FAQs

The Washington State Joint Underwriting Association (JUA) for Midwives & Birth Centers is a nonprofit insurance pool created under state law to provide professional liability coverage for eligible midwives and licensed birth centers who are unable to obtain commercial insurance.

Eligibility includes Licensed Midwives (LMs), Certified Nurse-Midwives (CNMs) who provide out-of-hospital care, and licensed freestanding birth centers in Washington State. For full details, see Who Qualifies for Coverage.

No. Coverage is only available to licensed midwives (LM or CNM) and licensed birth centers.

Anyone providing any unsupervised clinical care should have malpractice coverage, even if they are only doing office visits or early intrapartum care.

A “claims-made” policy provides coverage for incidents that happen after the policy has begun and are reported during the term of the policy. When you terminate coverage, you are not covered for any lawsuit filed against any incident that occurred during your policy term unless you either purchase a tail or reported the incident to the JUA during your policy term.

All policies are written at $1 million per claim / $3 million aggregate. Higher limits are not available through the JUA at this time.

No. The facility policy covers the birth center as an entity. Each midwife must carry their own separate individual policy through the JUA or another insurance provider.

JUA policies do not cover:

• criminal acts or intentional harm
• services performed outside the scope of midwifery licensure
• unlicensed individuals or students
• hospital-based practice (for CNMs)

Specific exclusions include:

• involving the practice of the Midwife as a Naturopathic Doctor
• planned breech labors and/or deliveries
• labors and/or deliveries of known multiple births
• planned labors and/or deliveries influenced by misoprostol
• planned VBAC labors and/or deliveries
• use of vacuum extractors or other instrumental delivery devices

Your policy does NOT automatically renew. The JUA can only issue policies for one calendar year at a time, and all policies expire at 12:01am on January 1 every year. To continue coverage, all midwives and birth centers must re-apply and demonstrate that they have satisfied the requirements for insurance through the JUA.

Unlike your midwifery license, your JUA policy must be renewed on Jan 1 every year. Each policy term is for a full calendar year, except your very first year if you start mid-year.

No. The JUA policy belongs to the midwife, not the practice. The midwife is the “named insured” on the policy, which means that the policy covers the midwife regardless of where they are practicing (as long as it is within the state of Washington). It doesn’t matter who is paying the premiums; the policy follows the midwife.

No. The JUA policy belongs to the midwife, not the practice. As long as you continue to pay your premiums, your JUA policy will follow you to your next practice. If you will be doing significantly more or fewer births with your new practice, you may want to adjust your estimates so that you’re not paying too much or too little on your premiums — contact the JUA Program Administrator.

If your practice was/will be paying your JUA premiums, please contact the JUA Program Administrator to make the new payment arrangements.

You want to estimate the number of primary births that you will be doing, where your name will be listed on the birth certificate as the attendant. This does not mean that these are the only births you’re covered for; it’s just a way for us to calculate your premiums.

Every January, you will be asked how many births you actually did as the primary midwife in the previous year, and your premiums will be recalculated. If you did more births than you estimated, an invoice will be sent for the extra premium owed. If you did fewer births than you estimated, a credit will be applied to your new policy term. Some midwives prefer to overestimate so there are no big bills in January; others prefer to underestimate to help with cash flow. It’s entirely your choice.

Yes. Just contact the JUA Program Administrator with the changes you’d like to make, and a new proposal will be emailed to you. A new payment authorization form may be needed.

Yes, although your premiums are calculated by the number of births you expect to do by the end of the calendar year AND when your policy starts. Both are factored into the premium costs. Contact the JUA Program Administrator with an estimated start date and number of births; we can provide an estimated cost for you.

You are eligible for a 25% new-to-practice discount for your first year if you apply for JUA coverage within 12 months of your first license date. This discount applies to the base rate (the premium you pay for the first 12 births). The incremental premiums for additional births above 12 are not discounted.

If your first-year JUA policy begins after July 1, this discount is also applied to your second-year policy.

The Rates page gives the full details on how your premium is calculated.

Yes. The JUA offers monthly and quarterly installments, in addition to paying the full annual premium all at once. Select the option that works best for you on the application form.

The JUA accepts payments in 3 ways:

• ACH/EFT – automatic bank transfers
• Credit/debit cards (processing fees apply)
• Check, cashiers check or money order, sent to our bank in Spokane (see Contact page for mailing address)

The authorization forms for ACH and credit/debit card charges can be downloaded from the Forms & Documents page.

Payments are due upon receipt of a Policy Proposal, Audit Results Letter, invoice, or other official JUA document unless otherwise specifically indicated. The JUA offers no grace period for payments.

For policyholders making monthly payments, these are typically run on the 1st of the month.

Coverage may be cancelled for non-payment of premiums. Please reach out to the JUA Program Administrator if you need to make other payment arrangements.

The midwife is ultimately responsible for payment of premiums, regardless of any other payment arrangements that may have been made. Coverage may be cancelled for non-payment of premiums. Please reach out to the JUA Program Administrator if you need to make other payment arrangements when you leave a practice.

Midwives covered by a JUA policy are required to engage in 10 hours of continuing education per year of coverage, up to 3 years/30 hours. After that, it’s a rolling 30 hours of CE over the last 3 years.

Midwives covered by a JUA policy are required to engage in peer review at least once every 2 years. Many midwives do peer review more frequently than that

The JUA requires proof of completion of peer review every 2 years. Peer review must be done through a WA State CQIP-approved organization. The list of approved organizations can be found here.

No — peer review is its own requirement, separate from continuing ed.

Participating in a MAWS Incident Review as either the midwife with the incident or as a reviewer counts toward continuing education for the JUA.

You should email your CE certificates and peer review certificates to [email protected]. You can send them anytime!

An incident is any event resulting in injury to client or baby, or having a serious potential for injury or damages.

Claims are of two basic types: formal and informal. 

• A formal claim results when you are served with a legal document or receive a letter from a claimant or attorney. A request for medical records by your client or an attorney should be regarded as a formal claim unless the request is unrelated to the care you provided.
• An informal claim is usually presented verbally, the most common being a threat of litigation or a request to waive fees or service billings.

You should report any incident that might reasonably be expected to lead to a claim, including but not limited to:

• A poor outcome or adverse event during prenatal care, birth, or postpartum care
• A client or family expressing dissatisfaction or concern
• Any indication that legal action may be considered
• A subpoena or request for records related to a past or current client
• A request for information from a state licensing board or regulatory body

For more details, go to our Report an Incident page.

An incident report usually takes 20-30 minutes over the phone. It is best to schedule this for a time when you are not driving and have the chart available in front of you. You can schedule a time using Wendy’s calendly link here.

Reporting an incident serves two purposes. By talking with us about the incident, we can advise you on what to do and not do. Your actions following an incident can influence the likelihood of an incident escalating to a lawsuit. It also provides protection for you: by reporting an incident, you ensure that you are covered for future claims on that incident, even if you do not purchase tail coverage.

A client has 3 years to make a claim for something that occurred to them during your care, and 21 years for the baby. Even when things seem fine after the birth, there are some issues that don’t become apparent until further down the road. Make it a habit to report all incidents as soon as possible after they occur, while the details are still fresh in your mind.

No. While your policy is active or you have tail coverage in place, it is never too late to report an incident.

No. You can only report for yourself, and/or your birth center if you are the owner. If there were other JUA-insured midwives involved in the incident, they must make their own report(s).

For midwives who have been with the JUA for 5 years or more, we offer a couple of options:

• a short-term practice reduction program, which is a temporary plan for up to 5 years where the midwife might attend 0-11 births
• a long-term practice reduction program, where the midwife is not doing any births but still doing clinic

Click here for full details on the practice reduction programs.

A locum tenens midwife is someone who fills in for another midwife while they’re unavailable — maybe during an illness or a trip out of town. If the covering midwife is a JUA policyholder, their own policy will provide coverage for the locum period. If you hire a locum who is NOT insured by the JUA, they can be added to your policy as an “additional insured” at no cost for up to 30 days. The 30 days can be consecutive or split up across several weeks or months.

During the locum period, the original midwife cannot provide any midwifery care at all; the locum is stepping in to provide all care. When the original midwife returns, the locum is done. There is no overlap between the two midwives.

The locum application can be downloaded from the Forms & Documents page.

Yes! The JUA offers a sabbatical program for 3-12 months to midwives who have held a JUA policy for at least one year. During the sabbatical, the midwife will not be providing any midwifery care whatsoever in Washington State. This would be appropriate for a midwife who is going on leave after giving birth or adopting, taking an extended vacation, etc.

The cost of sabbatical coverage is 1/3 of the base rate during the leave. Sabbatical coverage essentially keeps your policy active during the leave period so that you don’t have to start over again with a new policy when you return.

Contact the JUA Program Administrator with your start/end dates and we’ll provide a quote for your sabbatical.

When we stop paying our insurance premiums — whether it’s your health insurance, your car insurance, or your medical malpractice insurance — then your policy gets canceled. You could just cancel your policy during your time off and start a new policy when you return. Doing so would mean restarting the clock on your eligibility for sabbatical, short- or long-term practice reduction programs, and free tail coverage. It would also mean making a decision on purchasing tail coverage for the policy you’re canceling. (See FAQs below for more about tail coverage.)

Keeping your policy active during your time off maintains your coverage at a reduced price. Whenever a midwife has an active policy, there is potential exposure for the JUA to have to defend claims for that midwife, and because of this, it’s not free.

For midwives who need to cancel their JUA policy, please contact the JUA Program Administrator as soon as you know when your end date will be.

The JUA Program Administrator will ask you to complete an audit form, where you will state the number of primary births (and any well-person care as a CNM) that you did during the current calendar year. This will be compared to the estimate that you submitted at the beginning of the year, and prorated for the number of days that you had an active policy. If there is a difference between the new calculation and the amount that has already been paid, either a refund will be paid to you (or to the practice that had been paying your premiums) or we’ll send you an invoice for the amount that still needs to be paid.

Yes. All policies expire at 12:01am on January 1, and this includes all payment authorizations. If you have not sent in your renewal application, your policy will expire and you will no longer have JUA coverage. You would need to reapply and start a new policy if you want JUA coverage after expiration.

The JUA may cancel a policy for the following reasons:

• Not paying the premium
• Loss or suspension of the midwife’s or birth center’s license
• Any reason that would have been grounds for refusing coverage in the first place; the JUA would need to seek written approval from the Insurance Commissioner for this

Your JUA policy covers you for claims that were made or incidents reported while your policy was active. When you cancel your policy or it expires, it is no longer active and the window for reporting incidents closes. You have the option to extend this reporting period indefinitely by purchasing “tail coverage.”

Tail coverage doesn’t cover any new claims or lawsuits that arise from incidents that happen after your policy ended; it just extends the time you have to report something that happened while your policy was in effect.

We are in a profession where injuries that happen while a client or baby is in our care might not really show themselves for months or years later. Consider the client with an undiagnosed 3rd-degree tear who has ongoing incontinence or dyspareunia long after the postpartum period. You didn’t report it to the JUA because you didn’t find the tear. Their primary care provider finally diagnoses it months later, and now it’s going to take expensive surgery to repair it. Or the shoulder dystocia that was only 3 minutes and required a brief resuscitation, no transport required. Everything turned out fine so you didn’t report it to the JUA. Years later, the child is not meeting their developmental milestones and everyone is looking back at the circumstances around the birth as a potential cause.

Clients have 3 years after an incident to file a claim or lawsuit against their care provider. For a baby, it’s 21 years. If you had reported these incidents while you had an active JUA policy, you’re likely covered. But if you didn’t report them, and your policy is canceled or expires, and you are later notified of a lawsuit, there would be no coverage — unless you had a tail endorsement that extends the window for you to report those incidents indefinitely.

Any midwife or birth center with a current JUA policy is eligible for tail coverage when they terminate that policy. The only reason a policyholder would not be eligible for tail coverage is if their policy was canceled for non-payment.

When the premium for tail coverage is paid in full, the reporting window for incidents that occurred when that policy was active is extended indefinitely. If the policyholder opted for a 3-year payment plan (see below) and stops making payments before it is completely paid off, then the tail coverage will terminate as of the date of the last payment made.

Tail coverage doesn’t cover any new claims or lawsuits that arise from incidents that happen after your policy ended; it just extends the time you have to report something that happened while your policy was in effect.

Your tail coverage would remain in effect for the previous policy term, covering you for any claims that arise from incidents that occurred while that old policy was in effect. Tail coverage doesn’t cover any new claims or lawsuits that arise from incidents that happen after the old policy ended; it just extends the time you have to report something that happened while that previous policy was in effect.

When you come back to the JUA and start a new policy, now you have a second window for reporting new incidents and claims. When you decide to terminate this new policy down the road, you will be offered tail coverage for this policy as well. Tail coverage is attached to a specific policy term. It is possible for someone to have multiple tails for multiple policies over time.

The cost of tail coverage is 1.5 times the total amount of premium that was paid over the previous 12 months. Once this amount is paid, there are no further payments to make and the reporting period is extended indefinitely.

Midwives are provided free tail coverage under the following conditions:

• to a beneficiary if an insured midwife dies
• to an insured midwife who is totally and continuously disabled for at least 6 months as a result of sickness or accidental bodily injury
• to an insured midwife who retires from practice and has been continuously insured with the JUA for the last 5 years before retirement

The tail premium can always be paid in full in one lump sum, of course. Other options include the following:

• a 3-year installment plan with annual payments of 45%, 30% and 25% of the total, respectively
• monthly payments over a maximum of 3 years, with 45% of the total paid in year 1, the next 30% in year 2, and the final 25% in year 3. Larger monthly payments may be made if a faster payoff schedule is desired.

We all pay insurance premiums so that when something happens that could be costly, the insurance company pays for it. With medical malpractice claims, the costs can be in the millions. The insurer takes on this risk and sets premiums accordingly, so that the money is there when is it is needed.

With claims-made or reported policies like the JUA’s, the window of exposure for this risk is during the active policy term. When the policy is terminated, the window of risk for the JUA closes and only includes the incidents that were reported during the time when that policy was active.

If you want to keep that window open indefinitely for reporting claims that might pop up down the road from incidents that occurred while you were insured, then the JUA continues to incur some risk for that. For this reason, there is an additional, finite premium charged for that risk.