Marketing a medical practice directly to employers: onsite clinics, direct contracts and the rules behind the pitch

An independent practice that wants steadier volume can stop selling one patient at a time and sell to the company down the road instead. The offer can take a few shapes: a clinician who works a set number of hours at the employer’s site, a clinic near the site reserved for its staff, or a direct contract where the employer, or its self-funded health plan, pays your practice for care its employees receive. An HR director or benefits manager will listen to a clear pitch. Their lawyer and benefits adviser will then ask questions that a consumer ad never has to answer, and a practice that has thought about those questions before the first meeting looks far more credible.

This guide is for practice owners and marketing staff preparing that pitch. It covers whether the arrangement is part of an ERISA benefit plan, who may see employee health information, the ADA and GINA limits on employer health questions, honest savings claims and naming the practice that provides care. Offering discounts to groups of workers, such as teachers or first responders, is a different offer, covered in our guide to teacher, first responder and healthcare worker discounts. Working with another kind of institution on site is covered in our school-based health center marketing guide.

The short version

• Expect the ERISA question. Under 29 USC 1002(1), a program an employer maintains to provide medical care to its employees can be an employee welfare benefit plan. Do not tell an employer that your arrangement is not one. That is their counsel’s call.
• Know the narrow on-site exception. 29 CFR 2510.3-1(c)(2) excludes on-premises facilities for treating minor injuries or illness or rendering first aid during working hours. A full primary care clinic is more than that.
• Keep employee health data away from the employer. If your care is part of a group health plan, the plan may give the employer protected health information only on the terms in 45 CFR 164.504(f), which bar employment-related uses.
• Mind the ADA and GINA. 42 USC 12112(d)(4) limits employer medical exams and questions, and 29 CFR 1635.8 bars employers from requesting genetic information, including family medical history, with narrow exceptions.
• Sell savings you can back up. 15 USC 45 reaches deceptive practices in commerce, and the FTC expects a reasonable basis for objective claims. No invented ROI figures.

What you might be selling

No federal rule sorts these offers into types. We use three plain labels in this guide, because the legal questions shift with the shape of the deal.

• Onsite care. Your clinician works at the employer’s premises on a schedule. The employer supplies the room; your practice supplies the care, the records and the clinical judgment.
• Near-site care. A clinic location, or reserved hours at your own office, set aside for one employer’s staff or a small group of employers.
• Direct contract. The employer, or the health plan it sponsors, pays your practice an agreed rate or a per-employee fee for defined services, and employees use your existing office.

Each label raises the same three questions: who pays, is the arrangement part of a benefit plan, and who may see what happens in the exam room. Have your answers ready in writing.

Is it part of an ERISA plan? Why the employer will ask

Under 29 USC 1002(1), an employee welfare benefit plan is any plan, fund or program established or maintained by an employer, an employee organization or both, to the extent it provides its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical or hospital care or benefits. The words through the purchase of insurance or otherwise matter for a direct contract: an employer that pays a practice to care for its employees is providing medical care through something other than insurance.

The Department of Labor’s regulation at 29 CFR 2510.3-1(c)(2) excludes one thing from that definition: the maintenance on the premises of an employer of facilities for the treatment of minor injuries or illness or rendering first aid in case of accidents occurring during working hours. A first aid room fits those words. A clinic offering chronic disease care, annual exams, lab work or care for family members goes beyond them on their face.

Whether a given arrangement is a plan, and what the employer must then do, is a question for the employer’s ERISA counsel, not for your sales deck. No federal rule tells a practice what to say about it. We recommend describing your services, hours, who is eligible and how you are paid in plain terms, and leaving plan status to the employer. Avoid lines such as no plan paperwork needed or outside your benefits plan. If the arrangement turns out to be a plan, a promise like that becomes a problem for your client and a credibility problem for you.

Who sees employee health information

This is the question employees ask first, and the answer belongs in your pitch to the employer and in the materials employees see. Three rules shape it.

First, the HIPAA definition of protected health information in 45 CFR 160.103 excludes individually identifiable health information in employment records held by a covered entity in its role as employer. That exclusion protects the employer’s ordinary HR files. It does not turn your clinical records into employment records because the employer pays for the visit. If your practice is a covered entity, the records you create when you treat an employee are your records, held under the Privacy Rule.

Second, when your care is part of a group health plan, 45 CFR 164.504(f)(1)(i) says the plan, in order to disclose protected health information to the plan sponsor, which is the employer, must ensure that the plan documents restrict the sponsor’s uses and disclosures. Under 164.504(f)(2)(ii), the plan may disclose only after the sponsor certifies that the plan documents were amended and that it agrees, among other things, not to use or disclose the information for employment-related actions and decisions. Without that, 164.504(f)(1)(ii) and (iii) let the plan give the sponsor summary health information, when requested for getting premium bids or for modifying, amending or terminating the plan, and information on whether a person is enrolled.

Third, the ADA requires an employer that obtains medical information through a voluntary employee health program to keep it on separate forms, in separate medical files, and to treat it as a confidential medical record. Under 42 USC 12112(d)(4)(C), which applies the rules in 12112(d)(3)(B) and (C), supervisors and managers may be told only about necessary work restrictions and accommodations.

The sales point follows from these rules: the employer gets reports, not patients. No federal rule sets the format of a report to an employer. We recommend offering counts and trends, such as visits per month or the number of employees who used the service, with small groups suppressed, and writing into the contract that names, diagnoses and visit dates for individual employees go to no one at the employer. Whether a given report is summary health information under 164.504(a), or needs to meet the de-identification standard, is a question for counsel before the first report goes out.

Exams, health histories and the ADA

Under 42 USC 12112(d)(4)(A), an employer may not require a medical examination of an employee, or ask an employee whether they have a disability or about its nature or severity, unless the exam or question is job-related and consistent with business necessity. Under 12112(d)(4)(B), it may conduct voluntary medical examinations, including voluntary medical histories, that are part of an employee health program available to employees at that work site.

For your pitch, the word voluntary carries weight. A screening day, a health history form or a sign-up survey that the employer presents as required, or that feels required, raises the question the statute answers. Post-offer and fitness-for-duty exams are their own subject, covered in our occupational medicine marketing guide. Wellness rewards tied to participation or results are covered in our corporate wellness program marketing guide.

Family history and GINA

Under 29 CFR 1635.8(a), an employer covered by Title II of GINA may not request, require or purchase genetic information of an individual or a family member of the individual, except as the regulation provides. Family medical history counts. One exception, in 1635.8(b)(2), covers health or genetic services the employer offers, including as part of a voluntary wellness program. Among its conditions, individually identifiable genetic information may go only to the individual and the licensed health care professionals or board certified genetic counselors involved in the services, and must not be accessible to managers, supervisors or others who make employment decisions. It may reach the employer only in aggregate terms that do not identify specific people.

Under 1635.8(d), the ban applies to medical examinations related to employment, and the employer must tell health care providers not to collect genetic information, including family medical history, in an exam intended to determine the ability to perform a job. A practice that uses its standard new patient intake form, with its family history section, for an employer’s job exam has a problem the employer will notice. Build separate forms for employer exams and say so in your pitch.

Savings claims to employers

A claim made to an HR director is still a claim. Under 15 USC 45(a)(1), unfair or deceptive acts or practices in or affecting commerce are unlawful, and the statute’s words do not limit that to ads aimed at patients. The FTC Policy Statement Regarding Advertising Substantiation says advertisers must have a reasonable basis for objective claims before they make them, and that a claim of a specific level of support needs at least that level.

A savings figure is an objective claim. If you have no data from your own employer clients, you have no basis for a figure, and a number borrowed from an industry report describes someone else’s arrangement. No federal rule sets the form of a savings estimate. We recommend offering to model the employer’s own numbers instead: take their claims or utilization data, with their benefits adviser, apply your published prices and visit model, and show the assumptions on the same page as the result. Call it an estimate, name the inputs, and let the employer change them.

Claims about access deserve the same care. Same-day appointments, a named response time for messages, or a set number of visits per year are promises you can measure. Put them in the contract in the same words you use in the pitch, and track whether you meet them.

Whose clinic is it

When a clinician works at the employer’s site, employees may assume the employer runs the clinic. State rules known as the corporate practice of medicine may limit who may own or control a medical practice or employ physicians. We found no federal rule on it, and the state rules differ, so we cite none here. Our MSO and corporate practice of medicine guide explains how naming the professional entity works in ads.

No federal rule sets the wording. We recommend that each sign, flyer, portal page and intake form at an onsite or near-site clinic name your practice as the provider of care, say that the employer pays for or sponsors the service, and say that the employer does not see individual visit information. That one sentence answers a question employees may not ask out loud.

Marketing to employees after the contract is signed

Once the contract is signed, the employer becomes your distribution channel. Its benefits portal, HR emails, break room posters and new-hire packets reach employees in a way your own ads cannot. No federal rule sets the content of those announcements. We recommend writing them yourself for the employer to send, so that the wording on services, eligibility, cost to the employee, hours and confidentiality matches the contract.

Keep the flow of information one way at sign-up. An online booking page for employees should collect what you need to schedule and verify eligibility, and nothing should route back to the employer showing who booked. If an employer asks for a list of employees who have not used the service so HR can follow up, that is a list derived from visit records, and the answer under the rules above is no, unless counsel finds a basis for it. If you run Google Ads or a landing page for the employer program, the tracking rules for your own site apply in full; see our healthcare marketing rules guide.

Questions to ask the employer

• Is the company self-funded, fully insured, or does it have no group health plan at all?
• Who is your benefits adviser and who is your ERISA counsel, and will they review the arrangement before launch?
• Will our services be part of, or paid through, the group health plan?
• Which employees, and which family members, are eligible?
• What reports do you expect from us, and how will you use them?
• Who at the company will see the reports, and who will not?
• Will any part of the service be required, or tied to a reward or penalty?
• Do you also need job-related exams, and who will request them?
• Who approves announcements to employees, and through which channels?
• What happens to the records if the contract ends?

Use and avoid

• Use: “[Practice name] provides care at your site. You see monthly totals, not names.” Avoid: “Full visibility into your workforce’s health.”
• Use: “We can model your costs from your own claims data, with your benefits adviser.” Avoid: any savings percentage or ROI figure you cannot back with your own results.
• Use: “Your counsel should confirm how this fits your benefits plan.” Avoid: “No plan paperwork needed” or “outside ERISA”.
• Use: “Voluntary health check, open to all staff at this site.” Avoid: “All employees must complete a health history by Friday.”
• Use: a separate exam form for job-related exams, with no family history section. Avoid: your new patient intake form for employer exams.

An illustration

This example is invented. [Practice name], a family medicine practice in [Town], is approached by a manufacturer with a few hundred staff that wants care closer to the plant. The first draft of the pitch promises a clinic room on site four mornings a week, an annual savings figure taken from a trade article, and a monthly dashboard showing which departments use the clinic and for what conditions.

Before the meeting, the practice removes the savings figure and replaces it with an offer to model costs from the manufacturer’s own data with its benefits adviser. It replaces the dashboard with monthly visit totals and service categories, with small groups suppressed, and a sentence that no individual visit information goes to the company. It adds a page listing the services, eligible staff, hours and the practice as the provider of care, and a line asking the manufacturer’s counsel to confirm how the arrangement fits its health plan. The employee poster names the practice, says the company sponsors the clinic, and says the company does not see who visits.

Checklist

• Describe services, hours, eligibility and payment in plain terms, and leave plan status to the employer’s counsel.
• Do not promise that the arrangement is outside ERISA or needs no plan paperwork.
• Put in writing that no individual employee’s visit information goes to the employer.
• Define the reports the employer gets, with small groups suppressed, and have counsel review the format.
• Present screenings and health histories as voluntary, and route reward questions to your wellness program rules.
• Use separate forms for job-related exams, with no family medical history.
• Remove savings figures you cannot support with your own data. Offer to model the employer’s numbers instead.
• Name your practice as the provider of care on signs, flyers, portals and forms.
• Write the employee announcements yourself and match them to the contract.
• Keep booking data from flowing back to the employer.

How we help

We build practice websites, local SEO, Google Ads and lead generation and an AI front desk for independent practices. For employer programs, we write the employer-facing pages, pitch material and employee announcements in plain words, and set up booking that does not report individual visits back to the employer. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Sources

• 29 USC 1002: Definitions (employee welfare benefit plan)
• 29 CFR 2510.3-1: Employee welfare benefit plan (on-premises facilities)
• 45 CFR 160.103: Definitions (protected health information)
• 45 CFR 164.504: Uses and disclosures: organizational requirements (group health plans)
• 42 USC 12112: Discrimination (medical examinations and inquiries)
• 29 CFR 1635.8: Acquisition of genetic information
• 15 USC 45: Unfair methods of competition unlawful
• FTC Policy Statement Regarding Advertising Substantiation (1984)

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