Annually, and any time the practice changes what it does. Adding a procedure, adding an advanced practice provider you supervise, opening a second location, or treating patients by telehealth across state lines all change the exposure being rated. Facility and credentialing requirements move too, and those are usually the practical floor on the limit. One California reason to look yearly: the MICRA cap on noneconomic damages rises every January under Assembly Bill 35, so the ceiling that shaped a limit decision in one year is higher the next. Current as of August 2026.

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