Guide

The direct agreement: the clauses your statute names, in order

Summary

What a direct primary care agreement must contain is set by state statute, so the list is short in some states and long in others, and meeting it is what keeps the agreement out of the insurance code. Arizona names seven elements, including a signed writing, thirty-day termination, scope of services, fees, duration, and prescribed not-insurance wording. Utah names three. Read your own state's section before drafting.

By Gale Editorial · Updated 2026-09-02. Every figure cited to a dated source. How we write.

Why the statute lists clauses at all

The list is the price of staying out of the insurance code. Arizona says a direct primary care agreement meeting its requirements does not constitute the transaction of insurance business or a health care services organization in the state 1. That exemption is conditional. Miss an element and what you have is a contract the exemption does not cover.

Which clauses those are depends on where you practice. Arizona's article names seven 2. Utah's equivalent names three 3. Maine's list is shorter than Arizona's and adds one clause neither of the others carries, a statement that the fees may not be reimbursed or applied toward a deductible under a health insurance policy with an insurer 4. There is no national form, and a template drafted for one state carries that state's clause list.

But the first problem is finding your own state's section at all.

These statutes sit in different codes, under names that do not match the term the market uses. Arizona put its article in Title 44, trade and commerce 2. Utah put its in the insurance code 3. Maine put its in Title 22, health and welfare 4. Washington's chapter sits in the insurance title 5. Search your own code for retainer, direct agreement and direct health care before concluding the model is unregulated where you practice, and read the section rather than a summary of it.

Arizona's seven elements, at the long end of the range

Arizona's article carries the longest required-terms list among the states cited here, and it reads as a checklist. The agreement is in writing and signed. It carries a thirty-day termination right, separate terms for relocation and military duty, a description of the services covered, the periodic fee and any additional fees, a duration and renewal term, and a prescribed not-insurance disclaimer 2.

ClauseWhat the Arizona article requires
WritingThe agreement is in writing
SignatureSigned by the parties
TerminationEither party may end it on thirty days' written notice, with separate terms for relocation and military duty
ScopeA description of the services the periodic fee covers
FeesThe periodic fee, and any additional fees for services outside that scope
TermThe duration of the agreement and how it renews
DisclaimerProminent not-insurance wording, in substantially the form the statute prints

The termination element is an easy one to soften in drafting. The statute's own instruction is to "allow either party to terminate the agreement on a thirty-day written notice to the other party" 2, and it runs in both directions: the patient's exit and yours are on the same clock. Relocation and military duty are named separately, so a single general termination sentence leaves two named items unwritten.

A panel that can shrink on thirty days' notice is a revenue line with a thirty-day floor under it. The number in the fee clause comes out of the dpc equation, panel size against fixed overhead.

Utah's three elements, and the name that hides the statute

Utah requires three things. The agreement describes the specific routine health care services covered, states prominently and in writing that it is not health insurance, and prohibits the health care provider, but not the patient, from billing an insurer for the services provided under the agreement 3. That last distinction is worth copying exactly. The bar runs on the practice, and the statute is explicit that it does not run on the patient.

Utah's statute also never uses the phrase direct primary care agreement. It calls the instrument a medical retainer agreement, so a search for the industry term misses the section 3. Maine's section is headed direct health care service agreements 4. Washington regulates what its chapter calls a direct agreement 5. Three states, three names for one instrument, and none of the names is the term the market uses.

A short statutory list settles less, not more. Where Utah names three elements, the term, the refund treatment, the notice period and the renewal mechanics are all still open, and the contract has to settle them on its own. That is ordinary drafting work, and it is the part a one-page template usually skips.

The not-insurance disclaimer is not yours to word

Several states print the disclaimer wording and require the agreement to carry it. Arizona's element is a prominent written disclaimer that the agreement is not health insurance and that reads, in the statute's phrase, "in substantially the following form" 2. Washington fixes the sentence itself: "This agreement does not provide comprehensive health insurance coverage. It provides only the health care services specifically described." 5

But the disclaimer is not always the whole disclosure.

The prescribed Arizona text also states that the provider may not bill the patient's insurer for services the agreement covers 2. Washington adds a second layer outside the contract body. A separate disclosure statement goes out with the participation forms, covering the patient's financial rights and responsibilities, the encouragement to keep insurance for services the agreement does not cover, the rule against billing a carrier, and the state insurance commissioner's contact information 5. The same chapter reaches individual agreements only, so a group arrangement sits outside it.

Maine's clause is easy to miss, because it says something the others do not. The agreement has to state that the fees may not be reimbursed or apply towards a deductible under a health insurance policy with an insurer 4. A patient who assumes the membership fee counts toward a deductible has read the market's description rather than Maine's statute.

What the fee clause has to carry

Among the sections cited here, more state law lands on the fee clause than on any other. Arizona caps prepayment: a practice may not require more than twelve months of the periodic fee to be paid in advance, and prepaid months past a termination date go back to the patient 6. Washington runs the fee monthly and requires a prompt refund of unearned fees once written termination notice arrives, prorated to the date that notice is received 7.

Prorated to the date of receipt is a different instruction from prorated to the end of the billing month, and it is the kind of detail a billing setup either handles or does not. Washington also treats fees paid more than one month in advance as trust money, and holds fee changes to at least sixty days' advance notice, with no more than one increase a year 7. A price change announced on the website and a price change reaching existing patients are on two different clocks.

Arizona allows the periodic fee to be paid by an insurer or another third party without that payment turning the agreement into insurance 6. Employer-paid memberships come up early in a new practice, so the clause is worth reading before a local employer asks.

None of the state sections cited here decides whether a patient may pay the fee from a health savings account. DPC fees and the HSA is a separate question with a separate source.

Drafting order, and what to pull before the first signature

Write the clauses in the order your own statute names them, and check the list against the section itself. The sequence is short. Find the section, copy any prescribed wording exactly, add the fee mechanics the state fixes, then read what is left as ordinary contract drafting. Everything the statute does not name is still yours to write.

What to pull before the first signature:

  • The section itself, from the legislature's own site, with the date it was last amended 4.
  • The prescribed disclaimer text, character for character, where the state prints one 2.
  • The fee rules: prepayment caps, refund timing, notice periods and trust-account handling 7.
  • The termination clause, including separately named events such as relocation or military duty 2.
  • A note of what the statute leaves open, which the contract has to carry on its own.

The agreement is one line item in the stack in order, and it belongs in place before the first patient signs. Whether the practice is dpc or concierge changes which chapter applies in the first place, since the sections here describe an arrangement in which the practice does not bill a carrier for the services the fee covers 3.

Two situations are worth taking to counsel licensed in the state rather than settling from a statute page: a code with no such section under any of the three names, and a patient who moves or is seen across a state line, where which state's list governs is the open question. Maine's section was amended in 2025 4. A clause list copied last year is not necessarily the list in force now, so re-pull the section before the agreement is reprinted.

Common questions

In the states cited here, yes. Arizona names a signed writing among its seven required elements. Utah requires the not-insurance statement to appear prominently in writing. Washington prints a disclaimer sentence the written agreement has to carry. In each of those states the writing is part of what the section requires, so an unwritten arrangement falls short of the statute, whatever the parties intended. In Arizona, that puts it outside the insurance-code exemption.

It depends on the state, and two of the states here answer it directly. Arizona caps advance collection at twelve months of the periodic fee and requires prepaid months past a termination date to be returned. Washington runs the fee on a monthly basis, treats anything paid more than a month ahead as trust money, and requires unearned fees to be refunded promptly once written termination notice arrives.

Search the other names first. Utah calls it a medical retainer agreement, Maine calls it a direct health care service agreement, and Washington calls it a direct agreement, so a search for the market's term can miss a statute that exists. If nothing turns up under any of them, what governs the arrangement is a question for counsel licensed in that state.

Not where the statute prints the text. Arizona requires the disclaimer to read in substantially the form the statute sets out, and Washington fixes the sentence the agreement carries. Washington also requires a separate disclosure statement with the participation forms, including the state insurance commissioner's contact information. Copy the wording from the state's own section rather than from a sample agreement.

Maine requires it. That section says the agreement has to state the fees may not be reimbursed or applied toward a deductible under a health insurance policy, which is a clause the Arizona, Utah and Washington sections do not carry. Maine's provision was amended in 2025, so check the current text before copying wording from an older agreement.

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References

  1. 1.Arizona State Legislature (2025). 44-1799.96. Direct primary care agreements; regulation. Arizona Revised Statutes, Title 44, Chapter 11. link ✓Supports the framing claim that an Arizona direct primary care agreement meeting the article's requirements does not constitute the transaction of insurance business or a health care services organization in the state, which is why the required-terms list is conditional rather than advisory.
  2. 2.Arizona State Legislature (2025). 44-1799.92. Direct primary care agreements; requirements; notice. Arizona Revised Statutes, Title 44, Chapter 11. link ✓Supports Arizona's seven required elements (writing, signature, thirty-day termination with relocation and military-duty terms, scope of services, periodic and additional fees, duration and renewal, and the prescribed not-insurance disclaimer read in substantially the statutory form), including the quoted termination instruction and the placement of the article in Title 44.
  3. 3.Utah State Legislature (2012). 31A-4-106.5. Medical retainer agreements. Utah Code, Title 31A, Chapter 4. link ✓Supports Utah's three-element list (describe the specific routine services covered, state prominently in writing that it is not health insurance, and bar the provider but not the patient from billing an insurer) and Utah's naming of the instrument as a medical retainer agreement inside the insurance code.
  4. 4.Maine State Legislature (2025). Title 22, §1771: Direct health care service agreements. Maine Revised Statutes, Title 22, Chapter 403-A. link ✓Supports Maine's disclosure clause that the fees may not be reimbursed or applied toward a deductible under a health insurance policy, the section's placement and title as direct health care service agreements, and its 2025 amendment.
  5. 5.Washington State Legislature (2007). RCW 48.150.110 — Direct agreement requirements—Disclaimer. Revised Code of Washington, Chapter 48.150. linkSupports Washington's fixed disclaimer sentence, the individual-agreement-only rule, and the separate disclosure statement distributed with participation forms carrying financial rights and responsibilities, the rule against billing a carrier, and the insurance commissioner's contact information.
  6. 6.Arizona State Legislature (2025). 44-1799.94. Direct primary care agreements; fees. Arizona Revised Statutes, Title 44, Chapter 11. link ✓Supports Arizona's twelve-month cap on advance payment of the periodic fee, the return of prepaid months past a termination date, and the permission for an insurer or other third party to pay the fee without the agreement becoming insurance.
  7. 7.Washington State Legislature (2007). RCW 48.150.030 — Direct fee—Monthly basis—Designated contact person. Revised Code of Washington, Chapter 48.150. linkSupports Washington's monthly fee basis, the prompt refund of unearned fees prorated to the date written termination notice is received, the trust-account treatment of fees paid more than one month in advance, and the sixty-day notice and one-increase-per-year limits on fee changes.

https://www.gale.care/for-providers/se-dpc-agreement-required-terms · 7 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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