Delaware LLC for Telemedicine from India

Why would an Indian telemedicine founder form a Delaware LLC?

India has produced a wave of digital-health and telemedicine founders building products aimed at the US market: remote consultation platforms, chronic-care software, mental-health apps, second-opinion services, and the back-office tooling that medical practices run on. For any of these, having a recognised US legal entity solves real problems. US customers, partners, and payment processors prefer to contract with a US company, and a Delaware LLC gives your business a credible US identity without requiring you to leave India.

Delaware is the most widely recognised formation state in the United States. That recognition smooths the steps Indian founders find hardest: opening a US business bank account, getting approved by Stripe and other processors, and signing with US partners who want to see an American entity on the other side of the contract. The ongoing compliance load for an LLC is light — a flat $300 franchise tax, no annual report for LLCs, and no Delaware state income tax on an LLC with no Delaware operations.

But there is a boundary you must understand from day one, and it is more important in health than in almost any other vertical. A Delaware LLC is a corporate wrapper. It lets you own a business, sign contracts, and collect revenue. It does not grant any clinical or medical licence, and it does not let you practise medicine. The rest of this guide separates the two cleanly: what the LLC handles, and where US healthcare regulation takes over.

It is worth being clear about who this page is and is not written for. If you are building telehealth software, a scheduling or intake tool, a billing or revenue-cycle product, a patient-education platform, or back-office services that a US medical practice would buy, then the Delaware LLC is very likely all the corporate structure you need, and the regulatory caveats below are about data and privacy rather than licensing. If instead your plan is to have clinicians diagnose, prescribe, or treat US patients through your platform, then the LLC is still useful, but it is only the first of several pieces, and the licensing and professional-entity questions become central. Most Indian founders we speak with start on the software side and add a clinical layer later through partners — knowing which path you are on changes the order in which you do things.

Does a Delaware LLC let me treat US patients?

No, and this deserves its own section because getting it wrong is costly. The practice of medicine in the United States — including telemedicine — is regulated at the state level, not the federal level. In most states, a clinician must hold a licence in the state where the patient is physically located at the time of the consultation. Forming a Delaware LLC does nothing to satisfy that requirement. The LLC can own the business; it cannot hold a medical licence, because licences are issued to people, not companies.

Many US states also apply the corporate practice of medicine doctrine, which restricts who may own a medical practice. In those states, a practice that delivers clinical care must generally be owned by licensed practitioners through a professional entity, such as a professional limited liability company (PLLC) or a professional corporation, rather than a standard LLC owned by a non-clinician founder. This is why so many digital-health companies use a two-entity structure: a technology and management company (which a founder can own) that contracts with a separately owned, clinician-owned medical group.

The practical takeaway for an Indian founder is to decide early which side of the line you are on, and to involve a US healthcare attorney before you treat a single US patient. A Delaware LLC is the right wrapper for the business side. It is not a substitute for licensing, and no formation service can promise otherwise. We are happy to form the entity; the clinical structure is a separate, specialist piece of work.

It also helps to understand why the line exists. The corporate practice of medicine doctrine grew out of a concern that non-clinician owners, focused on profit, could pressure clinical judgement in ways that harm patients. That is why many states insist the entity delivering care be owned and controlled by licensed practitioners, with the business side kept structurally separate. For a founder, this is not red tape for its own sake; it shapes how you can build, who must own what, and how money flows between the technology company and the medical group. A well-designed two-entity structure keeps you compliant while still letting your company capture the value it creates through a properly papered management-services agreement — but the design has to be done by counsel who knows the specific states you operate in, because the doctrine is applied unevenly across the country.

How do you form the Delaware LLC from India?

The corporate side follows the same Delaware LLC formation path a US founder follows, routed so the EIN and banking steps work without an SSN. For an Indian founder it runs in a predictable order, and your healthcare-compliance work can proceed in parallel.

• Day 0 — Name and structure. You confirm an available Delaware name and decide whether you are a single owner or have co-founders. We run the Delaware name check first.
• Day 1-2 — Certificate of Formation. We file with the Delaware Division of Corporations, the state fee is included, and your LLC legally exists in about 48 hours with a registered agent included for year one.
• Weeks 1-4 — EIN. We submit Form SS-4 to the IRS without an SSN. This is the slowest step and the reason the overall corporate timeline runs in weeks, not days. See our EIN for a Delaware LLC guide.
• After EIN — Bank and Stripe. With the EIN, you open a US business account and apply for Stripe, both online from India.

The full walkthrough is on our how it works page. If you want the general non-resident picture before diving into health-specific issues, our Delaware LLC for non-residents guide covers the wider context.

A few details trip up Indian founders specifically, and they are worth flagging. You do not need an Indian-issued document apostilled to form the LLC; a clear copy of your passport is normally the identity document banks and processors expect. You can use your Indian residential address as the member address on the operating agreement — the registered agent supplies the required Delaware address, so you are not renting a US office. And the sequence is strict: the EIN must be fully issued before you apply for banking or Stripe, because applying with a pending EIN is one of the most common early rejections. Keep the name on your passport, the LLC name, and the address identical across every form, because mismatches between documents are the second most common cause of stalled applications. None of this is hard, but doing it in the wrong order costs weeks.

How do banking and Stripe work for a health business?

Once your EIN is issued, US fintech banks open business accounts for non-residents entirely online — no US visit required. The common choices are Mercury, Relay, and Wise. Approval is always the bank’s decision, so your specialist helps you apply to more than one until you are live with at least one account. For a deeper comparison, see our Delaware LLC banking guide.

For card payments, most health-software businesses use Stripe. Two things matter here. First, Stripe approval is Stripe’s decision, not ours and not guaranteed; we help you present a clean, accurate application, but the outcome rests with them. Second, health and telemedicine can be treated as a higher-scrutiny category by payment processors, and certain services may be restricted or require extra review. Describe your business honestly and precisely — a non-clinical software platform reads very differently to a processor than a service that bills for clinical care. If one processor declines, others may accept; each reviews independently, so a no from one is not a no from all.

One nuance worth understanding: payment processors and banks care less about your incorporation state than about what you actually do and how clearly you can show it. A telehealth platform that takes subscription payments for software is a routine recurring-revenue business in their eyes. A service that processes payments for clinical consultations, prescriptions, or anything that looks like billing for care may face additional review, documentation requests, or category restrictions, and some processors decline certain healthcare activities outright in their policies. The fix is not to obscure what you do, which backfires when accounts are later frozen, but to present a precise, accurate description and, where relevant, evidence of the licensing and compliance behind your clinical layer. A clean, honest application that matches your website and contracts is what gets approved.

Which structure fits which kind of telehealth business?

The right setup depends entirely on whether you deliver clinical care or sell technology and services. The table below is an orientation, not legal advice — confirm your structure with a US healthcare attorney, because the rules vary by state and the wrong choice is expensive to unwind.

Notice that a standard Delaware LLC is the right wrapper in every row — but in the rows that involve actual clinical care, it is only one part of the picture. The LLC handles ownership and money; the licensing and PLLC layer handles the practice of medicine. They are complementary, not interchangeable.

Does HIPAA apply to my Indian telemedicine company?

It can, and incorporation has nothing to do with it. HIPAA is a US federal health-privacy law that applies to covered entities — such as healthcare providers who transmit health information electronically — and to their business associates, which are vendors that handle protected health information on a covered entity’s behalf. That status follows the activity, not the place of incorporation or the location of your team. An Indian company that processes US patients’ health data, or that serves a US covered entity, can be a business associate with HIPAA obligations.

In practice that means business-associate agreements with your clients, appropriate administrative and technical safeguards, access controls, encryption, breach-notification procedures, and staff training. Forming a Delaware LLC contributes none of this; it is a separate compliance program you build alongside the entity, ideally with a US healthcare-privacy advisor. Build it early, because retrofitting HIPAA controls onto a live platform is far harder than designing for them from the start.

There is a second layer Indian founders often miss: where the data lives and who can see it. If your engineering or support team in India accesses US patients’ protected health information, that access has to be governed by the same safeguards and agreements, and you may need to think about data residency, sub-processor agreements with any cloud vendors, and which staff have access to what. US clients increasingly ask their vendors to demonstrate this in security questionnaires before they will sign, so strong HIPAA hygiene is not just a legal box to tick — it is a sales enabler. None of this depends on the LLC, but having a US entity that can sign business-associate agreements and contract on US terms makes the whole compliance conversation with US healthcare clients much smoother.

What US tax issues should an Indian telemedicine founder know?

This is an area where general guidance helps but a cross-border CPA matters. By default, a single-member Delaware LLC is a pass-throughfor US federal tax: the company itself does not pay income tax, and profit flows to the owner. Whether a non-resident owner owes US income tax depends on whether the LLC’s income is effectively connected to a US trade or business, or attributable to a US permanent establishment. Where your business contracts with US-licensed clinicians or has US-based operations, this analysis becomes more involved, which is exactly why it should not be settled from a guide.

India has an income tax treaty with the United States that is in force. Its business-profits provisions generally limit US taxation of a resident enterprise’s business profits to those attributable to a US permanent establishment, which is a meaningful protection for a genuinely India-operated business. We will not quote specific withholding numbers here, because the right figure depends on the type of income and your facts — for instance, certain US-source passive income can be subject to withholding while ordinary operating revenue is treated differently. The honest answer is to have a CPA who handles India-US matters confirm your position. For the general US picture, see our Delaware LLC taxes overview.

What that means in plain terms for a typical India-run telehealth software business: if you and your team are in India, your servers and operations are in India, and you simply sell software to US customers, much of your revenue is usually treated as foreign-source business profit rather than as income effectively connected to a US trade or business. The treaty’s business-profits article is designed to protect exactly that situation, provided you do not have a US permanent establishment such as a US office or dependent agent concluding contracts on your behalf. The picture changes once you put boots on the ground in the US, hire US-based staff, or stand up a clinical operation with US-licensed providers — at that point a US footprint may exist and the analysis shifts. Because the difference between “clean foreign-source revenue” and “US-taxable effectively connected income” turns on these specifics, get the assessment done before you scale rather than after, and never assume a number without a CPA confirming it.

One more point belongs here, because Indian founders ask it constantly: does forming a US LLC change what you owe back home? Yes — and not in the way the marketing of some formation services implies. A Delaware LLC is not a tax shelter. As an Indian resident, you are generally taxed in India on your worldwide income, so profits you earn through a US LLC are typically reportable in India. The India-US treaty and India’s foreign-tax-credit mechanism exist to reduce double taxation, but they do not make US income invisible to the Indian tax authorities.

How the income is characterised, when it is taxed, and what credits apply all depend on your residency status and your specific arrangement. Treat the US and Indian sides as two halves of one picture, and engage an Indian chartered accountant who handles cross-border and US-LLC income before you rely on any general rule. Doing this early avoids unpleasant surprises at filing time on either side.

What ongoing US filings does the LLC require?

Two obligations stay constant regardless of your clinical structure. The first is Delaware’s flat $300 LLC franchise tax, due June 1 each year starting in year two. There is no annual report for a Delaware LLC, so the franchise tax is the entire state obligation. Miss the June 1 deadline and Delaware adds a $200 penalty plus 1.5% interest per month, and your LLC loses good standing — which is why we track the date for you. Note that the “authorized shares” and “assumed par value” franchise-tax methods you may read about apply to Delaware corporations only, never to LLCs. Our Delaware franchise tax page covers this in full.

The second is Form 5472. If you are a non-US person owning 25% or more of a single-member Delaware LLC treated as a disregarded entity, the IRS requires Form 5472 each year, attached to a pro forma Form 1120. It reports reportable transactions between you and your LLC, such as the capital you contribute. It is due April 15 and can be extended with Form 7004. The penalty for failing to file is $25,000 under IRC 6038A, so most non-resident owners treat it as mandatory. The detail is in our Form 5472 for Delaware LLCs guide.

A word on the Corporate Transparency Act, since founders read conflicting things about it. Beneficial-ownership reporting to FinCEN changed significantly in 2025: a March 2025 interim final rule narrowed the scope so that US-formed domestic reporting companies are currently exempt, while foreign reporting companies registered to do business in the US can still be in scope. This area has been in flux and may shift again, so do not treat any summary, including this one, as the last word. We monitor the FinCEN position and flag changes to founders we work with, but the duty to file if a rule requires it ultimately rests with the owner. The safe approach is to confirm your current status at the source or with an adviser before each year’s filings rather than relying on what was true twelve months ago.

How much does it cost, year one and beyond?

Our service is a single flat fee of $397, and the Delaware state filing fee is already included — there is no separate state charge to add on. That one payment covers the Certificate of Formation, the EIN application, a registered agent for year one, your operating agreement, and US bank and Stripe application support, all with WhatsApp support. The healthcare-specific costs of a telemedicine business — clinical licensing, PLLC formation, HIPAA tooling, malpractice cover, and specialist legal advice — are separate and depend on your model.

So year two for the LLC itself is roughly the $300 franchise tax plus about $99 to renew your registered agent. For the full pricing picture, see our Delaware LLC costbreakdown. Budget the clinical and compliance costs separately — they are real, and they are where most of a health business’s setup spend actually goes.

How does a Delaware LLC compare to the alternatives?

A Delaware LLC is not the only way to wrap a telemedicine business, but for most Indian founders building US-facing software it is a clean default. The comparison below is orientation, not legal advice — confirm the entity type and the clinical layer with advisers before deciding.

If your plan is to raise US venture capital, investors usually expect a C-Corp rather than an LLC, so read our Delaware C-Corp guide before you form. If you are delivering clinical care, the LLC and a separate licensed medical structure work together rather than as alternatives. And whichever route you take, you can start the whole corporate process remotely from India — the healthcare-compliance work is the part that needs specialist US counsel alongside it.