North Dakota

Key Provisions

• **Regulatory Status:** Direct Primary Care agreements are not officially defined as insurance products by the North Dakota Insurance Department. To avoid potential regulatory scrutiny, DPC practices must include clear disclaimers in their patient agreements stating that the membership is not a comprehensive health insurance plan.
• **Contractual Basis:** The DPC model in North Dakota is governed by private contract law. Patient agreements must clearly outline the scope of included services, the monthly fee structure, any excluded services (such as hospital care or specialist visits), and the terms for cancellation by either the patient or the practice.
• **Physician Oversight:** All DPC physicians must be licensed by and in good standing with the North Dakota Board of Medicine. They are required to adhere to all standard professional conduct, scope of practice, and patient privacy regulations applicable to any primary care provider in the state.
• **HSA and Deductible Limitations:** Due to federal guidelines, monthly DPC membership fees are generally not considered qualified medical expenses for Health Savings Accounts (HSAs). Furthermore, these fees do not count toward a patient's health insurance deductible, requiring patients to budget for them separately from their insurance plan.
• **Absence of Legal Protections:** Without specific legislation, DPC practices operate without a "safe harbor" law that explicitly protects them from being regulated as an insurance business. This creates a degree of legal ambiguity and potential risk for practices operating in the state, even with clear contractual disclaimers.