General Liability
The contract-driven foundation Virginia hospitals and facilities expect to see, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
Virginia Home Care Insurance
For agencies already operating in Virginia. 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 Virginia 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 Virginia, and we do it mid-term when the contract will not wait.
Virginia is an open market, which is good for entry and hard on incumbents. Nothing gates how many agencies can compete for the same Northern Virginia or Richmond referral, so what you can evidence on a certificate is one of the few things that separates you from the agency behind you in the queue.
An agency running seventy-five to a hundred caregivers across Northern Virginia, Hampton Roads or the Richmond area has a different problem from a startup, and this page is written for the former.
What Virginia contracts require, and what happens when yours falls short
On liability Virginia sets very little by statute. The real requirements come from the contracts you sign.
What the contracts typically ask for
Hospitals, facilities and managed care payers across Northern Virginia, Hampton Roads and Richmond 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 to reach the higher totals hospital partnerships demand.
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.
Because Virginia is an open-market state with no Certificate of Need for home care, those contracts do more work here than the regulator does. The market, not a minimum, sets the number you carry, and an agency that has never been asked for more than $1 million has simply not met the counterparty that will ask.
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 Richmond or Northern Virginia 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 move from companion work into hands-on personal care, which crosses into licensed territory and a different risk profile.
- A new office, or a move into regions you did not previously serve.
- Agency-owned vehicles, which need commercial auto rather than a caregiver reimbursement arrangement.
- Caregivers regularly working across the District of Columbia, Maryland, North Carolina or Tennessee line.
- Taking on subcontractors, because their employees count toward your workers compensation total.
- 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.
Virginia also expects work injuries reported to the Commission within 10 days, so that clock belongs in your process rather than looked up on the day.
Coverages Virginia home care agencies carry
The full program, sized to your services and your contracts. Each coverage below has a page of its own.
Professional Liability
Clinical claims coverage for skilled Virginia agencies, weighted for the professional exposure that skilled and Medicare care carry.
Professional liability coverageWorkers Compensation
Required once you regularly employ more than two people, with caregivers properly classified. Priced on payroll and your experience modifier.
Workers compensation coverageCommercial Auto
Coverage for agency-owned vehicles used to reach and transport clients across Virginia, where a personal policy will not respond.
Commercial auto coverageHired and Non-Owned Auto
The coverage for caregivers driving their own cars for work, an exposure most Virginia agencies have and many overlook.
Hired and non-owned autoAbuse and Molestation
Coverage of up to $1 million for allegations that standard liability excludes, essential given caregivers work alone with vulnerable clients.
Abuse and molestation coverageUmbrella Liability
Excess limits stacked on top of your liability and auto, the efficient way to reach the higher totals Virginia hospital contracts require.
Umbrella liability coverageCyber Liability
Breach response for the protected health information your agency holds, including notification, ransomware, and regulatory defense.
Cyber liability coverageProvider types we insure in Virginia
Home Health Agencies
Skilled agencies providing home health under a plan of care, including Medicare-participating providers.
Home health agency insuranceHome Care Agencies
Non-medical Virginia agencies delivering hands-on personal care under the Home Care Organization license.
Home care agency insuranceSenior Care Providers
Agencies serving Virginia's growing senior population, weighted for wandering, falls, and abuse exposure.
Senior care coveragePrivate Duty Nursing
Skilled, high-acuity care that drives professional liability limits higher, often backed by an umbrella.
Private duty nursing coverageGroup Home Care
Residential group homes combining a facility with hands-on care, with premises and property exposure.
Group home care coverageVirginia workers compensation for home care agencies
Virginia's headline insurance rule is the workers compensation threshold, and it is worth stating precisely because its shape catches people out.
More than two, which means the third
Workers compensation is overseen by the Virginia Workers' Compensation Commission. A business that regularly employs more than two people must carry coverage, which in practice means the requirement begins at the third employee. Once coverage is required it is mandatory, with no waivers and no exceptions. Read how the coverage works on our workers compensation page.
The definition of employee is broad
This is where the threshold arrives sooner than owners expect. The definition includes part-time, seasonal and temporary workers, minors, trainees and working family members, and a home care agency's caregivers count. Subcontractors' employees count toward the total as well, which is the part most often missed by an agency that uses another firm to cover overflow shifts.
For a field that runs on caregivers, that threshold arrives fast. An established agency is well past it, so the live question is not whether you need coverage but whether everyone who should be counted actually is.
What going uninsured costs
Failing to carry required coverage can bring a civil penalty of up to $250 per day, capped at $50,000, plus liability to the injured worker. Virginia also expects work injuries reported to the Commission within 10 days. An agency that skipped coverage to save premium can face a daily penalty, an uninsured injury claim and a reporting failure at once, and misclassified caregivers are the most common way it happens.
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 best lever you control, and it improves how carriers underwrite the rest of the program.
Virginia licensing and regulatory context
Short version, because you already hold your licence. It earns space because the category of care you deliver drives both your licence and your insurance.
Home care is licensed by the Virginia Department of Health, through its Office of Licensure and Certification and the Home Care and Hospice Unit. The licence is the Home Care Organization, or HCO, licence. The governing law sits in the Code of Virginia, Title 32.1, Chapter 5, Article 7.1, with regulations at 12VAC5-381.
Two structural points matter to an operating agency. Virginia does not require a Certificate of Need for home care, so it is an open-market state and nothing limits how many agencies compete for the same referral. And not every provider needs the HCO licence: nurse registries and homemaker or companion services are not required to be licensed, and companion-only providers cannot provide hands-on personal care. That line is worth watching, because a companion-only operation that starts helping with bathing or transfers has moved into licensed territory and a different risk profile at the same moment.
Medicare, Medicaid and what actually sets your limits
Virginia delivers its Medicaid home and community-based services through the Commonwealth Coordinated Care Plus Waiver, a 1915(c) HCBS waiver now administered under the Cardinal Care Managed Care program. For a home care agency that waiver is where much of Virginia's Medicaid-funded home care is authorised and paid.
The detail that sets Virginia apart is that the CCC Plus Waiver has no waitlist, which is unusual among states. Where many states run waiver programmes with long queues, an approved Virginia client can start care rather than wait months or years. That means a steadier referral pipeline, and it is a genuine advantage worth planning around.
Medicare comes in separately where an agency provides skilled home health under a plan of care, raising the stakes on documentation and on professional liability. What sets your limits, though, 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.
The Virginia home care market
Virginia is a large and steadily aging market. The state population is about 8.88 million as of 2025, and roughly 1.5 million Virginians are 65 or older, a senior share projected to reach about one in five residents by 2030.
Demand concentrates in a few regions. Northern Virginia, Hampton Roads anchored by Virginia Beach and Norfolk, and the Richmond area carry the bulk of the state's home care activity, with dense senior populations, major hospital systems and the referral relationships that come with them. Agencies competing for those partnerships usually need higher contract-driven limits to win and keep the work.
Distance still matters between and within those regions. Caregivers covering wide territory put real miles on their vehicles, which raises auto exposure. 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.
Northern Virginia also sits in a dense corridor near the District of Columbia, so some agencies serve clients or recruit staff across nearby state lines. If your caregivers work beyond Virginia, the program has to satisfy the rules of each state they enter. You can see the full list on our coverage by state hub.
Virginia resources for home care providers
These are the Virginia bodies that shape how home care operates, for licensing, workers compensation, and industry advocacy. We name them so you know where each requirement comes from.
- Virginia Department of Health, Office of Licensure and Certification, Home Care and Hospice Unit, the regulator for the Home Care Organization license under 12VAC5-381.
- Virginia Workers' Compensation Commission, which oversees workers compensation and the 10-day injury reporting expectation.
- Virginia Association for Home Care and Hospice (VAHC), founded in 1983 and based in Henrico, the state industry body that represents home care through advocacy and education.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why Virginia 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 Northern Virginia commute 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 Virginia specifically, we count the workers compensation threshold the way the Commission does rather than the way an owner assumes. Part-time, seasonal and temporary workers, minors, trainees, working family members and subcontractors' employees all count toward more than two, and that last one is the item established agencies most often leave out. We also watch the companion and hands-on line, because crossing it changes your licence and your risk profile in the same moment.
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, 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.
Virginia home care insurance FAQ
Specific answers for agencies operating under Virginia 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, 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 move from companion work into hands-on care, a new office or region, agency-owned vehicles, taking on subcontractors, or an acquisition.
Once you regularly employ more than two people, which in practice means the requirement begins at the third employee. Workers compensation is overseen by the Virginia Workers' Compensation Commission, and once coverage is required it is mandatory, with no waivers and no exceptions. For a field that runs on caregivers that threshold arrives fast, so an established agency is well past it.
More people than owners expect, which is why the threshold arrives sooner than planned. The definition of employee includes part-time, seasonal and temporary workers, minors, trainees and working family members, and a home care agency's caregivers count. Subcontractors' employees count toward the total as well, and that last one is the item established agencies most often leave out when they use another firm to cover overflow shifts.
Failing to carry required coverage can bring a civil penalty of up to $250 per day, capped at $50,000, plus liability to the injured worker. Virginia also expects work injuries reported to the Commission within 10 days. An agency that skipped coverage can face a daily penalty, an uninsured injury claim and a reporting failure at once, and misclassified caregivers are the most common way that happens.
Your licence and your risk profile, at the same moment. Nurse registries and homemaker or companion services are not required to be licensed in Virginia, and companion-only providers cannot provide hands-on personal care. The moment an agency starts helping with bathing, transfers or other hands-on tasks it has moved into licensed territory under the Home Care Organization licence, and the exposure moves with it. Tell us before the change rather than at the next renewal.
The Virginia Department of Health, through its Office of Licensure and Certification and the Home Care and Hospice Unit, issuing the Home Care Organization licence. The governing law sits in the Code of Virginia, Title 32.1, Chapter 5, Article 7.1, with regulations at 12VAC5-381. Virginia does not require a Certificate of Need for home care, so it is an open-market state and nothing limits how many agencies compete for the same referral.
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, whether you use subcontractors, the regions you serve, 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 Virginia. There is no obligation.