My claims made policy says I pay the tail. What will it cost an OB/GYN?

Price it before you do anything else, because in obstetrics the tail is not a footnote. Your tail commonly runs 150 to 200 percent of your premium. A tail commonly costs 150 to 200 percent of your mature annual premium, due in one lump sum inside a short window after the policy ends, and on OB/GYN premiums that band produces a six figure exit check. Against the Miami Dade premium of $243,988, your tail prices at $365,982 to $487,976. Against the Los Angeles and Orange County premium of $49,804, it prices at $74,706 to $99,608. Your cost is your own premium times that band, and your state decides which end of the country you land on.

Part of the OB/GYN hub.

What you are actually being asked to carry

A claims made policy and an occurrence policy split the same risk at different seams. Occurrence coverage answers for any incident that happened while the policy was in force, whenever the claim arrives. Claims made coverage answers only for claims reported while the policy is still in force, which is why the tail exists: formally an extended reporting period, it keeps you covered for claims reported after the policy ends, for care you gave while it was in force. Skip it and you are personally exposed for every delivery of your years there. Three features make the OB/GYN version of this bill heavy. First, the premium it multiplies can reach $243,988 a year. Second, it is due in one payment, inside a short election window after the policy ends, exactly when you are between jobs, and carriers generally bill within about two months of cancellation. Third, the exposure runs long in your specialty: in many states the malpractice clock for a child does not start running until the patient turns 18, so a delivery today can become a claim nearly two decades from now.

The arithmetic deserves to be written out, because the band is not the story. The premium is the story. Florida, Miami Dade, at $243,988 a year: $243,988 times 1.5 equals $365,982, and $243,988 times 2 equals $487,976. California, Los Angeles and Orange County, at $49,804 a year: $49,804 times 1.5 equals $74,706, and $49,804 times 2 equals $99,608. The Florida tail at the top of the band is nearly five times the California tail, for the same physician under the same policy form. Other markets in the same AMA exhibit fall between the poles, Illinois at $207,907, New York at $176,358, Connecticut at $159,537, Pennsylvania at $135,974, and New Jersey at $94,640. There is no national number to plan around.

One refinement matters. Your tail is priced off the mature premium, the rate your policy reaches after its early step ups, not the discounted first year premium you may be paying now. Ask the carrier for the actual tail quote rather than estimating from your current bill. It replaces every estimate on this page with your number.

How to carry it, or avoid carrying it

Start by rereading your contract for the exits the clause does not cover. The strong version of a tail clause has the employer paying on the exits that are not your choice: termination without cause, nonrenewal, retirement, and disability, and many policy forms waive the tail on death, disability, and retirement after a minimum age and years of continuous coverage that the policy sets. A young attending leaving early qualifies for none of those waivers, which is why the contract clause matters more than the policy form. If your contract assigns you the tail on a voluntary exit, three levers remain. Negotiate at the next signature, not at the resignation. Ask the next employer about nose coverage, where the new carrier covers your prior acts by honoring your retroactive date, which erases the bill entirely when the new carrier accepts it. And if the tail stays yours, treat it as a debt you already owe: fund it monthly inside your Safety Net reserve, so the exit check is sitting in cash the day you resign.

The contrast case shows what the clause is worth when it points the other way. Heidi, the new attending in the Heidi and Spencer case, practices under claims made coverage with the tail covered by her employer. She never has to fund this reserve or price this check into a job change. That term is compensation, as surely as her salary of about $320,000 is. If you hold the opposite term, you hold a liability that grows with every year you stay, payable in full on the day you leave.

The number also grades offers while you still hold them. A job that carries your tail is worth the priced tail against an otherwise identical job that does not, and in a high premium state that difference can exceed a year of the salary gap between the two offers. Read the tail clause as a compensation line, and price the exit before you walk through it.

Follow up questions

Can I pay the tail in installments or put it on a card?

Plan as if you cannot. The tail is quoted as a one time lump sum due inside a short election window after the policy ends, and missing the window leaves your past years uncovered. The reliable version is a reserve funded monthly at the quoted estimate, held in your Safety Net bucket, so the lump sum is a transfer and not a crisis.

What if I just do not buy it and take the risk?

Then you are self insuring every delivery and surgery of your years under that policy, across a window that can run nearly two decades, because the malpractice clock for a child in many states does not start until the patient turns 18. A single claim in that window arrives against you personally.

Related questions

• Occurrence vs. claims made malpractice: which OB/GYN policy do I have?
• How does tail coverage work when my group switches malpractice carriers?
• Large group for malpractice coverage or small practice for ownership?

Sources

• Physician Side Gigs, malpractice tail insurance coverage guide, which establishes that tail coverage typically costs 150 to 200 percent of the mature annual premium, payable in a single lump sum, and that in many states the clock for a child does not run until the patient turns 18, accessed October 2026.
• Today's Hospitalist, tail coverage before you take that job, which establishes that carriers generally bill within about two months of cancellation, accessed October 2026.
• American Medical Association, Policy Research Perspectives, medical liability premiums, which reports $1M/$3M OB/GYN premiums of $243,988 in Miami Dade and $49,804 in Los Angeles and Orange County, accessed October 2026.
• Financial Fellowship Heidi and Spencer case, the new attending under claims made coverage with the tail covered by the employer, accessed October 2026.

Takeaways

• A personal tail costs commonly 150 to 200 percent of your mature annual premium, in one lump sum at exit.
• On the Florida premium of $243,988 the range is $365,982 to $487,976. On the California premium of $49,804 the range is $74,706 to $99,608.
• Ask your carrier for the actual tail quote now, and fund it monthly inside your Safety Net reserve if it stays yours.
• Nose coverage from a new employer can erase the bill entirely. Heidi's employer paid term shows the other side.