Opt-in or opt-out enrollment for employer groups

With opt-in enrollment, employees choose to sign up. With opt-out, the employer enrolls everyone eligible and people can decline. The choice changes how many members you get, how you price the contract and how billing works. Settle it before you quote a price.

Opt-in

Employees sign up if they want to. Enrollment may be lower at first. The employer pays only for those who join.

Good for: employers testing DPC, and practices with limited room.

Opt-out

Everyone eligible is enrolled unless they decline. Enrollment is higher. Some members may not use the practice much, at least at first. Billing follows the employer's eligibility list instead of individual sign-ups.

Good for: employers who want everyone to have access, and practices with room to absorb a larger group.

How it changes your pricing

With opt-out, you'll have more members, and some may rarely visit. With opt-in, fewer members, and those who join may use more care. Price each one on the use you expect.

In a made-up example, a 100-person employer goes opt-out and 85 stay enrolled. With opt-in, 45 join. At $65 per member, that's $5,525 a month versus $2,925. But the 45 who chose to join may visit more often than the average opt-out member, so your cost per member can be higher. Track how much care each group uses so the next price is based on what happened.

Billing

• Opt-in: bill on your enrolled list. Each new sign-up needs a start date.
• Opt-out: bill on the employer's eligibility list, less those who declined in writing. You need that list every month. Here's what it should contain.

Put it in the contract

Write down which method applies, who counts as eligible, how employees decline, and when changes take effect for billing. Ask your attorney to review the wording.

What I'd do this week

• Decide which method you'll offer by default.
• Price both for your next proposal, so the employer can compare.
• Write down how a decline is recorded and when it stops billing.

Common questions

Which method do employers prefer?
It varies. Ask what matters more to the employer: paying only for users or covering everyone.

Can I mix the two?
One option is to enroll employees automatically and let dependents opt in. Write the rules down clearly.

What if an opted-out employee wants to join later?
Set a rule, like joining at the next month or the next open enrollment, and put it in the contract.