How to Actually Offer Direct Primary Care as an Employee Benefit — Before Open Enrollment

Most small-business health plans renew on January 1. Which means the decisions that shape your 2027 benefits are made in October and November — usually in a two-week window after your broker sends the renewal, when the increase is already on paper and nobody has time to consider anything other than accepting it or shopping the same product somewhere else.

This is the fourth post in our series for Central Ohio small business owners. We have covered what concierge and direct primary care look like as an alternative, what it actually costs, and what your employees give up under a traditional plan. This one is the practical version: the six steps to actually put Direct Primary Care in front of your team before open enrollment closes.

Step 1 — Get clear on what Direct Primary Care actually is

Direct Primary Care (DPC) is a flat monthly membership that covers primary care directly, with no insurance company in between. For your employees that generally means unlimited visits, direct phone and text access to their clinician, same-day or next-day appointments, 30 to 60 minute visits instead of seven, and labs and common medications at or near cost.

It is not insurance, and it should never be presented to your employees as insurance. DPC does not cover hospitalization, surgery, specialists, advanced imaging, or a catastrophic event. It covers the 80 to 90 percent of care that actually happens — the sinus infection, the blood pressure recheck, the lab panel, the sports physical, the thing someone has been ignoring for six months.

The model employers use is a pairing: a lower-premium, higher-deductible major medical plan for the catastrophic risk, plus a DPC membership for everyday care. Confusing those two pieces is the single most common reason these conversations stall out in week one.

Step 2 — Talk to your CPA before you talk to anyone else

This is the step business owners skip, and it is the one that determines whether the whole arrangement is clean. Before you price anything, sit down with your accountant and ask:

• How do we deduct membership fees paid on behalf of employees, given our entity type?
• Do we treat this as a fringe benefit, run it through a Section 105 arrangement, or fold it into an ICHRA?
• What are the payroll and W-2 reporting implications for our employees?
• If our employees contribute to Health Savings Accounts, how does a DPC arrangement interact with their HSA eligibility, and what documentation do we need?
• Does anything change if some employees participate and others do not?

That fourth question matters more than it looks. The rules governing how Direct Primary Care arrangements interact with HSA eligibility have changed in the last two years and are still being interpreted. Do not take your tax position from a blog post — including this one — from a broker summary, or from any practice’s marketing page. Get it in writing from your own CPA. We will give you the structure and the numbers; your accountant tells you how they land on your return.

Step 3 — Bring your insurance broker in early, and frame it correctly

Business owners often avoid this conversation because they assume the broker will fight them. Some will. The framing that works is not “I’m replacing you” — it is “I want to redesign the plan.” Your broker keeps the major medical piece either way, and a good one will model it for you.

Ask your broker for three things in writing:

• Your actual renewal increase on the current plan design, in dollars per employee per month.
• A quote for one or two higher-deductible, lower-premium plan designs alongside it.
• The employer contribution and the employee payroll deduction under each scenario.

Now you have a baseline. The DPC membership sits next to those numbers as a separate line item, and you can see for the first time what the whole benefit actually costs versus what it delivers.

Step 4 — Book an employer consultation with Retro Health

This is where the abstract becomes specific to your business. In an employer consultation we go through:

• Headcount, who is currently on the plan, and who has been waiving it — that last group is often the most telling number in the room.
• Your current plan design and the renewal your broker just sent.
• What your people actually use care for, and where they go now when something comes up.
• What the membership would cost for your specific group, and what the employer-paid versus employee-paid split could look like.
• Whether a full-group offering, a voluntary benefit, or a leadership-only pilot makes the most sense for your first year.

You leave with real numbers you can hand back to your CPA and your broker. There is no obligation, and we will tell you plainly if we do not think it is a fit for your business right now.

Step 5 — Present it to your employees the right way

Here is the thing nobody warns you about: when employees hear “we’re changing your health benefits,” they assume something is being taken away. That reaction is earned. They have sat through a decade of announcements where the change meant a higher deductible and a thinner network.

So lead with what they gain, and be explicit about what stays the same:

• What they gain: a clinician they can call or text directly, same-day and next-day appointments, no copay for primary care visits, real appointment length, and labs and medications at cost.
• What does not change: they still have major medical coverage for hospitalization, surgery, specialists, and emergencies.
• What they should expect: a deductible that may be higher on the insurance side, offset by everyday care that no longer runs through it.

Then hold a live session. Twenty to thirty minutes, on-site or virtual, where your team asks questions of a clinician rather than of HR. We run that session for you. It is the single highest-impact thing you can do for enrollment, because most of the hesitation is not financial — it is people not believing that healthcare is allowed to work this way.

Step 6 — Handle the logistics before the plan year starts

The operational side is smaller than people expect, but it needs to be settled before January 1, not during it:

• Roster and enrollment: who is participating, effective dates, and how you handle employees who join or leave mid-year.
• Billing: a single monthly invoice to the business, employee payroll deduction, or a split — decided up front and documented.
• Effective date: aligned to your plan year so there is no gap and no double coverage.
• Onboarding visits: scheduled in the first 30 to 60 days. Utilization in month one is the best predictor of whether the benefit sticks.
• Point of contact: one named person at Retro Health and one at your company, so questions do not disappear.

The timeline, working backward from January 1

• Now through mid-October: CPA conversation, broker renewal numbers, employer consultation.
• Late October: decide on plan design and finalize the numbers.
• November: announce to employees, hold the Q&A session, collect enrollment.
• December: finalize the roster and set up billing.
• January 1: coverage and memberships effective, onboarding visits underway.

If you are reading this in early October, you are on time. If you are reading it in late November, the pilot-group version is still very much on the table — and it is often the better first year anyway.

Start with a conversation about your actual numbers

Every business is different, and the only way to know whether this works for yours is to put your headcount, your renewal, and your utilization on the table and look at it honestly. That is what the employer consultation is for.

Gregory LaFontaine, PA-C is the co-founder and Director of Men’s Health & Wellness at Retro Health & Aesthetics in Worthington, Ohio. He specializes in concierge primary care, men’s health, and employer health benefits.