TownHealth Partners helps employers design a benefit plan around direct primary care, then places the coverage that sits underneath it. The plan design leads. The coverage follows.
Roughly 80 percent of what people use healthcare for is primary care, chronic condition management, and coordination. None of that needs to run through an insurance claim. The other 20 percent, the hospitalizations, surgeries, and serious events, is exactly what coverage is built to protect against.
We are not anti insurance. We are against the misuse of it. When the everyday care comes from a membership relationship and the catastrophic layer is right sized, employers spend less and employees get more.
Plan architecture, cost sharing structure, TPA coordination, and transition planning. The design work is the engagement.
Stop-loss, accident, and hospital indemnity, selected to fit the design rather than sold off a shelf.
Moving off a fully insured plan is a project, not a signature. We help employers understand what actually changes, and when.
Tell us about your group and we will walk you through what a care first benefit stack could mean for cost and for your employees.
Start a ConversationAnyone can place a stop-loss policy. What employers actually need is someone to design the full benefit stack around direct primary care, decide what goes where, and make the layers fit together. That advisory work is the core of what we do. The coverage we place is how the plan gets backed.
We help employers build a complete benefit stack around direct primary care: plan architecture, cost sharing structure, how the layers fit together, TPA coordination, and what the employee experience looks like day to day. This is the advisory work, and it is what makes us worth calling instead of a generic broker. Everything below is how we back that design with the right coverage.
Whether a group is self-funded, level-funded, or moving away from fully insured, these are the layers that make a care first design work. We place all three across multiple A rated carriers.
The foundation of any self-funded or level-funded design. Stop-loss protects the employer when individual or total claims exceed a set threshold.
Sets a per-person threshold, typically $25,000 to $75,000. If any single employee's claims exceed that amount in a plan year, the carrier reimburses the excess. This protects the budget from one cancer diagnosis, premature birth, or major surgery.
Sets a ceiling on total group claims, usually 120 to 125 percent of expected annual spend. If claims across all employees exceed that corridor, the carrier covers the overage. This protects against a bad year where moderate claims stack up.
Pays a fixed cash benefit directly to the employee when an accidental injury occurs. It is not tied to the claims system and does not require a deductible to be met first.
A broken bone, torn ligament, concussion, or other covered injury triggers a predetermined benefit paid directly to the employee, regardless of other coverage. In a DPC model, the membership handles the visit and diagnosis while accident coverage helps with out-of-pocket costs like an ER visit, imaging, or time away from work.
Typically offered on a voluntary or employer contributed basis. It is affordable, easy to understand, and gives employees protection for the unexpected events that fall between routine care and a catastrophic hospitalization.
Pays a fixed cash benefit when an employee is admitted to a hospital, has outpatient surgery, or visits an emergency room. Like accident coverage, it pays directly to the employee.
Pays a set daily, weekly, or per-admission benefit during a hospital stay, and some policies pay for ER visits, ICU stays, and outpatient surgery. The benefit goes directly to the employee to use however they need.
Direct primary care handles the routine. Stop-loss protects the employer from catastrophic claims. Hospital indemnity sits in between, giving the employee cash in hand when they are in the hospital and facing the plan's cost-sharing. A practical, low cost layer that makes the design feel complete.
When an employer uses direct primary care, 80 percent or more of healthcare interactions never generate a claim. Primary care, chronic disease management, labs, imaging, and coordination all run through a monthly membership, outside the claims system entirely.
That means claims exposure is limited almost entirely to hospitalizations, surgeries, and major medical events. When we submit a group, we include the data on the model: what share of care is handled outside claims, the chronic disease protocols in place, and the expected impact on ER and admissions. We give carriers a reason to price the group differently, because the group is different.
We collect the employee census (age, gender, ZIP code) and group characteristics. No protected health information is required at the quoting stage.
We submit to multiple A rated carriers at once for each product line. Quotes typically return within 48 to 72 hours.
We present a side by side comparison of carrier options, benefit levels, and premium costs, with a clear recommendation based on the group's profile and design.
We coordinate effective dates with the employer's benefit start date, submit the final enrolled census, and confirm coverage is active.
We provide monthly census updates for adds, terminations, and changes, and serve as the employer's liaison to the carrier for any claims questions or issues.
We work with employers who have 5 to 250 employees. Whether you are already self-funded, currently level-funded, or exploring how to move away from a fully insured plan, we design the benefit and place the coverage that protects your employees and your bottom line. Where a group is on that journey shapes how we engage.
Companies that pay healthcare claims directly rather than buying a fully insured plan. This gives visibility into actual costs, control over plan design, and real savings when claims are managed well. Stop-loss is what makes self-funding viable at smaller sizes, and accident and hospital indemnity round out the design with cash-in-hand protection for employees.
Companies paying a fixed monthly amount that bundles expected claims, stop-loss, and administration, keeping the savings when claims come in low. We work with level-funded groups pairing their design with direct primary care, making sure the stop-loss is competitively priced and the supplemental layers are placed correctly.
Companies facing another 8 to 12 percent renewal and ready for a better path. Moving to level-funded or self-funded coverage paired with direct primary care gives visibility, control, and meaningful savings. The transition can feel complicated, and that is where we come in: we walk through the options, design the stack, place the coverage, and coordinate with the TPA to make the effective date seamless.
Companies giving employees unlimited access to a personal physician for a flat monthly fee, deliberately removing the insurance layer from the 80 percent of care that is routine. They still need protection for the 20 percent that is not predictable, hospitalizations, surgery, cancer treatment, accidental injury, and that is exactly what we place.
TownHealth Partners is licensed and actively placing coverage in Florida and Virginia, with additional state licensing in progress. Our primary focus is South Florida, covering Miami-Dade, Broward, and Palm Beach counties, and Northern Virginia, covering Fairfax, Arlington, and Loudoun counties.
If you get your everyday care through an OffPlan direct primary care membership, you still want real protection underneath for the rare, expensive event. TownHealth Partners is the licensed agency that puts that protection in place: a real ACA plan as your floor, and optional cash supplements as a cushion. We do it with you, at no extra cost and no obligation.
Your OffPlan membership handles the 80 percent of care you actually use day to day. Our job is the other 20 percent, and making sure the pieces fit together correctly.
These protect you in very different ways, and we will always be straight with you about which is which.
This is the layer that prevents medical bankruptcy. It carries a federally capped out-of-pocket maximum, $8,500 for an individual or $17,000 for a family in 2026 for in-network covered care, and it covers a serious diagnosis and specialty drugs with no dollar cap. After you reach the maximum, covered in-network care is paid in full for the rest of the year. This is the only layer that does that, and the one we make sure you have.
If you are hospitalized or injured, these hand you a fixed amount of cash to help absorb your deductible. Useful, and affordable. But they pay a set amount and then stop. They do not cap your exposure, and they are never a substitute for the floor. We will never present a cash supplement as protection against a serious illness, because it is not.
A note on the Catastrophic tier. The ACA has a plan tier called Catastrophic, with very low premiums and a high deductible, a strong fit as an emergency-only backstop for an OffPlan member. By law anyone under 30 can buy one. At 30 or older you can still qualify through a hardship or affordability exemption, and if you do not qualify, an ACA Bronze plan is the equivalent floor. We figure out which one you qualify for and place it for you.
When your floor is an HSA-eligible high-deductible Bronze or Catastrophic plan, you can pay for qualified costs, including a portion of your membership, with pre-tax dollars. An HSA carries a triple tax advantage: contributions are deductible, the balance grows tax-free, and withdrawals for qualified medical expenses are tax-free. The 2026 contribution limits are $4,400 for individual coverage and $8,750 for family coverage, with an extra $1,000 if you are 55 or older. In a year you barely use, the balance stays yours, invested and growing for when you need it.
Eligibility is based on your health plan, not your job. An independent contractor, a W-2 employee, or someone between jobs can all open one. We make sure the plan we place qualifies, and we walk you through opening the account.
To open and contribute to an HSA, all four need to be true:
Without an employer to set it up, the account is yours to manage. We walk you through each step:
This is education, not personal tax advice. Eligibility and deduction limits depend on your situation. Talk to your own tax advisor before filing.
If you recently lost coverage at a job, aged off a parent's plan, left an employer plan heading into early retirement, or had a marriage, a baby, or a move, you likely have a 60-day window to enroll in a real ACA plan right now. Outside that window, the next chance is open enrollment in the fall. Tell us where you stand and we make sure your window does not close on you. Your membership can start any day of the year, and we schedule your coverage for the right enrollment moment so it actually happens.
Paying a high monthly premium for a plan you have used twice in five years. Keep coverage for the rare event, and stop paying insurance prices for routine care.
Uneven income, and the only options have felt like the Marketplace or nothing. A predictable membership plus a right-sized floor is a third path.
One doctor relationship for the household and a floor sized for your family, placed and explained by a licensed agency so the math is clear.
You see a doctor once a year and resent the premium. Turn low spending into a tax-advantaged asset, and keep real coverage for the day you are wrong.
Tell us where you stand and we will walk you through your options. No cost, no obligation, just a licensed agency making sure you are actually protected.
Start a ConversationTownHealth Partners is a licensed insurance agency and benefits advisory firm. We help employers design benefit plans around direct primary care and place the catastrophic, accident, and hospital indemnity coverage that sits underneath. We work alongside OffPlan, a direct primary care platform built on the same idea: insurance belongs around the serious 20 percent of healthcare, and the everyday 80 percent is better delivered through a membership relationship.
We maintain relationships with stop-loss carriers, MGUs, and supplemental benefit carriers willing to evaluate employer groups using direct primary care on their actual risk profile.
When we submit a group for quoting, we include data on the direct primary care model: the share of healthcare interactions handled outside the claims system, the chronic disease management protocols in place, and the expected impact on ER utilization and admissions. We give carriers a reason to price the group differently, because the group is different.
We are not appointed exclusively with any single carrier. We quote across multiple A rated markets for every group, every product line. Our obligation is to the employer, not to any carrier's production targets.
Every group is different. The first conversation is about understanding yours.
Start a ConversationWhether you are an individual or family looking for the right coverage around an OffPlan membership, a self-funded employer exploring stop-loss, a fully insured employer considering the transition, a benefits advisor working with a DPC group, or a carrier interested in our pipeline, we would like to hear from you. We respond to all inquiries within one business day. For employer groups ready to quote, we will need a basic census (employee count, ages, ZIP codes). For individuals and families, just tell us where you stand, including any recent life change, and we will walk you through the options before any paperwork.