. An agency that opts out forfeits the common-law defenses that normally protect an employer, so an injured caregiver can sue the agency directly for negligence with those defenses stripped away. In a field where lifting and transfer injuries are the most common claim, that exposure can dwarf the premium an agency thought it was saving.
The part that shows up in contracts
There is a second consequence that gets less attention and lands sooner. A nonsubscriber has nothing to evidence when a hospital, facility or payer asks for proof of workers compensation, and most will not accept an explanation in place of a certificate. An agency that opted out years ago as a small operation can find the decision quietly capping which contracts it can win.
So the question we actually ask an established Texas agency is not whether the opt-out is legal, which it plainly is, but whether it still fits the business you are running now. Compare the tradeoffs on our workers compensation coverage page, and tell us what your largest contracts require before you decide.
If you subscribe
Coverage is priced per $100 of payroll, and each carrier applies its own loss cost multiplier to the published rates, with your experience modifier then raising or lowering the result based on your claims history. Two Texas agencies with the same payroll can pay meaningfully different premiums for that reason, and a clean claims record is the single best lever you control.
One related exposure worth naming, because it catches agencies on both sides of the decision: misclassifying caregivers as 1099 contractors. Texas regulators and courts can reclassify workers as employees, which exposes an agency that skipped coverage and creates back-liability for an injury it assumed was not its problem.
Texas licensing and regulatory context
Short version, because 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 Texas is regulated by the Texas Health and Human Services Commission, through its Long-Term Care Regulatory Division and the HCSSA unit, under 26 Texas Administrative Code, Chapter 558. Texas uses a single licensing framework, the Home and Community Support Services Agency, with categories matched to the care you provide: Personal Assistance Services for non-medical work, a licensed home health category for skilled care, and certified status for Medicare billing.
Two operating details matter more than the rest. The licence renews every three years under 26 TAC section 558.3, a cycle long enough to forget. And Texas requires no Certificate of Need, so entry is not gated on demonstrating community demand, which is part of why the major metros are as competitive as they are.
Medicare, Medicaid and what actually sets your limits
Medicare covers short-term skilled home health under a plan of care, raising the stakes on documentation and on professional liability. Texas Medicaid, administered by HHSC, funds a large share of home and community based care.
What sets your limits, though, is a combination of your contracts and the size a Texas claim can reach. On the second point Texas is relatively predictable, because of the tort reform in the Civil Practice and Remedies Code. Under section 74.301, noneconomic damages are capped at $250,000 per claimant against a physician or individual provider and $250,000 per institution, with a total ceiling of $750,000 where multiple defendants are involved. The wrongful death all-damages cap under section 74.303 is CPI-indexed and currently exceeds $2.5 million.
The caps only go so far. There is no cap on economic damages, so lost income, medical costs and the cost of future care can still drive a Texas claim well into seven figures. A catastrophic injury to a working-age client or a fragile patient needing lifetime care is exactly the scenario an umbrella exists for, which is why agencies serving higher-acuity clients or holding large contracts carry one over their primary limits. 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 Texas home care market
Texas is one of the largest home care markets in the country, and the demographics behind it keep growing. Roughly 4.4 million Texans are 65 and older, about 14 percent of the state population, and that number climbs every year as Texas adds residents faster than most states.
Demand concentrates in the major metros. Houston, the Dallas and Fort Worth area, San Antonio and Austin anchor most of the state's home care activity, with large senior populations, dense hospital systems and the referral relationships that come with them. Agencies in those markets usually need higher contract-driven limits to partner with the local health systems.
Rural Texas is a genuinely different exposure. The distances between clients across West Texas, the Panhandle and the Rio Grande Valley put real miles on caregivers' vehicles, which is why 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.
Texas borders four states, so many agencies serve clients or recruit staff across a line, and a program has to satisfy each state's rules where caregivers actually work. Read our Louisiana, Oklahoma, New Mexico and Arkansas pages, and the full list is on our coverage by state hub.
Texas resources for home care providers
The Texas sources behind everything above. Each opens in a new tab.
- Texas Health and Human Services Commission, the regulator for HCSSA licensing and the Long-Term Care Regulatory Division.
- 26 Texas Administrative Code, Chapter 558, the rules governing Home and Community Support Services Agencies, published through the Texas Secretary of State.
- Texas Medicaid, the state programme funding a large share of home and community based care.
- Texas Association for Home Care and Hospice, the state industry association for advocacy, education and updates.
- Texas Department of Insurance, for insurance regulation in Texas and to file a complaint about a carrier.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why Texas agencies choose HCBI
We work with agencies that are 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 long Panhandle route exposes how little a personal auto policy does on a work trip. Those are the calls, and they are why we ask for the insurance exhibit rather than a summary of it.
On Texas specifically, we can talk through the subscriber and nonsubscriber decision in plain terms rather than treating it as a box already ticked, explain how the Chapter 558 categories map to what you actually deliver, and size your liability to the contracts you are chasing in the Houston, Dallas and Fort Worth, San Antonio and Austin systems. A generalist broker rarely understands why a Texas agency might opt out of workers compensation, or why that choice can quietly limit which contracts it can win.
We place coverage through exclusive carrier programs that write home care risks, and we coordinate the whole program: general liability, professional liability, the workers compensation decision, commercial and hired and non-owned auto for long Texas routes, 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.
Texas home care insurance FAQ
Answers for agencies already operating under Texas 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 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 hiring and turnover does not require a policy change. What does need reporting is a change in what the agency does: a new HCSSA category, a move from personal assistance services into skilled care, a new branch, agency-owned vehicles, an acquisition, or regular work over a state line.
No. Texas is the only state where workers compensation is optional for private employers, with no employee-count threshold that forces coverage. A Texas home care agency can legally operate as a nonsubscriber, carrying none at all. That option is genuinely unique to Texas, and it is the single decision on this page most worth revisiting at renewal rather than leaving as it was set years ago.
An agency that opts out forfeits the common-law defenses that normally protect an employer, which means an injured caregiver can sue the agency directly for negligence with those defenses stripped away. In a field where lifting and transfer injuries are the most common claim, that direct exposure can dwarf the premium the agency thought it was saving. It also shows up in contract negotiations, because a counterparty asking for evidence of workers compensation will not accept nonsubscriber status as a substitute. We walk through the subscriber and nonsubscriber decision rather than letting an agency stumble into it.
No. Texas sets no universal statutory dollar minimum for general liability or professional liability simply to hold a basic HCSSA licence. In practice the limits are driven by your contracts: hospitals, facilities, managed care payers and referral partners commonly require $1 million per occurrence and often more. The absence of a statutory floor does not mean you can operate thin, because the market sets the real requirement and it moves without notice.
Under Texas Civil Practice and Remedies Code section 74.301, noneconomic damages are capped at $250,000 per claimant against a physician or individual provider and $250,000 per institution, up to a total of $750,000 when multiple defendants are involved. The wrongful death all-damages cap under section 74.303 is CPI-indexed and currently exceeds $2.5 million. There is no cap on economic damages, so lost income, medical costs and the cost of future care can still drive a Texas claim well into seven figures. That is why agencies serving higher-acuity clients or holding large contracts carry an umbrella over their primary limits.
The Texas Health and Human Services Commission, through its Long-Term Care Regulatory Division and its HCSSA unit, administering the rules in 26 Texas Administrative Code, Chapter 558. Providers are licensed as a Home and Community Support Services Agency, with the category matching the services delivered: non-medical agencies typically hold Personal Assistance Services, agencies providing skilled care hold a licensed home health category, and Medicare billing requires certified status. The licence renews every three years under 26 TAC section 558.3.
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 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, where in Texas you operate, whether you subscribe to workers compensation, 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 Texas. There is no obligation.