What insurance do TriWest and Optum require to join the VA Community Care Network?
Professional liability, and the amount depends on who administers your region. TriWest, which runs Regions 4 and 5, requires professional liability "in an amount in accordance with the laws of the state in which the care is provided," except in Alaska, where it requires $1,000,000 per occurrence and $3,000,000 aggregate. Optum, which runs Regions 1 to 3, requires $1,000,000 per occurrence and $3,000,000 aggregate, but unskilled providers such as homemaker agencies need only the coverage common for their scope. Neither handbook sets a general liability or workers comp limit, and neither says a certificate must be approved in writing.
Tell us the situation.
One licensed human replies the same business day — not five agents, not an auto-responder. If the policy you have is already the right one, we will tell you.
We use this to quote and service your insurance, and we do not sell it or pass it to lead networks. Privacy policy.
Kevin Kelsey
Founder | Principal Agent
Founder of Boring Insurance, with a background in compliance and risk management for some of Hollywood’s largest production companies.
Send us what you have. We’ll tell you if it’s right.
Your current policy paperwork, a renewal notice, or nothing at all. A licensed agent reads it and replies the same business day.
The detail
TriWest’s handbook applies to "TriWest Healthcare Alliance (TriWest) network providers in Regions 4 and 5," and its credentialing requirements say: "Provider shall provide and maintain professional liability insurance in an amount in accordance with the laws of the state in which the care is provided."
TriWest’s Alaska Appendix sets a fixed limit instead: professional liability "with a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: $1,000,000 per occurrence; $3,000,000 aggregate," with an exception for state entities that self-insure.
TriWest may terminate a provider agreement immediately on written notice if the provider’s "professional liability coverage as required under Provider’s Agreement is reduced below required amounts or is no longer in effect," and the provider must notify TriWest in writing immediately of any "Reduction in insurance coverage below the required limits."
Optum’s manual states that "Optum was awarded Region 1, Region 2, and Region 3" and that providers must keep professional liability "of not less than (per specialty per occurrence): $1,000,000 per occurrence, $3,000,000 aggregate." A provider may self-insure its malpractice and its commercial general liability instead of buying coverage.
Optum, VA Community Care Network Provider Manual, October 2026, pp. 25-26
The same page says "Unskilled or non-clinical providers" are "only required to maintain insurance coverage consistent with the types and limits commonly necessary for their scope of practice, as determined by Optum and VA," and that providers "must notify Optum of any change in professional liability insurance carrier."
Optum, VA Community Care Network Provider Manual, October 2026, pp. 25-26
The $1,000,000 and $3,000,000 wording follows the VA acquisition clause for health care contracts, which leaves the dollar amount to the contracting officer and requires certificates with an endorsement that cancellation is not effective "until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer."
VA Acquisition Regulation 852.237-70, Indemnification and Medical Liability Insurance (OCT 2019)
What this means for you
- Find out which administrator sends your referrals. Regions follow the provider’s location. Under Optum the floor is $1,000,000 per occurrence and $3,000,000 aggregate for licensed care. Under TriWest it is whatever your state requires of your license, and many states set no number at all, so the limit you carry is a business decision.
- Skilled and unskilled home care are read differently. Skilled home health is licensed clinical care and meets the professional liability rule in full. Homemaker and home health aide services are unskilled care under CCN, and Optum leaves their insurance to what is common for that scope as Optum and the VA decide. Ask your contracting contact to put the number in writing before you buy.
- Keep the limit in force for the whole agreement. Both administrators treat professional liability as a condition of staying in the network. A lapse or a lower limit at renewal is grounds for TriWest to terminate immediately, and both expect written notice of a change.
- Buy general liability and workers comp for their own reasons. Neither handbook sets a limit for them. Your state requires workers comp once you have employees, and a caregiver who injures a veteran or damages the home is a general liability claim. Home care packages usually put general and professional liability on one policy.
Go deeper on any of these
Related questions
- Does TriWest have to approve my certificate of insurance in writing?
Not according to its handbook. The handbook requires you to notify TriWest in writing of a reduction or termination of coverage, and TriWest gives written notice when it terminates. It sets no certificate approval step and no certificate holder wording. If your agreement or a TriWest request names one, follow that document and send it to us.
- Checking a contract’s insurance requirements
- Who goes in the certificate holder box?
Whoever asked for the certificate, at the address they give. Neither TriWest’s handbook nor Optum’s manual prescribes wording, and Optum’s credentialing list asks only for proof of professional liability. Do not add TriWest, Optum or the VA as an additional insured unless your agreement asks for it.
- What goes on a certificate
- Does the VA itself set a malpractice limit for community care providers?
Not in its regulations. We searched the VA’s medical regulations at 38 CFR Part 17 on October 4, 2026 and found no professional liability limit for community providers. The limits come from the administrator’s network agreement and handbook.
- Is $1M/$3M occurrence or claims-made?
The handbooks state limits per occurrence and in the aggregate without requiring an occurrence form. Many malpractice policies are claims-made, so if you leave the network or change carriers, plan for tail coverage.
- Occurrence vs claims-made
- We also take Medicaid waiver clients. Does one policy cover both?
Usually, if the limits meet the higher of the two requirements and the policy covers every service you provide. Medicaid waiver programs and county contracts often add requirements of their own, auto among them.
- Medicaid waiver provider insurance
Need this handled?
Reading about it and having it handled are different jobs, and the second one is ours. We place the accounts other brokers decline — claims history, a cancellation, an unusual operation, a business nobody wants to underwrite twice — and we will tell you when the policy you already have is the right one. Tell us the situation and a licensed human replies the same business day.
Written by the licensed brokers at Boring Insurance. Last updated 2026-10-04. See all guides.