It’s renewal season. You open your CM&F quote and see a 15% increase. You hear colleagues talking about NCMIC. Both are giants in the midwife world, but which one actually pays out when the crisis hits? I dug into the specimen policies so you don’t have to.
Key Takeaways
- Underwriting Differences: CM&F (Medical Protective) is often stricter on protocols (VBAC bans). NCMIC is chiropractic-rooted but has embraced midwifery; they may be more flexible on holistic scopes.
- Occurrence vs. Claims-Made: This is the dealbreaker. CM&F is typically Occurrence (safer long-term). NCMIC offers both; know what you are buying.
- Defense Costs: Check if defense costs are “Outside Limits.” Both usually offer this, but verify.
- Consent to Settle: Look for this clause. It means the insurance company cannot settle a claim (admitting your guilt) without your permission.
The “Why” (The Trap): The “Tail” Coverage Nightmare
The biggest difference often isn’t the price—it’s the Claims-Made trap.
If you switch from NCMIC (Claims-Made) to CM&F (Occurrence) without buying “Tail Coverage” from NCMIC, you leave a massive gap. If a lawsuit comes in from a birth 2 years ago, NCMIC won’t cover it (policy is dead) and CM&F won’t cover it (happened before their policy started).
The Investigation: Head-to-Head
1. CM&F Group (Underwriter: MedPro)
- Pros: backed by Warren Buffett’s Berkshire Hathaway. Incredible financial stability. Occurrence policies are standard. Automated, fast online dashboard.
- Cons: Very rigid. If you operate in a gray area of your state’s laws, they will likely decline you. No wiggle room on VBAC exclusions in some states.
2. NCMIC
- Pros: Deep understanding of holistic/chiropractic/midwifery overlap. Often excellent customer service where you can talk to a human.
- Cons: Claims-Made policies require careful management. Price can be volatile based on state litigation climates.
3. ACNM (Southern Cross)
- Note: Often tied to hospital-based practices. Good for CNMs, harder for CPMs/Home birth.
Comparison Table: 2026 Snapshot
| Feature | CM&F Group | NCMIC |
| Policy Form | Occurrence (mostly) | Claims-Made & Occurrence |
| Financial Strength | A++ (Superior) | A (Excellent) |
| Consent to Settle | Yes (Pure) | Yes (usually) |
| License Defense | Up to $25k | Up to $25k |
| Best For | Strict protocol followers | Holistic/Private Practice |
[IMAGE: Bar chart comparing average annual premiums for CPMs by state]
Step-by-Step Action Plan
- Check Your Current Type: Look at your Dec Page. Does it say “Claims-Made” or “Occurrence”?
- Get a Specimen Policy: Don’t just look at the price. Ask for the full policy wording PDF before paying.
- Compare “Exclusions”: Search the PDF for “Home Birth,” “VBAC,” “Breech,” and “Twins.” See which carrier excludes fewer of your core services.
- Call About “Tail”: If considering switching, ask the old carrier: “How much is unlimited tail coverage?” Factor that into the switch cost.
FAQ Section
Why is Midwife insurance so expensive?
Because birth lawsuits involve “damaged babies.” These result in the highest jury awards (millions of dollars) because the care is needed for a lifetime.
Can I go without insurance (go bare)?
In some states, yes. But you risk losing your home, savings, and future earnings. Also, many backup doctors/hospitals won’t collaborate with uninsured midwives.
Does this cover my birth assistants?
No. They usually need their own policies or to be added as named insureds (which costs extra).