Small businesses can shop off-exchange through a broker, directly with...

https://wiki-cable.win/index.php/Primary_Care_Doctor_Not_in_Network:_What_Should_I_Do_as_an_Employer%3F

Small businesses can shop off-exchange through a broker, directly with carriers, or by comparing small-group plans. Before choosing, check whether employees’ doctors and hospitals are in-network; a low premium won’t help if their care is out of reach.