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Employer health terminology direct care physicians need to know

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The employer sponsored healthcare market is an increasingly viable opportunity for direct primary care (DPC) physicians. Employers look for ways to save money for the business and for the employees as well as ways to ensure their employees are healthy and happy. New and innovative options such as a DPC practice could be an enticing incentive for an employer to use in recruiting and retaining quality talent.

For DPC practices pursuing employers, understanding certain employer health terminology would be helpful for DPC physicians to be able to market and provide healthcare services effectively. DPC physicians should become familiar with these terms:

Benefit year – Unlike individual DPC memberships, employer healthcare plans typically span a year’s time. Often the benefit year will begin on January 1 and end on December 31. Sometimes, though, the employer will opt to begin the benefit year on July 1 and end it on June 30.

Employer contribution – Many employers contribute a portion or all of the employee’s healthcare coverage costs, which would be the membership fee for a DPC. Employers may or may not contribute a portion of the employee’s dependent coverage.

Open enrollment period – New employees are usually eligible to sign up for healthcare after starting their new job; however, current employees are typically only eligible to sign up during a specified period of time. For example, if the benefit year starts on January 1, open enrollment may occur during October or November of the previous year.

Life events – Employees are generally allowed to make changes to their healthcare coverage if certain life events occur, such as getting married or having a new baby.

Premium – Employer-sponsored healthcare plans typically charge a premium, which is the amount charged for the healthcare coverage each month. For a DPC practice, the premium would be the monthly membership fee.

Wellness programs – In an effort to provide incentives for employees to become and stay healthy, employers are increasingly offering wellness programs, such as smoking cessation classes, weight loss programs, and fitness centers, in addition to their healthcare coverage plans. DPCs may benefit from typing these wellness programs into their service offerings.