Starting a direct primary care (DPC) practice in Ohio means working through how the membership agreement will function, from the first payment to the end of the relationship. Ohio Revised Code § 3901.95 sets out conditions for a DPC agreement to receive its specified treatment outside insurance regulation.
Your agreement, fee schedule and payment system should fit together. A clear contract helps patients understand the services they will receive and helps the practice administer the arrangement consistently.
Use Ohio’s agreement requirements as a review starting point
Ohio Revised Code § 3901.95 addresses written agreements, periodic payments, service descriptions, additional fees and termination. It also requires authorization for third-party payment and a prominent statement about the agreement’s insurance status. The exclusion depends on meeting all of the listed conditions, not simply using a DPC label. R.C. § 3901.95.
Ask counsel to review the current statute alongside the arrangement you actually plan to offer. Keep questions about ownership, professional practice and other legal duties separate from whether the membership meets this provision.
Design a termination process the practice can carry out
Ohio requires written termination notice and an agreement permitting termination to take effect immediately upon the other party’s receipt of notice or no later than 60 days after receipt. It prohibits a termination penalty or termination fee. It also addresses charges for the services prescribed in the agreement. R.C. § 3901.95(C)–(J).
Translate those questions into an operational review: how does a patient submit notice, who records its receipt, and how is the effective date passed to the billing system? Ask counsel to distinguish ordinary amounts owed, prepaid-fee handling and a prohibited termination charge rather than assuming they are interchangeable.
For example, a membership platform may have a default cancellation fee or continue recurring charges after staff receive a written notice. Test those settings before using the platform with patients. A contractual right should not depend on a staff member finding an undocumented workaround.
Match the fee schedule to the services
Prepare a list of the services included in the periodic fee and any additional charges. Make it clear when a laboratory, pharmacy or other provider bills separately.
Review a few realistic patient journeys:
- A patient uses only routine visits and secure messages.
- A patient needs a service outside the membership.
- Someone else pays the patient’s membership fee.
- A patient gives written notice shortly after a recurring payment.
For each journey, compare the website, agreement, receipt and staff instructions. Identify charges or promises that appear in one place but not another. Ask counsel which terms and workflows need revision.
This exercise is especially useful before selecting an enrollment platform. Choose settings that implement the reviewed agreement rather than allowing default software language to define the relationship.
Make the insurance status statement visible
Section 3901.95(K) requires a prominent statement explaining that the agreement is not health insurance, is outside the state insurance laws specified by the provision, and does not satisfy any individual insurance mandate that federal law may require. Ask counsel to confirm the current requirements and the exact wording for your arrangement. R.C. § 3901.95(K).
Include the statement when reviewing the agreement and enrollment process. Check how it appears on a phone as well as on a printed copy, and make sure marketing descriptions do not suggest that membership replaces health insurance.
Examine third-party payment arrangements separately
Ohio’s agreement conditions address permission for a third party to pay fees. That does not settle every question about a particular employer-sponsored arrangement or give the payer unrestricted access to patient information.
If an employer plans to pay, document who signs which agreement, what the payment covers, what happens when employment ends, and what information the employer expects to receive. Bring that description to counsel before using an individual membership form for the entire arrangement. These are review questions, not a conclusion about a particular benefits structure.
Keep Medicare and patient privacy on the launch checklist
An Ohio DPC agreement does not by itself resolve federal Medicare requirements, and serving a Medicare beneficiary does not automatically require opting out. Review your participation status, planned patients and services before deciding how to handle Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) describes eligibility, affidavits, private contracts and timing for the opt-out process. A DPC membership agreement alone is not the Medicare private contract. See 42 C.F.R. §§ 405.410 and 405.415.
For HIPAA, ask whether the provider transmits health information electronically in connection with a covered transaction. Electronic records or messaging alone do not establish covered-entity status; examine how patient information moves through records, messaging, intake and vendors. See 45 C.F.R. § 160.103.
Cunningham Law’s existing DPC and HIPAA guide offers further questions for that discussion. Review other applicable confidentiality and contractual duties as well.
What to prepare for your Ohio practice review
Gather the proposed agreement, service and fee schedules, cancellation instructions and payment-platform settings. Include ownership information, existing employment and payer contracts, and details of any third-party payment arrangement.
Identify unresolved decisions before choosing an enrollment date. A checklist organizes the work; it does not establish that the practice is legally ready to open.
Common questions
Can an Ohio DPC agreement include a cancellation penalty?
The cited § 3901.95 text prohibits termination penalties and termination fees as a condition of its exclusion. Have counsel review the current law and proposed charges before adding them to the contract or payment platform.
Does a third party paying the fee resolve an employer arrangement?
No. Payment permission is one issue. The agreements, eligibility changes, benefits questions and information-sharing expectations need their own review.
Discuss your Ohio DPC plans with Kim
Kim Cunningham is licensed in Ohio and helps DPC practices with setup, agreements and policies. Explore her healthcare legal services or request a consultation. Keep the first inquiry general and omit patient information and confidential records.
General information, not legal advice. Current law and your particular arrangement determine the appropriate approach. Reading this article or contacting the firm does not create an attorney/client relationship.