Is HPSO professional liability insurance any good?
If you're a nurse, therapist, or allied health professional shopping for malpractice insurance, you've probably seen HPSO (Healthcare Providers Service Organization). They've been around for over 40 years, cover more than 200 professions, and partner with over 85 associations — including the APTA, where they've been the member program since 1992, covering roughly one in three physical therapists. But does that make them the right choice for you?
This review cuts through the marketing. I'll cover what HPSO actually offers, what it costs, how it compares to other carriers like NSO, Proliability, and Berxi, and when you might want to look elsewhere.
What coverage does HPSO provide?
HPSO policies are underwritten by CNA (rated A by A.M. Best) and administered by Aon Affinity. The core coverage is an occurrence policy with limits up to $1 million per claim and $6 million annual aggregate. That's a key point: it's occurrence form, meaning you're covered for incidents that happened while the policy was active, even if the claim is filed years later. No need to buy tail coverage when you leave a job or retire.
Here's what's typically included in an HPSO/NSO individual policy:
- Professional liability: Up to $1M per claim / $6M aggregate for covered medical incidents.
- License defense reimbursement: Up to $25,000 per year for defending your license before a state board.
- HIPAA proceedings coverage: Up to $25,000 per year for costs related to a HIPAA violation complaint.
- Portability: The policy stays with you between jobs, even if you're not actively working.
- Premium financing: Installment payment plans may be available.
One thing HPSO doesn't advertise heavily: unlike some competitors (like Berxi), defense costs are inside the liability limits. That means the money spent on your legal defense reduces the amount available to pay a settlement or judgment. In practice, that's standard for many carriers, but it's worth knowing.
How much does HPSO professional liability insurance cost?
HPSO doesn't publish rates, but based on industry data and competitor pricing, here are realistic annual ranges for common professions:
- Registered Nurse (RN): $100–$150
- Nurse Practitioner (NP): $990–$2,000 (Proliability quotes around $991 employed, $1,190 self-employed; Berxi typical $1,400 for $1M/$3M)
- Physical or Occupational Therapist: $100–$350
- Dental Hygienist: $45–$150
- Massage Therapist: $96–$235 (BBI from $96/yr, ABMP $199/yr, AMTA $235/yr)
- Allied health techs (CNA, phlebotomist): $50–$200
- Notary E&O: $20–$100
Your exact premium depends on your specialty, state, claims history, and whether you're employed or self-employed. APTA members get a 10% discount through HPSO. The only way to know your price is to get a quote, which HPSO claims takes about 5 minutes.
HPSO vs. NSO: What's the difference?
This confuses a lot of people. HPSO and NSO (Nurses Service Organization) are sister companies under the Aon Affinity portfolio, both underwriting through CNA. The difference is simple: NSO is specifically for nursing professionals — RNs, NPs, CRNAs, CNMs, students, and nursing schools. HPSO covers everyone else: therapists, counselors, dental hygienists, pharmacists, physician assistants, and more.
If you're a nurse, when you go to HPSO's site, you'll be redirected to NSO. The policy features are essentially the same: $1M/$6M occurrence, $25k license defense, portability. NSO has insured over 600,000 nursing professionals and has been around for 45+ years. So for nurses, NSO is the direct equivalent of HPSO.
How does HPSO compare to other carriers?
Let's look at a few alternatives:
- Proliability (Mercer): Offers up to $1M/$3M occurrence via Liberty Mutual. Sponsored by AANP for NPs. Includes $25k board reimbursement and $50k HIPAA coverage. NP premiums start around $991 employed. Strong for advanced practice nurses.
- Berxi (Berkshire Hathaway): Offers both occurrence and claims-made policies. Key difference: defense costs are outside the limits (so they don't erode your coverage). Also includes reputation coverage and $0 deductible. Premiums are competitive, e.g., ~$363/yr supplemental for therapists.
- CM&F Group: Provides up to $1M/$6M portable occurrence policies with telemedicine and license defense included. Been around since 1947.
- CPH & Associates: Specializes in therapists. Offers occurrence policies with unlimited defense attorney fees and $35k state licensing board defense. A++ rated. Often lower premiums for counselors.
HPSO's main advantages are its size, association partnerships, and the APTA discount. The trade-off: less customization. You won't find as many add-ons or flexible limits as with some smaller carriers. For most individual practitioners, though, the standard $1M/$6M is sufficient.
Who should buy HPSO?
HPSO is a solid choice if:
- You want an occurrence policy (no tail worries).
- You work in multiple settings or change jobs frequently — portability matters.
- You're a physical therapist and want the APTA member discount.
- You're in one of the 200+ professions they cover and want a one-stop shop.
Consider alternatives if:
- You want defense costs outside the limits (look at Berxi).
- You're an NP and want AANP sponsorship (Proliability).
- You're a therapist and want unlimited defense attorney fees (CPH).
- You need higher limits (some carriers offer $2M/$4M or more).
How to get a quote or renew with HPSO
Getting a quote is straightforward: go to HPSO's page or call 1-800-982-9491. You'll answer a few questions about your profession, work setting, and claims history. Quotes take about 5 minutes. For nursing professionals, you'll be directed to NSO (1-800-247-1500). Renewals can be done online or by phone.
One caveat: the numbers I've given are estimates based on industry data. Your actual premium depends on your specific situation and underwriting. Always get a quote before deciding.
Is employer coverage enough? A quick reality check
If you're relying solely on your employer's policy, you should know that employer coverage typically protects the facility first, not you. It may exclude license defense, and it usually ends the day you leave the job. A 2022 NPDB report showed that 26% of medical malpractice payments from 2012–2022 involved non-physicians — and those are just the payments that went to court. Many more are settled quietly. Your own policy fills those gaps.
For more on whether you need your own coverage, see our guide: Is employer malpractice insurance enough?
Bottom line
HPSO is a reputable, established carrier with broad coverage and strong association ties. It's not the cheapest in every category, nor the most customizable, but for most allied health professionals, it's a safe bet. Compare quotes from a few carriers — see our carrier comparison hub — and choose the policy that fits your specific risks and budget.