TownHealth Partners is a licensed insurance agency that places stop-loss, accident, and hospital indemnity coverage for employers using direct primary care. Whether you are self-funded, level-funded, or considering the move away from fully insured, we place the protection that makes the transition work.
Most brokers quote traditional fully insured groups. We specialize in employers who deliver primary care through membership, not insurance. That changes the risk profile, and we know how to present it to carriers.
Stop-loss protects against catastrophic claims. Accident insurance pays a fixed benefit when an employee is injured. Hospital indemnity pays a daily or per-admission benefit during a hospital stay. We place all three, independently, across multiple A-rated carriers.
Placing coverage requires alignment between the employer, the TPA, and the carrier. We manage that coordination so effective dates, census data, and enrollment are handled without gaps or surprises.
Most healthcare does not need to run through a claims system. Primary care, chronic care management, labs, imaging, and care coordination can all be delivered directly for a flat monthly fee. Insurance protects the 20% of healthcare that is unpredictable: hospitalizations, surgeries, accidents, and major medical events. That is where insurance belongs.
TownHealth Partners places stop-loss, accident, and hospital indemnity coverage for employers who use direct primary care. Whether you are already self-funded, level-funded, or considering the transition away from a fully insured plan, we place the insurance products that make the model work.
Stop-loss is the foundation of any self-funded or level-funded benefit design. It protects the employer when individual or total claims exceed a set threshold.
Specific stop-loss 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 stop-loss carrier reimburses the excess. This protects employers from one employee's cancer diagnosis, premature birth, or major surgery breaking the budget.
Aggregate stop-loss sets a ceiling on total group claims, typically at 120-125% of expected annual spend. If total claims across all employees exceed that corridor, the carrier covers the overage. This protects employers from a "bad year" where multiple moderate claims stack up.
Accident insurance 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.
If an employee breaks a bone, tears a ligament, suffers a concussion, or has any other covered accidental injury, the policy pays a predetermined benefit amount directly to the employee. The benefit is paid regardless of other coverage the employee may have.
For employers using direct primary care, accident insurance fills a specific gap. The DPC membership handles the doctor visit, diagnosis, and care coordination. Accident insurance helps the employee cover out-of-pocket costs for things like emergency room visits, imaging, physical therapy, or time away from work.
Accident insurance is typically offered on a voluntary or employer-contributed basis. It is affordable, easy to understand, and gives employees financial protection for the unexpected events that fall between routine care and a catastrophic hospitalization.
Hospital indemnity pays a fixed cash benefit when an employee is admitted to a hospital, has outpatient surgery, or visits an emergency room. Like accident insurance, it pays directly to the employee.
Hospital indemnity policies pay a set daily, weekly, or per-admission benefit when an employee is hospitalized. Some policies also pay benefits for ER visits, ICU stays, and outpatient surgical procedures. The benefit goes directly to the employee to use however they need.
In a direct primary care model, the physician handles most healthcare needs without generating a claim. But when a hospitalization does occur, the employee may face significant out-of-pocket costs from the self-funded plan's cost-sharing design. Hospital indemnity helps offset that exposure.
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 real expenses. It is a practical, low-cost layer that makes the overall benefit design feel complete to employees.
Employers using direct primary care present a fundamentally different risk profile to carriers, and we know how to tell that story.
When an employer uses direct primary care, 80% or more of healthcare interactions never generate a claim. Primary care visits, chronic disease management, lab work, imaging, and care coordination are all handled through a monthly membership fee, outside the claims system entirely.
That means the employer's claims exposure is limited almost exclusively to hospitalizations, surgeries, and major medical events. The stop-loss carrier is insuring a fundamentally lower-risk pool, and we present the data to prove it.
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 simultaneously for each product line. Quotes typically come back 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 benefit design.
We coordinate effective dates with the employer's benefit start date, submit the final enrolled census to the carrier, and confirm all coverage is active.
We provide monthly census updates (adds, terminations, 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 place the insurance products that protect your employees and your bottom line.
TownHealth Partners serves a specific segment of the employer market. If your company fits one of these profiles, we are built to serve you.
Self-funded employers take on the responsibility of paying employee healthcare claims directly, rather than purchasing a fully insured group plan from a carrier. This gives the employer visibility into actual costs, the ability to design the plan, and the potential for significant savings when claims are managed well.
Stop-loss insurance is what makes self-funding viable for smaller employers. Accident and hospital indemnity coverage round out the benefit design by giving employees cash-in-hand protection for injuries and hospital stays.
Level-funded employers pay a fixed monthly amount that includes expected claims, stop-loss premium, and administration. If actual claims come in below expectations, the employer keeps the savings. It is a structured way to participate in self-funding without taking on full risk from day one.
We work with level-funded groups that are pairing their benefit design with direct primary care, ensuring the stop-loss component is competitively priced and the supplemental products (accident, hospital indemnity) are properly layered in.
If your company is currently fully insured and facing another 8-12% renewal increase, there is a better path. The move to level-funded or self-funded coverage, paired with direct primary care, gives you visibility into where your money goes, control over plan design, and the potential for meaningful savings.
The transition can feel complicated, and that is where we come in. We help employers understand exactly what coverage they need on day one: stop-loss to protect against catastrophic claims, accident insurance to protect employees from injury-related costs, and hospital indemnity to fill the gap when a hospital stay occurs. We walk through the options, place the coverage, and coordinate with your TPA to make the effective date seamless.
Employers who use direct primary care provide their employees with unlimited access to a personal physician for a flat monthly fee. These employers have made a deliberate decision to remove the insurance layer from the 80% of healthcare that is routine, predictable, and best handled through a direct physician relationship.
These employers still need protection for the 20% that is not predictable: hospitalizations, emergency surgery, cancer treatment, accidental injuries, and other major medical events. That is exactly what we place.
TownHealth Partners is licensed and actively placing coverage in Georgia, Florida, and Virginia, with additional state licensing in progress. Our primary focus is South Florida (Miami-Dade, Broward, and Palm Beach counties) and Northern Virginia (Fairfax, Arlington, and Loudoun counties).
TownHealth Partners exists because the employers we work with need insurance placed by someone who understands how direct primary care changes the risk equation. We are not a generalist brokerage. We place stop-loss, accident, and hospital indemnity coverage for employers who have decided that insurance belongs on the care that actually needs it.
Omar Fernandez is the principal and licensed producer at TownHealth Partners. He brings a background in healthcare operations, benefit design, and employer-facing sales to the insurance placement process.
TownHealth Partners was created to fill a specific gap. Employers who use direct primary care need an agency partner that understands the model, can explain the risk profile to carriers, and can place stop-loss, accident, and hospital indemnity coverage efficiently without trying to cross-sell products the employer does not need.
Omar is also the co-founder and COO of OffPlan, a direct care platform built on physician-owned practices. That firsthand operational knowledge of how DPC reduces claims exposure and changes the benefit design conversation informs every placement TownHealth Partners makes.
TownHealth Partners operates as an independent, licensed insurance agency. It is not a division or subsidiary of any healthcare platform. It maintains its own carrier appointments, its own E&O coverage, and its own regulatory compliance.
We maintain relationships with stop-loss carriers, MGUs, and supplemental benefit carriers who are 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: what percentage of healthcare interactions are handled outside the claims system, the chronic disease management protocols in place, and the expected impact on ER utilization and hospital admissions. We give carriers a reason to price the group differently because the group is different.
TownHealth Partners is not appointed exclusively with any single carrier. We quote across multiple markets for every group. Our obligation is to the employer, not to any carrier's production targets.
Whether you are a self-funded employer exploring stop-loss options, 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) to get started. For employers considering the transition from fully insured, we are happy to walk through the options before any paperwork is needed.