General Liability
The layer West Virginia hospitals and health systems name first, commonly at $1 million per occurrence and $2 million aggregate.
General liability coverage
Coverage by State
West Virginia Home Care Insurance
For agencies already operating in West 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 West Virginia 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 all of it through exclusive carrier programs that write home care in West Virginia, including workers compensation, and we do it mid-term when the contract will not wait.
That last point deserves emphasis here. West Virginia used to run an exclusive state fund and plenty of guidance still describes it that way. It privatised. Since 2008 private carriers have written workers compensation in this state, so your whole program can be placed together rather than split around a monopoly.
An agency running seventy-five to a hundred caregivers across Charleston, Morgantown or the eastern panhandle has a different problem from a startup, and this page is written for the former.
What West Virginia contracts require, and what happens when yours falls short
No West Virginia 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. Workers compensation at statutory limits with employers liability behind it. Auto liability covering 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.
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.
When the contract asks for more than you carry
This is what brings most established agencies to us, so here are the routes out.
The first 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, auto and employers liability 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 Charleston or Morgantown 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. 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 needs 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 Ohio, Kentucky, Maryland, Virginia or Pennsylvania.
- 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 West Virginia 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
Written by private carriers in West Virginia since the market opened in 2008, so it sits inside the same program as everything else.
Workers compensation coverageCommercial Auto
For agency-owned vehicles running the mountain routes, where a single visit can absorb most of a shift.
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 West Virginia
Home Care Agencies
Non-medical agencies delivering personal care and companion work across the valleys and the rural counties between them.
Home care agency insuranceHome Health Agencies
Agencies overseen by OHFLAC within the Office of Inspector General, delivering care under a plan of care.
Home health agency insurancePersonal Care Services
Bathing, dressing, grooming, and daily living support, the core of a West Virginia non-medical book.
Personal care services coverageSenior Care Providers
Agencies serving the roughly 381,000 West Virginia residents aged 65 and older, one of the oldest populations in the country.
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 coverageWest Virginia workers compensation for home care agencies
Two things matter to an operating agency here, and both are settled in published text rather than left to interpretation.
This is not a state-fund state, and has not been since 2008
West Virginia once ran an exclusive state fund, and enough guidance still says so that the point is worth making plainly. It privatised. W. Va. Code 23-2C-3 is titled for private carriers not being subject to certain premium taxes, surcharges, and credits, and it imposes a regulatory surcharge on private carriers and self-insured employers. The operative wording is direct: with respect to fiscal years beginning on and after July 1, 2008, each private carrier shall collect a surcharge on the premium collected.
Read that for what it tells an agency. Private carriers write workers compensation here, self-insurance is contemplated in the same section, and the former Commission's regulatory functions sit with the Offices of the Insurance Commissioner, which issues bulletins to insurance carriers. So West Virginia workers compensation belongs inside your program alongside general liability, auto and umbrella, rather than being arranged separately around a monopoly the way Ohio, North Dakota, Washington and Wyoming still require.
The domestic services question, which West Virginia actually answers
Almost every state leaves the agency caregiver question open. West Virginia does not, and the rules are worth reading in order.
Title 85 rule 3.3 defines domestic services as services of a household nature performed by an employee in or about a private home of the person by whom he or she is employed. Rule 3.3.1 then gives examples, and caregivers and medical providers appear on that list alongside cooks, housekeepers, babysitters and gardeners. On its own, that reads badly for a home care agency.
Rule 3.3.2 is the one that settles it. The term domestic services does not include services of a household nature performed by an employee in or about the private home of a person when that employee is employed by someone other than a member of the household. And the rule supplies its own example: employees of maid services, temporary employment agencies, or other businesses do not provide domestic services under the provisions of this rule.
The practical reading is straightforward. A caregiver on your payroll is employed by the agency rather than by the household, so the domestic carve-out is not written for them. Confirm with your own counsel before relying on any reading in either direction, but the drafting here is unusually explicit and it points one way.
Casual employer status is not a route out either
The other exemption agencies ask about is casual employment, defined tightly. Title 85 rule 3.1 describes a casual employer as one who employs not more than three employees for a period that is temporary, intermittent, and sporadic in nature and does not exceed ten calendar days in any calendar quarter.
All three conditions have to hold together. An agency running regular client schedules fails the temporary, intermittent and sporadic test and the ten-day test both, whatever its headcount. Casual status is not on the table.
West Virginia licensing and regulatory context
Short version, because you already hold whatever authority you operate under. It earns space only because that authority is what a carrier underwrites against.
Home care oversight in West Virginia runs through the Office of Health Facility Licensure and Certification, known as OHFLAC, which sits inside the West Virginia Office of Inspector General. The state also operates a Certificate of Need programme through the West Virginia Health Care Authority.
We could not confirm to our own standard whether the Certificate of Need programme reaches home health agencies, nor the exact mechanics for home care providers not otherwise licensed or certified, so this page does not state either. Confirm your own position with OHFLAC, tell us what applies, and we will build the program to the authority 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 West Virginia's Medicaid in-home programmes. We could not confirm how they are structured or funded, and those details should come from the Bureau for Medical Services.
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 West Virginia 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 West Virginia home care market
West Virginia has about 1.77 million residents, and roughly 381,000 of them are 65 or older, close to 21.5 percent of the civilian population. That is one of the oldest populations in the country and the second oldest in this set, behind Maine.
The state's largest metro is not its own: the Washington, Arlington and Alexandria area reaches into the eastern panhandle, and Hagerstown and Martinsburg span Maryland. Huntington and Ashland span Kentucky and Ohio. Charleston and Morgantown anchor a mountainous interior of winding roads and low density.
For an operating agency that combination is the whole risk conversation. An old client base means higher acuity. Long mountain drives mean auto exposure a personal policy will not absorb. And the panhandle and river edges mean caregivers regularly work over a line, which is the most common gap we find in an established West Virginia 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, Maryland, Virginia and Kentucky pages, and the full list is on our coverage by state hub.
West Virginia resources for home care providers
The sources behind everything above.
- W. Va. Code 23-2C-3, the section on private carriers and the surcharge applying from 1 July 2008.
- Title 85 workers' compensation rule, where the domestic services and casual employer definitions sit.
- W. Va. Code 23-2-1, employers subject to the chapter.
- Offices of the Insurance Commissioner, workers compensation.
- Office of Health Facility Licensure and Certification.
- Certificate of Need, through the West Virginia Health Care Authority.
- Home Care Association of America, West Virginia chapter. We checked for a West Virginia-specific home care association and could not find one that resolves to a real association site.
- National Association for Home Care and Hospice, for national home care standards and guidance.
Why West Virginia 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 mountain 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 the West Virginia facts we are precise, because two are commonly got wrong. This is not a state-fund state and has not been since 2008, so your whole program including workers compensation can be placed together. And the domestic services carve-out does not shelter agency caregivers, because rule 3.3.2 says so in terms and names agencies as its example. Where we could not verify something, 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 long mountain routes, 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.
West Virginia home care insurance FAQ
Answers for agencies already operating under West Virginia rules.
Usually, and usually before renewal. Three routes exist and the contract wording decides which 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 program. Where the carrier will not extend, the program is re-marketed. Send us the insurance exhibit itself 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 provision. Those are endorsements to a policy, not lines typed onto a form. Send us contract wording when it first arrives rather than on the day the certificate is due.
Yes. West Virginia used to run an exclusive state fund and no longer does. W. Va. Code 23-2C-3 addresses private carriers directly and provides that with respect to fiscal years beginning on and after July 1, 2008, each private carrier shall collect a surcharge on premium. Private carriers write workers compensation here, self-insurance is contemplated in the same section, and the Offices of the Insurance Commissioner regulate the market. Anything describing West Virginia as a state-fund state is more than a decade out of date.
No, and West Virginia is one of the few states that answers this in its own rule text rather than leaving it to argument. Title 85 rule 3.3.1 does list caregivers and medical providers among services of a household nature. But rule 3.3.2 then states that the term domestic services does not include services of a household nature performed by an employee in or about the private home of a person when that employee is employed by someone other than a member of the household, and gives employees of maid services, temporary employment agencies, or other businesses as its example. A caregiver on your payroll is employed by you, not by the household.
Almost certainly not, because all three conditions have to hold at once. Title 85 rule 3.1 defines a casual employer as one who employs not more than three employees for a period that is temporary, intermittent, and sporadic in nature and does not exceed ten calendar days in any calendar quarter. An agency running regular client schedules fails the second and third conditions whatever its headcount, so casual status is not a route out for an operating home care business.
It depends on the line, and West Virginia raises this more than most states because its largest metro belongs to Washington DC and reaches the eastern panhandle, while Huntington and Ashland span Kentucky and Ohio. Workers compensation is state-specific and each state your caregivers work in needs to be listed properly rather than assumed. Liability and auto usually travel, but a contract over the line can demand wording your West Virginia policy does not carry. Ohio is worth flagging separately: it is a monopolistic state and works differently.
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 service line, a move from personal care into skilled work, a new office, agency-owned vehicles, an acquisition, or regular work over a state line. Those change the exposure rather than the volume.
The Office of Health Facility Licensure and Certification, known as OHFLAC, which sits within the West Virginia Office of Inspector General. West Virginia also operates a Certificate of Need programme through the Health Care Authority. We could not confirm to our own standard whether that programme reaches home health agencies, or the exact mechanics of registration for providers not otherwise licensed, so confirm your own position with OHFLAC and tell us what applies to you.
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 is not a verdict on the agency, but it 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, 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, workers compensation included, through exclusive carriers that write home care in West Virginia. There is no obligation.