Why Choose Direct Primary Care? Comprehensive FAQs

You have questions. We have answers.

Q&A

FREQuently asked questions

What is Decent?

Decent is a third-party administrator headquartered in Austin, Texas. We specialize in administering level-funded health plans for groups down to 5 employees, designed around the Direct Primary Care (DPC) model.

What is Decent?

At Decent, we build health plans around the most important relationship in healthcare: the one between you and your primary care provider. We specialize in administering level-funded health plans for groups down to 5 employees, designed around the Direct Primary Care (DPC) model.

What is the Direct Primary Care model?

Direct Primary Care (DPC) is a healthcare model that focuses on a direct relationship between patients and their primary care providers. Gaining tremendous popularity in recent years as a way to address some of the challenges in the traditional healthcare system and provide more patient-centric, value-based care. Typically patients pay a monthly fee or subscription directly to their primary care provider, however, with a Decent Health plan, DPC is included. No deductibles, no copays, no claims.

What is the Direct Primary Care model?

What's the difference between a DPC and a Primary Care Physician (PCP)?

PCPs typically see a large number of patients each day, and spend less time with their patients on average than a DPC.

DPCs can treat and manage all the same medical issues that PCPs do. They do not submit claims to your insurance. (That’s us!) Instead, we pay your DPC a part of your monthly premium simply to be your primary care provider, regardless of how often you need to see them.

What's the difference between a DPC and a Primary Care Physician (PCP)?

How does DPC work in a Decent plan?

With a Decent plan, your care starts with seeing an in-network Direct Primary Care provider or DPC. Think of it like having a doctor in your family who will get to know you and your health. When you get your care through your DPC, it's free to you.

How does DPC work in a Decent plan?

WIth a Decent plan, your care starts with seeing an in-network Direct Primary Care provider or DPC. Think of it like having a doctor in your family who will get to know you and your health. When you get your care through your DPC, it's free to you.

What is a DPC Provider?

A Direct Primary Care (DPC) provider is typically a primary care doctor who operates under a flat-fee model—paid monthly, quarterly, or annually by the patient or health plan. This covers a wide range of services without insurance billing, copays, or deductibles.

What is a DPC Provider?

What is the difference between a DPC, a PCP, and a specialist?

DPC (Direct Primary Care)

• A doctor you can see for most of your health needs

• Works on a flat monthly fee—no copays or deductibles

• Offers longer visits, direct access, and more personalized care

• Doesn’t bill insurance

PCP (Primary Care Provider)

• A traditional primary care doctor who bills through insurance

• May have shorter visits and longer wait times

• Typically requires copays or coinsurance for each visit

• Can refer you to a specialist when needed

Specialist

• A doctor who focuses on specific health conditions (e.g., cardiology, dermatology, orthopedics)

• Usually requires a referral from your DPC or PCP

• Often comes with higher costs or deductibles, depending on your plan

Bottom line: Your DPC is your main partner for care and can treat up to 80% of your healthcare needs—with more time, access, and fewer costs than a traditional PCP.

What is the difference between a DPC, a PCP, and a specialist?

Why are Decent plans built around the DPC model?

To provide better healthcare at a lower cost. Your DPC is paid to focus on you. This way, they can truly act as your quarterback of care.

The DPC model leads to healthier members. Healthier members mean Decent is able to administer health plans at a lower cost. That means lower costs and better care for all our members.

Why are Decent plans built around the DPC model?

To provide better healthcare at a lower cost. Your DPC is paid to focus on you. This way, they can truly act as your quarterback of care. The DPC model leads to healthier members. Healthier members mean Decent is able to administer health plans at a lower cost. That means lower costs and better care for all our members.

How can I work with Decent?

Email us at dpc@decent.com, swing by www.decent.com/direct-primary-care or give us a ring at 1-888-DECENT-9 to get the ball rolling.

How can I work with Decent?

What DPCs are available in my area?

When your employer signs up with Decent, we assign a DPC based on location or collaborate with your employer if they have a preferred provider.

What DPCs are available in my area?

When your employer signs up with Decent, we assign a DPC based on location or collaborate with your employer if they have a preferred provider.

Can I choose a DPC based on specific preferences (like gender, language, or background)?

Yes! We want you to feel comfortable and confident with your DPC.

Here’s how we can help:

1. Check your current DPC group – Many DPC practices have multiple providers. We’ll start by seeing if there’s another doctor in the same office who aligns with your preferences.

2. Browse your options – If you’d like to explore beyond your assigned DPC, we’ll send you a list of available DPCs in your area with links to their websites.

3. Do a little research – We recommend visiting provider websites or calling the office to learn more about their care philosophy, experience, and background.

4. Found a match? Let us know! – Email care@decent.com with the provider you’d like to switch to. We’ll confirm they can work with Decent and update your record.

📌 We’ll do our best to help you find a provider who meets your needs and supports your health journey.

Can I choose a DPC based on specific preferences (like gender, language, or background)?

What if I don’t use a DPC?

If you seek care outside of a DPC, your Decent plan will still work like a good traditional health plan with a deductible. You can still get all of the coverage you need, but at additional cost.

If you continue to seek care that isn't coordinated through a Direct Primary Care provider (outside of your Pediatrician and OBGYN), your Decent plan offers the following standard coverage: decent.com/plan

What if I don’t use a DPC?

If you seek care outside of a DPC, your Decent plan will still work like a good traditional health plan with a deductible. You can still get all of the coverage you need, but at additional cost. If you continue to seek care that isn't coordinated through a Direct Primary Care provider (outside of your Pediatrician and OBGYN), your Decent plan offers the following standard coverage: decent.com/plan

Is DPC the only thing covered in my Decent plan?

Nope! While your Direct Primary Care (DPC) doctor is a big part of your plan, it’s not the only benefit.Your Decent plan also includes:

• Specialist visits

• Hospital care

• Prescription coverage

• Preventive care (like screenings and vaccines)

For a full breakdown of what’s included—and what you might need to pay for—check your benefits grid. It shows exactly what’s covered and what your costs might be.

Is DPC the only thing covered in my Decent plan?

"Nope! While your Direct Primary Care (DPC) doctor is a big part of your plan, it’s not the only benefit. Your Decent plan also includes: • Specialist visits • Hospital care • Prescription coverage • Preventive care (like screenings and vaccines) For a full breakdown of what’s included—and what you might need to pay for—check your benefits grid. It shows exactly what’s covered and what your costs might be."

What group sizes does Decent serve?

Decent serves groups with 5 or more employees. Our minimum group size varies based on state laws. There is no maximum group size.

What group sizes does Decent serve?

Decent serves groups with 5 or more employees. Our minimum group size varies based on state laws. There is no maximum group size.

Why can't I keep my PCP?

Decent plans are built around Direct Primary Care (DPC) for more access, more time with your doctor, and fewer out-of-pocket costs.

If your current PCP isn’t part of our DPC network, they’re considered a non-preferred provider. That means you can still see them, but your deductible will apply, and you’ll likely pay more out of pocket.

To get the most value from your plan, we recommend working with your assigned DPC.

Why can't I keep my PCP?

What geographies does Decent serve?

Decent can serve employers and members nationwide.

What geographies does Decent serve?

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Are prescription medications covered?

Yes! Many commonly prescribed medications are covered under your Decent plan. When your DPC writes a prescription, you can fill it at any pharmacy—just show your Decent ID card to ensure it’s billed correctly.

💡 Tip: Using your Decent ID card helps you access medications at low or no cost, depending on the prescription.

Are prescription medications covered?

What sets Decent apart from other health plan options in the market?

Decent stands out as an innovative group health plan solution with its focus on the Direct Primary Care model, and a sincere commitment to providing the best rates and service. We're dedicated to creating a positive and unique experience for employers, members, and advisors. We may not be the best option for everyone, and we will tell you when we’re not.

What sets Decent apart from other health plan options in the market?

What pharmacies can I use?

Members can use any pharmacy. Decent’s pharmacy benefit manager, DisclosedRx, supports open access across retail chains and local pharmacies.

What pharmacies can I use?

Members can use any pharmacy. Decent’s pharmacy benefit manager, DisclosedRx, supports open access across retail chains and local pharmacies.

What are my out of pocket costs?

Members who choose preferred options can get all their care for free ($0 out of pocket). If you prefer to work with an out-of-network provider, you may, and a $3000 deductible, coinsurance, and Rx copays will apply.

See our plan page for more information: decent.com/plan

What are my out of pocket costs?

Which PBM (Pharmacy Benefit Manager) does Decent use?

Decent partners with DisclosedRx as its PBM.

Which PBM (Pharmacy Benefit Manager) does Decent use?

Which TPA (Third Party Administrator) does Decent use?

Decent partners with Edison as its TPA.

Which TPA (Third Party Administrator) does Decent use?

What is a deductible?

A deductible is what you pay out of pocket for healthcare services before your plan starts covering costs. For example, with a $1,000 deductible, you pay the first $1,000 before coverage kicks in.

What is a deductible?

A deductible is what you pay out of pocket for healthcare services before your plan starts covering costs. For example, with a $1,000 deductible, you pay the first $1,000 before coverage kicks in.

Who is the stop loss for Decent plans?

Decent leverages a panel of A-rated domestic Stop Loss carriers to ensure the best rates for groups.

Who is the stop loss for Decent plans?

What is my copay?

• Decent Zero: $250 copay for ER visits; copays may apply for some medications

• Decent HSA: $250 ER copay; all other services go toward the deductible

What is my copay?

"• Decent Zero: $250 copay for ER visits; copays may apply for some medications • Decent HSA: $250 ER copay; all other services go toward the deductible"

How does Decent underwrite groups?

Decent's panel of stop-loss partners employs multiple AI underwriting tools to return quotes within a few days. Notably, we do not require health questionnaires or claims experience data for a binding quote.

How does Decent underwrite groups?

I got bloodwork done at my DPC—will Decent cover it?

If the labs are medically necessary, they’re covered by the Decent Zero Plan. Some DPCs include labs in their membership fee; others charge separately. If you pay out of pocket, submit a Decent Reimbursement Form for reimbursement.

I got bloodwork done at my DPC—will Decent cover it?

What do I do if I get a bill from my doctor or a hospital?

You are only responsible for any applicable copays, deductibles and coinsurance of your plan. If you have questions regarding a bill you have received, please contact us immediately by calling 1-888-Decent-9.

What do I do if I get a bill from my doctor or a hospital?

How does Decent handle claims fund surplus for groups?

In order to provide the lowest possible rates and maintain superior service, Decent retains aggregate funds not spent on claims.

How does Decent handle claims fund surplus for groups?

Where can I go if I need urgent or emergency care?

Start with your DPC! Many DPCs can treat things like cuts, infections, or minor injuries—often same-day.

If your DPC can’t help:

• Urgent care is typically out-of-network, so you may have to pay out of pocket.

• For true emergencies (like chest pain, broken bones, or difficulty breathing), go to the nearest ER or call 911.

📌 Decent doesn’t provide real-time support for urgent or emergency care. When in doubt, your DPC is the best place to start.

Where can I go if I need urgent or emergency care?

"Start with your DPC! Many DPCs can treat things like cuts, infections, or minor injuries—often same-day. If your DPC can’t help: • Urgent care is typically out-of-network, so you may have to pay out of pocket. • For true emergencies (like chest pain, broken bones, or difficulty breathing), go to the nearest ER or call 911. 📌 Decent doesn’t provide real-time support for urgent or emergency care. When in doubt, your DPC is the best place to start."

You have questions. We have answers.

What is Decent?

What is Decent?

What is the Direct Primary Care model?

What is the Direct Primary Care model?

What's the difference between a DPC and a Primary Care Physician (PCP)?

What's the difference between a DPC and a Primary Care Physician (PCP)?

How does DPC work in a Decent plan?

How does DPC work in a Decent plan?

What is a DPC Provider?

What is a DPC Provider?

What is the difference between a DPC, a PCP, and a specialist?

What is the difference between a DPC, a PCP, and a specialist?

Why are Decent plans built around the DPC model?

Why are Decent plans built around the DPC model?

How can I work with Decent?

How can I work with Decent?

What DPCs are available in my area?

What DPCs are available in my area?

Can I choose a DPC based on specific preferences (like gender, language, or background)?

Can I choose a DPC based on specific preferences (like gender, language, or background)?

What if I don’t use a DPC?

What if I don’t use a DPC?

Is DPC the only thing covered in my Decent plan?

Is DPC the only thing covered in my Decent plan?

What group sizes does Decent serve?

What group sizes does Decent serve?

Why can't I keep my PCP?

Why can't I keep my PCP?

What geographies does Decent serve?

What geographies does Decent serve?

Are prescription medications covered?

Are prescription medications covered?

What sets Decent apart from other health plan options in the market?

What sets Decent apart from other health plan options in the market?

What pharmacies can I use?

What pharmacies can I use?

What are my out of pocket costs?

What are my out of pocket costs?

Which PBM (Pharmacy Benefit Manager) does Decent use?

Which PBM (Pharmacy Benefit Manager) does Decent use?

Which TPA (Third Party Administrator) does Decent use?

Which TPA (Third Party Administrator) does Decent use?

What is a deductible?

What is a deductible?

Who is the stop loss for Decent plans?

Who is the stop loss for Decent plans?

What is my copay?

What is my copay?

How does Decent underwrite groups?

How does Decent underwrite groups?

I got bloodwork done at my DPC—will Decent cover it?

I got bloodwork done at my DPC—will Decent cover it?

What do I do if I get a bill from my doctor or a hospital?

What do I do if I get a bill from my doctor or a hospital?

How does Decent handle claims fund surplus for groups?

How does Decent handle claims fund surplus for groups?

Where can I go if I need urgent or emergency care?

Where can I go if I need urgent or emergency care?

Decent humans are here to help.