Employer Contracts Guide¶

Reviewed by Jack Forbush, DO · last verified 2026-09-22 · what this means

Quick Summary: Employer contracts can accelerate panel growth and provide stable revenue. Expect 10-25% discounts from individual rates (typical convention; unsourced), longer sales cycles, and more administrative complexity. Start with small local businesses where relationships matter.

Caution

Educational content only. Employer-paid DPC touches federal tax, HSA, ERISA and ACA rules that change regularly. This guide is general education, not legal or tax advice. Have a healthcare attorney review your contract and tell each employer to consult its own benefits counsel.

Why Employers Choose DPC¶

Employer Motivations¶

Cost savings: - Reduce insurance claims through better primary care - Decrease ER and urgent care utilization - Lower pharmacy costs - Potential insurance premium reductions

Employee satisfaction: - Better access to care - No copays or deductibles for primary care - Less time away from work for appointments - Healthier, more productive employees

Competitive advantage: - Attract and retain employees - Differentiate benefits package - Show investment in employee health

The Employer Value Proposition¶

Frame DPC as: - An investment in employee health and productivity - A benefit that employees actually use and value - A complement to (not replacement for) health insurance - A way to reduce total healthcare spending

Types of Employer Arrangements¶

Full Panel Membership¶

Employer pays for all employees to have DPC membership.

Pros: - Simple administration - High utilization - Predictable revenue

Cons: - Larger financial commitment - Some employees may not use it - Employer bears all cost

Voluntary/Subsidized¶

Employer subsidizes membership; employees pay difference or opt in.

Pros: - Lower employer cost - Employees who join are motivated - Flexibility

Cons: - Lower participation - More admin complexity - Adverse selection possible

Hybrid Arrangements¶

Combination approaches: - Full coverage for employee, subsidized for dependents - Tiered employer contribution - Wellness incentives tied to participation

Pricing for Employers¶

Typical Discounts¶

These are common conventions, not sourced figures:

Group Size	Typical Discount
5-15 employees	10-15% below individual rates
16-50 employees	15-20% below individual rates
50+ employees	20-25% below individual rates

Pricing Structures¶

Per Employee Per Month (PEPM): Most common structure. Employer pays X dollars per enrolled employee monthly.

Example: - Individual rate: $99/month - Employer PEPM: $85/month (14% discount; illustrative, unsourced)

Family considerations: - Employee only: Base PEPM - Employee + spouse: Higher PEPM - Employee + children: Higher PEPM - Employee + family: Highest PEPM

What to Include¶

Standard: - All services included in individual membership - Same access and availability - Same scope of care

Consider adding: - On-site visits (if feasible) - Health screenings - Basic occupational health - Health education sessions

What to Charge Extra¶

Pre-employment physicals
Workers' comp visits (may have separate requirements)
DOT physicals
Drug testing
Other occupational health services

Finding Employer Clients¶

Ideal First Clients¶

Start with: - Small local businesses (10-50 employees) - Business owners you know personally - Companies frustrated with health insurance costs - Businesses that value employee wellness

Why small first: - Decisions made by owner, not committee - Faster sales cycle - Personal relationships matter - Good reference for larger clients

Prospecting Approaches¶

Network-based: - Your existing patients who are business owners - Chamber of Commerce connections - Local business associations - Professional networks

Direct outreach: - Identify target companies - Research decision-makers - Personalized introduction - Offer to present

Referrals: - Ask satisfied employer clients for introductions - Insurance brokers (some are DPC-friendly) - HR consultants - Benefits advisors

Who Makes the Decision¶

Company Size	Decision Maker
<25 employees	Owner/CEO directly
25-100 employees	Owner/CEO or HR lead
100-500 employees	HR director, benefits committee
500+ employees	Benefits team, executives, consultants

The Sales Process¶

Initial Conversation¶

Discover their pain: - What's frustrating about current benefits? - What do employees complain about? - What's happening with insurance costs? - Have they heard of DPC?

Educate: - Brief DPC explanation - How it complements insurance - Local success stories if available

Don't sell yet. Listen first.

Proposal Development¶

Gather information: - Number of employees - Location(s) - Current benefits structure - Budget considerations - Timeline

Proposal elements: - Executive summary - DPC explanation - Proposed pricing - Implementation timeline - ROI considerations (if appropriate)

The Presentation¶

To decision-makers: - Focus on business value - Address their specific concerns - Share patient/employer testimonials - Be clear on pricing and terms

To employees (if invited): - Focus on access and convenience - Address common questions - Make it relatable

Closing¶

Common objections: - "We already have insurance" — DPC complements, doesn't replace - "How do we know it works?" — Offer pilot, references - "Employees won't use it" — Discuss engagement strategies - "Too expensive" — Discuss ROI, total healthcare costs

Trial arrangements: - 3-6 month pilot with subset of employees - Early termination clause - Clear success metrics

Contract Essentials¶

Key Terms¶

Duration: - 12-month contracts typical (convention; unsourced) - Auto-renewal with notice period - Termination provisions

Pricing: - PEPM rate by coverage tier - Annual adjustment mechanism - What's included/excluded

Enrollment: - Who's eligible - How employees enroll - Effective dates - Open enrollment vs. ongoing

Administration: - Who provides employee data - How changes are communicated - Billing and payment terms

Termination: - Notice period (typically 60-90 days; convention, unsourced) - Proration of fees - Continuation options for employees

Sample Contract Sections¶

Illustrative language only; the notice periods and payment terms shown are conventions, not sourced requirements.

Services description:

Provider will make available to Enrolled Employees all primary care services offered under Provider's standard DPC membership, including office visits, telehealth, secure messaging, and [other services].

Enrollment:

Eligible employees may enroll during annual open enrollment or within 30 days of qualifying life events. Employer will provide updated roster monthly.

Payment:

Employer will pay Provider [rate] per enrolled employee per month, due by the 15^th of each month for that month's coverage.

Termination:

Either party may terminate with 90 days written notice. Upon termination, enrolled employees may continue membership at individual rates.

Legal Review¶

Have a healthcare attorney review your employer contract template before use.

Tax and Benefits Compliance¶

Employer-paid DPC crosses into tax and benefits law that a cash-pay practice otherwise never touches. The rules below carry dates so you know when to re-check them.

HSA rules for employer-paid DPC (2026)¶

Subject to change

Since January 1, 2026, 26 USC 223©(1)(E) (added by P.L. 119-21 §71308) treats a qualifying DPC service arrangement as not being a health plan, so enrollment no longer blocks an employee's HSA contributions—before 2026 it did. The arrangement qualifies only if the fee is $150/month or less for employee-only coverage or $300/month or less for a tier covering more than one person (indexed after 2026), and it provides only primary care: no bundled non-ambulatory labs and no prescription drugs other than vaccines. Set your employee-only and family PEPM rates with those caps in mind. IRS Notice 2026-05 adds three points that matter in employer deals: fees an employer pays, including through a §125 cafeteria plan, are excluded from the employee's income under 26 USC 106 and cannot also be reimbursed from the employee's HSA (Q&A-18); an HDHP may not itself provide DPC before the deductible is met (Q&A-15); and DPC fees do not count toward the HDHP deductible (Q&A-16).

ERISA and ACA exposure¶

Subject to change

When an employer pays for DPC, the arrangement is generally an employee welfare benefit plan under 29 USC 1002(1), which brings ERISA plan-document, fiduciary and disclosure duties for the employer. The IRS has also said that an employer payment plan that pays for or reimburses medical care is a group health plan subject to the ACA market reforms unless it is integrated with major-medical coverage (Notice 2013-54 and Notice 2015-87); a stand-alone arrangement that fails those reforms can trigger the 26 USC 4980D excise tax. Proposed regulations that would have let HRAs reimburse DPC fees (REG-109755-19, June 2020) were never finalized, so do not promise FSA or HRA reimbursement. Tell the employer to run the arrangement past its benefits counsel before signing, and say so in the contract.

Operations and Administration¶

Onboarding¶

For the employer: - Contract signing - Payment setup - Employee communication materials - Enrollment process

For employees: - Welcome communication - Enrollment instructions - Schedule first appointments - Access setup (portal, messaging)

Ongoing Administration¶

Monthly: - Roster reconciliation - Invoicing - Payment processing - New enrollee onboarding

Periodically: - Utilization reports (if requested) - Employee satisfaction check - Relationship management - Contract renewal discussions

Reporting¶

Employers may request: - Aggregate utilization data - Participation rates - Satisfaction scores - Health outcomes (be careful with PHI)

Important: Never share individual PHI with employers without employee authorization. A cash-only DPC practice that never submits an electronic claim may not be a HIPAA covered entity under 45 CFR 160.103, but your membership agreement, the employer contract and state privacy law still bind you—treat HIPAA as the floor.

Common Challenges¶

Low Utilization¶

Problem: Employees have membership but don't use it.

Solutions: - Better onboarding - Employer communication support - On-site presence (if feasible) - Regular engagement reminders

Administrative Burden¶

Problem: Roster changes, billing issues, HR coordination.

Solutions: - Clear processes - Designated employer contact - Simple enrollment systems - Automate where possible

Contract Negotiations¶

Problem: Large employers want extensive contract modifications.

Solutions: - Know your non-negotiables - Standard contract for small employers - Flexibility for large accounts - Walk away if terms don't work

Employee Turnover¶

Problem: High turnover means constant enrollment changes.

Solutions: - Monthly roster reconciliation - Prorated billing - Simple add/drop process

Checklist¶

Before Pursuing Employers¶

Stable individual panel (don't neglect core patients)
Capacity for additional patients
Administrative systems in place
Employer contract template (attorney-reviewed)

For Each Employer Client¶

Sources checked against primary law and agency guidance on 2026-09-22.

Employer contracts can grow your practice and stabilize revenue. Start small, deliver excellent care, and let satisfied clients become your best marketing.