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Sample Policy Forms (updated 2024)

To view or download NSO and HPSO’s sample professional liability insurance policy forms, please select your state of residence below. There will be two categories of forms: forms that are applicable to all states, and forms that are specific to each state.  

To determine the appropriate forms, please refer to the list of forms found on Page Two of your Certificate of Insurance, if applicable. Please note that these forms are specimen and do not constitute or replace the terms and conditions of any insurance policy. If you would like to obtain a paper copy of your policy, please email us at service@nso.com.

Click here to view previous sample policy forms for policies renewed before July 1, 2024.

Select your state of residence:
Alabama-specific policy forms
CNA100351AL (11-20) - Punitive Damages Endorsement - Alabama CNA101512AL (7-23) - Cancellation And Non-Renewal Amendatory Endorsement - Alabama
Alaska-specific policy forms
CNA68615AK (01-16) - Alaska Attorneys Fees - Notice To Insureds - Coverage Notice A CNA68616AK (6-12) - Alaska Attorneys Fees - Notice To Insureds - Coverage Notice B CNA101476AK (7-23) - Healthcare Providers Purchased Extended Reporting Period Endorsement - Alaska CNA101479AK (10-23) - Cyber Liability And First Party Loss (Including Privacy) Endorsement - Alaska CNA101524AK (4-24) - Amendatory Endorsement (Workplace Liability Coverage Part) - Alaska CNA101512AK (2-24) - Cancellation And Non-Renewal Amendatory Endorsement - Alaska CNA101521AK (2-24) - Amendatory Endorsement (General Terms And Conditions) - Alaska CNA101522AK (4-24) - Amendatory Endorsement (Healthcare Providers Professional Liability Coverage Part) - Alaska CNA101525AK (4-24) - Amendatory Endorsement (General Liability Coverage Part) - Alaska
Policy forms for all states
CNA101429 (07-23) - General Terms and Conditions CNA101432 (07-23) - Healthcare Providers Professional Liability Coverage Part (Occurrence) CNA101433 (07-23) - Healthcare Providers Professional Liability Coverage Part (Claims Made and Reported) CNA101435 (07-23) - General Liability CoveragePart CNA101436 (07-23) - Workplace Liability Coverage Part CNA101438 (07-23) - Employment Practices Liability Coverage Part CNA101441 (07-23) - Cosmetic Procedures Exclusion Endorsement CNA101442 (07-23) - Case Management Services Liability Coverage Endorsement CNA101443 (07-23) - Media Event Expenses Supplementary Benefits Endorsement CNA101444 (07-23) - Employment Practices Liability Coverage Part (Defense Costs only) CNA101445 (07-23) - Consent to Settle Endorsement CNA101446 (07-23) - Additional Insured Endorsement (Professional Liability) CNA101449 (07-23) - Medical Specialty Exclusion Endorsement CNA101450 (07-23) - Entity, Employees or Independent Contractor Exclusion Endorsement CNA101451 (07-23) - Additional Locations Endorsement (General Liability) CNA101453 (07-23) - Medical Director or Administrator Sublimits of Liability Endorsement CNA101454 (07-23) - Cosmetic Procedures Coverage Endorsement CNA101455 (07-23) - Business Owner Coverage Extension Endorsement CNA101456 (07-23) - Prescriptive Authority Exclusion Endorsement CNA101457 (07-23) - Specified Wellness Modalities Exclusion Endorsement CNA101458 (07-23) - HIPAA Proceedings Supplementary Benefits Endorsement CNA101459 (07-23) - Specified Activities Exclusion Endorsement CNA101460 (07-23) - Consulting Services Liability Coverage Endorsement CNA101461 (07-23) - Increased General Liability Limits Endorsement (When Required By Written Contract) CNA101462 (07-23) - Fitness Services Liability Coverage Endorsement CNA101463 (07-23) - Personal Liability Coverage Endorsement CNA101467 (07-23) - Professional Liability Limits of Liability Endorsement (by State) CNA101472 (07-23) - Coverage Restriction for Specified Entities Endorsement CNA101476 (07-23) - Healthcare Providers Purchased Extended Reporting Period(s) Endorsement CNA101478 (07-23) - Named Insured "D/B/A" (Doing Business As) Endorsement CNA101479 (07-23) - Cyber Liability and First Party Loss (Including Privacy) Endorsement CNA101480 (07-23) - Professional Liability Split Limits of Liability Endorsement (by Retroactive Date) CNA101481 (07-23) - Professional Liability Split Limits of Liability Endorsement (Specified Insured) CNA101483 (07-23) - Medicare and Medicaid Proceeding Defense Costs Only Reimbursement Supplementary Benefit CNA101486 (07-23) - Policy Aggregate Limit Endorsement CNA101491 (07-23) - Damage to Client Personal Property Employee Theft CNA101492 (07-23) - Policy Period Extension Endorsement CNA101493 (07-23) - Specified Individual or Entity Exclusion CNA101496 (07-23) - Amended Definition of Professional Services (Orthotics and Prosthetics) CNA101497 (07-23) - Amendment to Certificate of Insurance CNA101499 (07-23) - Schedule of Named Insureds Endorsement (No Additional Limits) CNA101500 (07-23) - Deletion of Endorsement CNA101501 (07-23) - Agreement to Provide Notice of Cancellation to Specified Person and/or Entity Endorsement CNA101502 (07-23) - Amended Definition of Professional Services (Home Medical Equipment) CNA101503 (07-23) - Physical Therapist Amendatory Endorsement CNA101506 (07-23) - Skin Care Specialist Coverage Endorsement CNA101509 (07-23) - Acupuncturist Amendatory Endorsement (Specified Exclusion) CNA101511 (07-23) - Abuse and Molestation Claim Sublimit Endorsement (Damages and Defense Costs) CNA101516 (07-23) - Amended Abuse and Molestation Sublimits Endorsement (When Required By Written Contract) CNA101518 (07-23) - Additional Insured Endorsement (General Liability) CNA101519 (07-23) - Entity Endorsement (Including Specified Procedures and Services and Office Sharing Exclusions) CNA101520 (07-23) - Dental Mid-Level Provider Procedures Exclusion Endorsement
Arizona-specific policy forms
CNA101512AZ (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521AZ (07-23) - Amendatory Endorsement (General Terms & Conditions) - AZ
Arkansas-specific policy forms
CNA101476AR (07-23) - Healthcare Providers Purchased Extended Reporting Period - AR CNA101479AR (08-23) - Cyber Liability and First Party Loss Endorsement - AR CNA101512AR (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521AR (07-23) - Amendatory Endorsement (General Terms & Conditions) - AR
Colorado-specific policy forms
CNA101512CO (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Connecticut-specific policy forms
CNA101512CT (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521CT (07-23) - Amendatory Endorsement (General Terms & Conditions) - CT CNA101535CT (07-23) - Healthcare Providers Amendment to the Limits of Liability Endorsement - CT
DC-specific policy forms
CNA101512DC (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Delaware-specific policy forms
CNA101512DE (10-23) - Cancellation & Nonrenewal Amendatory Endorsement
Florida-specific policy forms
CNA101512FL (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521FL (07-23) - Amendatory Endorsement (General Terms & Conditions) - FL CNA81758FL (01-21) - Policy Holder Notice – Florida Terrorism Coverage
Georgia-specific policy forms
CNA101512GA (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521GA (07-23) - Amendatory Endorsement (General Terms & Conditions) - GA
Hawaii-specific policy forms
CNA101512HI (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Idaho-specific policy forms
CNA101512ID (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Illinois-specific policy forms
CNA100201IL (1-21) - Civil Union Endorsement - Illinois CNA101463IL (1-24) - Personal Liability Coverage Endorsement - Illinois CNA101479IL (2-24) - Cyber Liability And First Party Loss (Including Privacy) Endorsement - Illinois CNA101512IL (7-23) - Cancellation And Non-Renewal Amendatory Endorsement - Illinois CNA101521IL (1-24) - Amendatory Endorsement (General Terms And Conditions) - Illinois CNA101522IL (1-24) - Amendatory Endorsement (Healthcare Providers Professional Liability Coverage Part) - Illinois CNA101524IL (2-24) - Amendatory Endorsement (Workplace Liability Coverage Part) - Illinois CNA101525IL (2-24) - Amendatory Endorsement (General Liability Coverage Part) - Illinois
Indiana-specific policy forms
CNA101512IN (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Iowa-specific policy forms
CNA101512IA (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Kansas-specific policy forms
CNA101512KS (1-24) - Cancellation And Non-Renewal Amendatory Endorsement - Kansas CNA101521KS (7-23) - Amendatory Endorsement (General Terms And Conditions) - Kansas
Kentucky-specific policy forms
CNA101512KY (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Louisiana-specific policy forms
CNA101512LA (7-23) - Cancellation And Non-Renewal Amendatory Endorsement - Louisiana CNA101521LA (12-23) - Amendatory Endorsement (General Terms And Conditions) - Louisiana CNA101522LA (12-23) - Amendatory Endorsement (Professional Liability Coverage Part - Abuse And Molestation) - Louisiana CNA101523LA (12-23) - Amendatory Endorsement (Professional Liability Coverage Part - Abuse And Molestation) - Louisiana CNA101525LA (12-23) - Amendatory Endorsement (General Liability Coverage Part) - Louisiana
Maine-specific policy forms
CNA101512ME (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521ME (09-23) - Amendatory Endorsement (General Terms & Conditions) - ME
Maryland-specific policy forms
CNA101512MD (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA81753MD (03-15) - Cap on Losses from Certified Acts of Terrorism CNA81758MD (01-21) - Policy Holder Notice – Maryland Offer Of Terrorism Coverage & Disclosure of Premium
Michigan-specific policy forms
CNA101512MI (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA62841MI (01-16) - Policyholder Notice - Exempt Filing
Minnesota-specific policy forms
CNA101512MN (11-23) - Cancellation And Non-Renewal Amendatory Endorsement - Minnesota CNA101521MN (1-24) - Amendatory Endorsement (General Terms And Conditions) - Minnesota CNA103510MN (10-22) - Policyholder Notice - Minnesota
Mississippi-specific policy forms
CNA101512MS (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521MS (07-23) - Amendatory Endorsement (General Terms & Conditions) - MS
Missouri-specific policy forms
CNA101512MO (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521MO (11-23) - Amendatory Endorsement (General Terms & Conditions) - MO CNA101522MO (11-23) - Amendatory Endorsement (Healthcare Providers PL Coverage Part) - MO CNA101524MO (11-23) - Amendatory Endorsement (Workplace Liability) - MO CNA101525MO (11-23) - Amendatory Endorsement (General Liability) - MO CNA93296MO (10-22) - Missouri Property And Casualty Insurance Guaranty Association Endorsement
Nebraska-specific policy forms
CNA101511MT (09-23) - Abuse and Molestation Claim Sublimits Endorsement - MT CNA101512MT (09-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101563MT (07-23) - Table of Contents - Workplace CNA101516MT (09-23) - Amended Abuse and Molestation Sublimits Endorsement Where required by written contract - MT CNA101554MT (07-23) - Table Of Contents - Dentists Professional Liability Coverage Part (Claims Made) CNA101555MT (07-23) - Table Of Contents - Dentists Professional Liability Coverage Part (Occurrence) CNA101561MT (07-23) - Table Of Contents - Erisa Fiduciary Liability Coverage CNA101556MT (07-23) - Table of Contents - AHP PL Claims Made CNA101562MT (07-23) - Table of Contents - General Liability CNA101557MT (07-23) - Table of Contents - AHP PL Occurrence CNA101560MT (07-23) - Table Of Contents - Employee Benefits Liability Coverage Part CNA101558MT (07-23) - Table of Contents - Employment Practices Liability CNA101559MT (07-23) - Table of Contents - Employment Practices Liability Defense Only
Nebraska-specific policy forms
CNA101512NE (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
New Hampshire-specific policy forms
CNA101512NH (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521NH (10-23) - Amendatory Endorsement (General Terms & Conditions) - NH CNA101524NH (07-23) - Amendatory Endorsement (Workplace Liability) - NH CNA101525NH (07-23) - Amendatory Endorsement (General Liability) - NH
New Mexico-specific policy forms
CNA101512NM (10-23) - Cancellation & Nonrenewal Amendatory Endorsement
North Carolina-specific policy forms
CNA101512NC (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521NC (07-23) - Amendatory Endorsement (General Terms & Conditions) - NC CNA101574NC (07-23) - Purchasing Group Membership Fee Acknowledgement
North Dakota-specific policy forms
CNA101512ND (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521ND (07-23) - Amendatory Endorsement (General Terms & Conditions) - ND
Ohio-specific policy forms
CNA101512OH (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA81758OH (01-2021) - Policy Holder Notice – Ohio Offer Of Terrorism Coverage & Discloure Of Premium
Oklahoma-specific policy forms
CNA101512OK (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521OK (07-23) - Amendatory Endorsement (General Terms & Conditions) - OK CNA81753OK (03-15) - Cap on Losses from Certified Acts of Terrorism CNA101532OK (07-23) - Policyholder Notice CNA81758OK (01-21) - Policyholder Notice - Offer of Terrorism
Oregon-specific policy forms
CNA101512OR (10-23) - Cancellation & Nonrenewal Amendatory Endorsement
Rhode Island-specific policy forms
CNA101512RI (12-23) - Cancellation And Non-Renewal Amendatory Endorsement - Rhode Island
Wyoming-specific policy forms
CNA101512WY (10-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521WY (10-23) - Amendatory Endorsement (General Terms & Conditions) - WY CNA101575WY (10-23) - Defense Cost Within Limit - Acknowledgement
Pennsylvania-specific policy forms
CNA101476PA (08-23) - HEALTHCARE PROVIDERS PURCHASED EXTENDED REPORTING PERIOD ENDORSEMENT - PENNSYLVANIA CNA101512PA (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521PA (07-23) - Amendatory Endorsement (General Terms & Conditions) - PA
South Carolina-specific policy forms
CNA101512SC (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Texas-specific policy forms
CNA101512TX (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521TX (07-23) - Amendatory Endorsement (General Terms & Conditions) - TX CNA101522TX (07-23) - Amendatory Endorsement (Healthcare Providers PL Coverage Part) - TX CNA101524TX (07-23) - Amendatory Endorsement (Workplace Liability) - TX CNA101525TX (07-23) - Amendatory Endorsement (General Liability) - TX CNA101528TX (07-23) - EPL Defense Only Amendatory CNA101527TX (07-23) - EPLI Amendatory CNA80079TX (7-16) - Policyholder Notice - Texas
South Dakota-specific policy forms
CNA101479SD (09-23) - Cyber Liability and First Party Loss Endorsement - SD CNA101512SD (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521SD (09-23) - Amendatory Endorsement (General Terms & Conditions) - SD
Virgin Islands-specific policy forms
CNA101512VI (7-23) - Cancellation And Non-Renewal Amendatory Endorsement - Virgin Islands CNA81758VI (01-21) - Notice – Offer Of Terrorism Coverage; Disclosure Of Premium
Utah-specific policy forms
CNA101512UT (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Tennessee-specific policy forms
CNA101501TN (10-23) - Agreement to Provide Notice of Cancellation - TN CNA101512TN (07-23) - Cancellation & Nonrenewal Amendatory Endorsement
Washington-specific policy forms
CNA101479WA (11-23) - Cyber Liability and First Party Loss Endorsement - WA CNA101512WA (12-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521WA (11-23) - Amendatory Endorsement (General Terms & Conditions) - WA CNA101524WA (11-23) - Amendatory Endorsement (Workplace Liability) - WA CNA101525WA (11-23) - Amendatory Endorsement (General Liability) - WA
Wisconsin-specific policy forms
CNA101512WI (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521WI (07-23) - Amendatory Endorsement (General Terms & Conditions) - WI CNA101522WI (07-23) - Amendatory Endorsement (Healthcare Providers PL Coverage Part) - WI
West Virginia-specific policy forms
CNA101512WV (07-23) - Cancellation & Nonrenewal Amendatory Endorsement CNA101521WV (04-24) - Amendatory Endorsement (General Terms & Conditions) - WV CNA62866WV (07-23) - Policyholder Notice - Surcharge
This information is provided for general informational purposes only and is not intended to provide individualized guidance. All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. Any references to AIS, NSO, HPSO websites are provided solely for convenience, and AIS, NSO and HPSO disclaims any responsibility with respect to such websites.  This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, HPSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information.   

Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.