The Employee Retirement Income Security Act of 1974 (ERISA) is a “federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans.” If an employer is paying the DPC fee then their broker, TPA, and human resources department will likely agree that this decision to offer DPC as a benefit to employees is thus part of an ERISA employee welfare benefit plan. It is the burden of these entities (TPAs, brokers, consultants) to make this determination. They are collectively tasked with ERISA compliance and this should not materially affect how the DPC practice delivers medical care. DPC practices will need to note that this implicates COBRA, and thus patients will have the option to pay the monthly fee on their own and remain a part of the DPC practice for a defined time period (up to 36 months) even if their job is terminated.

ERISA broadly defines employee welfare benefit plans in Section 3(1) of ERISA, 29 U.S.C. §1002(1) as ““any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment, or vacation benefits, apprenticeship or other training programs, or day care centers, scholarship funds, or prepaid legal services, or (B) any benefit described in section 302(c) of the Labor Management Relations Act, 1947 (other than pensions on retirement or death, and insurance to provide such pensions).” See this Dept of Labor MEWA guide to federal and state regulation.

As DPC practices we provide information to brokers, TPAs, employers etc to help them complete their paperwork, but we generally should not have to complete their paperwork for them (such as the form 5500 - note that the instructions state on page 3 that if the plan has less than 100 participants then there may not be a need to file this document - and the employer might be more likely to look into QSEHRA options where ERISA may not apply). Here is a guide to the ERISA Form 5500 Annual Report.

I would argue that DPC practices are NOT "covered service providers" within the meaning of an employee welfare benefit plan and thus we do not need to file a form 5500 schedule C. Please see the definition described in 29 CFR § 2550.408b-2: (I've copied the most important language below):

(iii) Covered service provider. For purposes of this paragraph (c)(1), a “covered service provider” is a service provider that enters into a contract or arrangement with the covered plan and reasonably expects $1,000 or more in compensation, direct or indirect, to be received in connection with providing one or more of the services described in paragraphs (c)(1)(iii)(A), (B), or (C) of this section pursuant to the contract or arrangement, regardless of whether such services will be performed, or such compensation received, by the covered service provider, an affiliate, or a subcontractor.

(A) Services as a fiduciary or registered investment adviser.
(1) Services provided directly to the covered plan as a fiduciary (unless otherwise specified, a “fiduciary” in this paragraph (c)(1) is a fiduciary within the meaning of section 3(21) of the Act);
(2) Services provided as a fiduciary to an investment contract, product, or entity that holds plan assets (as determined pursuant to sections 3(42) and 401 of the Act and 29 CFR 2510.3-101) and in which the covered plan has a direct equity investment (a direct equity investment does not include investments made by the investment contract, product, or entity in which the covered plan invests); or
(3) Services provided directly to the covered plan as an investment adviser registered under either the Investment Advisers Act of 1940 or any State law.

 (B) Certain recordkeeping or brokerage services. Recordkeeping services or brokerage services provided to a covered plan that is an individual account plan, as defined in section 3(34) of the Act, and that permits participants or beneficiaries to direct the investment of their accounts, if one or more designated investment alternatives will be made available (e.g., through a platform or similar mechanism) in connection with such recordkeeping services or brokerage services.

 (C) Other services for indirect compensation. Accounting, auditing, actuarial, appraisal, banking, consulting (i.e., consulting related to the development or implementation of investment policies or objectives, or the selection or monitoring of service providers or plan investments), custodial, insurance, investment advisory (for plan or participants), legal, recordkeeping, securities or other investment brokerage, third party administration, or valuation services provided to the covered plan, for which the covered service provider, an affiliate, or a subcontractor reasonably expects to receive indirect compensation (as defined in paragraph (c)(1)(viii)(B)(2) of this section or compensation described in paragraph (c)(1)(iv)(C)(3) of this section).

 (D) Limitations. Notwithstanding paragraphs (c)(1)(iii)(A), (B), or (C) of this section, no person or entity is a “covered service provider” solely by providing services -
(1) As an affiliate or a subcontractor that is performing one or more of the services described in paragraphs (c)(1)(iii)(A), (B), or (C) of this section under the contract or arrangement with the covered plan; or
(2) To an investment contract, product, or entity in which the covered plan invests, regardless of whether or not the investment contract, product, or entity holds assets of the covered plan, other than services as a fiduciary described in paragraph (c)(1)(iii)(A)(2) of this section.

You may also find this DOL fact sheet and these DOL Conflict of Interest FAQs to be helpful.

If you are interested in a summary about how AHPs, MEWAs, HRAs, and STLDIs interact please see this two page document entitled “MEWA Like Your HSA Just Don’t Give me a Bad STLDI” that I prepared for a talk given at the Hint Summit in April 2019.

As you speak with employers and brokers about plan design and DPC you will want to be familiar with all the contents of this ERISA page and all the contents of my tax page as well.