Care in someone else’s home, at the end of their life, with a family watching every decision.

Professional liability

Pain management, medication orders, the plan of care and the decision not to escalate — harm alleged from the clinical service itself.

Without it — The defining exposure of hospice, and the claim general liability does not touch.

Abuse and molestation

Allegations involving patients who are, by definition, dependent and often alone with a caregiver.

Without it — Excluded from general liability, and asked for by name by every facility and health system you contract with.

General liability

Injury or damage in a patient’s home or a facility you serve, and the additional insured wording your contracts require.

Without it — A dropped oxygen concentrator or a fall in a patient’s hallway is a general liability claim against the agency.

Workers compensation

Nurses, aides, social workers and chaplains — lifting, transfers, needlesticks and driving between visits.

Without it — Driving is the leading cause of serious work injury in home-based care, and it happens on the clock.

Hired and non-owned auto

Staff driving their own cars between patient homes — which in hospice is most of the working day.

Without it — The driver’s personal policy is primary and limited; the agency is the party with assets and the one that gets sued.

Business cyber

Patient records and Medicare billing data on laptops and phones that travel to every visit.

Without it — A lost tablet is a reportable breach, and hospice records are among the most sensitive data anyone holds.

The nonprofit liability package

For nonprofit hospices: general, professional, abuse and molestation and board coverage on one policy, with volunteers covered as insureds.

Without it — Medicare requires hospice volunteers, so a policy that does not cover them leaves a mandated part of the workforce uninsured.

Which carriers write hospice, and can we approach them ourselves?

Philadelphia Insurance Companies — PHLY, part of Tokio Marine, rated A++ by AM Best — is the carrier that has told us in writing it wants home health care and hospice, and it is where most of our human-services submissions go first. PHLY does not sell to organizations directly: it works only through appointed agents, and we hold that appointment, so your file reaches their underwriter with our name on it rather than through a second intermediary. What their underwriter wants to see is specific and we assemble it before anything is sent — their supplemental application for your class, the standard applications, three years of valued loss runs (a report from each prior insurer showing every claim and its reserve), photographs of the premises, your brochure or website, and — for hospice specifically — a copy of your state facility license. Payment plans are available once the annual price reaches $2,000. None of that is a promise to bind — every quote is subject to their underwriting review — but a complete file is the difference between a quote and a list of questions.

A health system we contract with wants $3M/$6M abuse and molestation. Is that available?

Read the number carefully, because it decides your price. PHLY’s primary abuse and molestation limit is $1,000,000 per occurrence with a $1,000,000, $2,000,000 or — on occasion — $3,000,000 aggregate. Anything above that has to come from an umbrella, and their umbrella capacity is smaller in Los Angeles County than elsewhere, needs every control in place (screening, supervision, training, reporting) and is decided case by case. So a funder or landlord asking for $3,000,000 per occurrence and $6,000,000 aggregate is not asking for a bigger policy; they are asking for a tower — a primary plus one or more excess layers — and excess abuse coverage runs roughly $15,000 per $1,000,000 of limit, often more than the underlying policy itself. Before you buy that, let us read the requirement. Many are boilerplate copied from a construction contract, and a sourced request to the funder explaining what the market actually offers gets them reduced more often than people expect. We quote the primary first, and build the tower only when the requirement genuinely will not move.

Stand-alone abuse and molestation: when it is the right route, and what it costs

Are our volunteers covered?

They have to be, because Medicare makes them mandatory: the hospice conditions of participation require volunteers to provide administrative or direct patient-care services in an amount at least equal to five percent of total patient-care hours. So a hospice’s volunteers are not a nice-to-have on the policy; they are a regulated part of the workforce. The right package names volunteers as insureds under general and professional liability and includes them in the abuse and molestation coverage — a volunteer sitting alone with a patient is exactly the exposure that section exists for. Volunteer injury is separate: most states let you elect volunteers onto workers compensation, and otherwise a volunteer accident policy covers their medical bills.

We are buying an existing hospice. Does the insurance transfer?

Not automatically, and the part that matters most is the part most likely to be lost. Professional and abuse liability in this class is usually written claims-made, which means the policy covers claims made while it is in force for incidents after a retroactive date. Buy the agency and start a fresh policy with a new retroactive date, and every incident before the purchase is uninsured — the seller’s policy has expired and yours does not reach back. The fix is either prior-acts coverage on the new policy or an extended reporting period on the old one, and it has to be negotiated before closing, not after. California has had a moratorium on new hospice licenses since 2022, so most hospice buyers we meet are buying an existing license, and this is the question we raise first.

How is a hospice priced?

On revenue and payroll first, then on the answers to the questions that separate hospices from one another: average daily census, the split between routine home care and inpatient or facility-based care, whether you employ or contract your clinicians, how many staff drive and how far, and your survey history with the state and with Medicare. Three years of valued loss runs carry more weight than any of it. A clean, complete file from a licensed hospice with a stable census is a class carriers compete for; the price comes down to whether the file is complete.

Do we need a separate policy for the inpatient unit?

Usually the same policy, underwritten differently. An inpatient hospice unit adds premises exposure — patients, families and visitors on your property around the clock — and medical equipment, pharmacy storage and often a kitchen. It moves part of the professional liability from a home setting to a facility setting, which carriers rate separately. If you lease the unit inside a hospital or skilled nursing facility, the lease will name the landlord as additional insured and set its own limits; send us the lease with the application, because those limits are the ones you actually have to meet.