Direct Primary Care Employers EMPLOYERS DPC This is

Direct Primary Care & Employers

EMPLOYERS & DPC • This is a GREAT benefit for employees • ROI is the most probable for a self-funded employer • Less absenteeism • Self-Funded employers experience reduced claims • DPC’s are free market friendly • Do not funnel patients to the hospital system • Make the best choice for patients – clinically and financially

EMPLOYERS & DPC • The employer needs to be careful of regs. • If employee is enrolled in a Qualified High Deductible Health Plan and has an HSA… • DPC ‘unqualifies’ the HDHP • Employee loses the right to make contributions to HSA • Employee may be put in an adverse tax situation (does not matter who pays for DPC or whether employer funds the HSA) • See FMMA. org and DPCFrontier. com for more details

EMPLOYERS, DPC AND THE IRS • IRC s 104/s 105 allows employer to offer benefits pre-tax • IRC s 213 describes “deductible medical expenses” that employers can provide pre-tax (list) • The IRS has not caught up with the market. “Concierge” is ACCESS • Direct Primary Care is CARE not just ACCESS • Your language/word choice is important! • DPC vs. Concierge

EMPLOYERS – WITH A HEALTH PLAN • Integrated HRA recommended • For self-funded, if IRS has an issue, protects the group health plan • Must document plan assets were used for CARE not access or membership fee

SMALL EMPLOYERS - NO HEALTH PLAN • If Employer tries to pay DPC fees pre-tax (IRC s 105) through a stand-alone HRA • May be considered a ‘health plan’ • ACA fines for a non-compliant plan that fails to meet other ACA coverage mandates • MUST pay DPC fee as a taxable benefit