Tail Coverage for Physician Assistants: Costs, Prior Acts, and How to Avoid Gaps

Fast links:

• PA Insurance Guide

• PA Cost by State (2025) data

• Claims-Made vs Occurrence for Physician Assistants

• Arizona Physician Assistant Insurance

• Florida Physician Assistant Insurance

• Pennsylvania Physician Assistant Insurance

• New York Physician Assistant Insurance

• California Physician Assistant Insurance

• Texas Physician Assistant Insurance

• Tennessee Physician Assistant Insurance

• North Carolina Physician Assistant Insurance

• New Jersey Physician Assistant Insurance

Tail coverage for physician assistants

If you’re on a claims-made policy and you cancel or switch without preserving your retroactive date, you’ll likely need tail coverage for physician assistants (an Extended Reporting Period) to protect against late-filed claims for past work. The best way to avoid buying tail is to secure prior acts on your new policy—i.e., the new insurer carries your existing retro date forward.

Fast answers:

• You need tail when you end a claims-made policy and your new carrier won’t carry your retro date (or you’re retiring/pausing practice).

• You don’t need tail when the new policy lists the same retro date (prior acts) or if your old policy was occurrence.

• Tail cost is a one-time premium determined by carrier/tenure/limits—your actual cost is underwritten individually.

What tail coverage for physician assistants is (and isn’t)

Tail coverage (Extended Reporting Period endorsement) keeps the reporting window open after a claims-made policy ends—so claims reported later for past acts remain covered. Tail does not cover new incidents after your policy ends; it only allows you to report late on old incidents that occurred on or after your retro date and before policy termination.

Key terms to know

• Retroactive date (retro date): Earliest date your claims-made policy will cover acts.

• Prior acts coverage (a.k.a. “nose” coverage): Your new carrier accepts your old retro date, so past acts are protected—often eliminating the need for tail.

• Occurrence: A separate policy structure that covers incidents that occurred during the term—no tail needed for those acts.

When tail coverage for physician assistants is required

You’ll typically need a tail if any of these are true:

• You switch employers and the new policy doesn’t carry your retro date.

• You change carriers and can’t obtain prior acts on the new policy.

• You retire, take an extended break, or move out of practice and won’t keep a policy active.

• A group policy terminates or you’re no longer named, and there’s no continuation/ERP provided.

Pro tip: Get written confirmation that your new declarations page will list your retro date before you cancel the old policy.

How to avoid paying for tail (legitimately)

You have three main paths to skip or minimize tail cost:

1. Prior acts carried by the new carrier

   • The ideal outcome. Your new policy lists your existing retro date → no tail purchase from the old carrier.

2. Employer pays your tail (contracted)

   • Negotiate this in your offer letter. If they won’t pay 100%, consider shared payment or a sliding scale by tenure.

3. Occurrence going forward (with the right transition plan)

   • You may still need a tail for past claims-made exposure, but future acts under occurrence won’t need tail.

Costs: how carriers think about tail (and practical math)

Tail is a one-time premium that varies by carrier, tenure, state(s), specialty/procedures, limits, and claims history. Some markets reference tail as a multiple of your expiring annual premium; others use individual rating.

Illustrative math (examples only):

• Expiring annual premium: $2,100

• Tail quoted at ~175% → $3,675 one-time

• New claims-made annual premium: $2,050

• Year-one total if you must buy tail: $5,725 (vs. ~$2,050 if prior acts is carried)

For a sense of underlying malpractice pricing (not tail), see:PA Cost by State (2025) data

Retirement tails: Some carriers provide complimentary or discounted retirement tail if you meet age + continuous coverage thresholds. Ask before you plan your exit.

Contracts: how to negotiate tail coverage for physician assistants

Put tail in writing before you accept. Options to request:

• Employer-paid tail at termination without cause, retirement, disability, or death.

• Shared tail based on tenure (e.g., 50% after 2 years, 100% after 5).

• Prior-acts carry requirement in the group’s next policy if they change carriers.

• Minimum notice period if the employer changes carriers or structure (to allow your own tail arrangement).

• Consent-to-settle language on the malpractice section and confirmation of defense costs outside limits if available.

Timeline: switching with zero gaps

1. T-45 to T-30 days: Get quotes; share loss runs and your retro date; ask if new carrier will carry prior acts.

2. T-21 to T-14 days: Choose structure; if no prior acts, request tail options from the old carrier.

3. T-7 to T-3 days: Secure written retro-date confirmation on the new declarations page (or bind tail).

4. T-1 to T-0 days: Bind new policy and cancel old policy for the same day.

5. T+1 to T+7 days: File new dec page and—if applicable—tail endorsement with HR/credentialing.

Risk scenarios

Scenario: New job won’t carry prior acts

• Fix: Buy a tail from the old carrier; request multiple tail terms (3-year, 5-year, unlimited) and check premium windows.

Scenario: Group policy ends; you’re no longer named

• Fix: Confirm whether the group arranges tail for all providers. If not, arrange your own ERP immediately.

Scenario: You’re taking a 12-month break

• Fix: If you cancel claims-made coverage, buy a tail for the gap—or keep a low-exposure policy active and maintain the retro date (ask your broker).

Scenario: Mixed employment + moonlighting

• Fix: Employer coverage may exclude outside work. Keep an individual policy with a stable retro date and ensure all sites/states are scheduled.

Tail coverage for physician assistants: FAQs

Do I need tail if my new carrier overlaps dates with my old policy? Overlap alone isn’t enough. You need the retro date carried on the new policy to protect past acts.

Can I buy tail months after I cancel? Usually no. Tail often has a short purchase window after cancellation. Miss it and it may be unavailable later.

Is occurrence “better” because it avoids tail? Occurrence is simpler for future acts, but may be less available or cost more. Past claims-made exposure still needs a plan (tail or prior acts).

Can my employer’s tail protect my moonlighting? Typically not. Employer tails protect employer-covered acts. Maintain your own strategy for non-employer work.

What limits should my tail match? Tail typically mirrors the limits/terms of the expiring policy. Confirm in your quote/endorsement.

What to do next

1. Know your price context: PA Cost by State (2025) data

2. Choose structure wisely: Claims-Made vs Occurrence for Physician Assistants

3. Get definitions & a shopping checklist: PA Insurance Guide

4. Localize & quote: Swap the state at the end to your state → https://www.careproinsurance.com/physician-assistant-insurance/new-york

Compliance note

Coverage descriptions are illustrative only. Each situation is underwritten. Availability and pricing vary by state, specialty, procedures, limits, carrier, and claims history. Common benchmarks include $1,000,000 per claim / $3,000,000 aggregate and $2,000,000 / $4,000,000 aggregate. Tail, prior acts, board defense, and HIPAA/cyber may be subject to endorsements and sub-limits.