July 18, 2019
On July 17, 2019, the Internal Revenue Service (IRS) issued Notice 2019-43, expanding the list of preventive care to include a range of chronic conditions that are now permitted to be provided by a high deductible health plan (HDHP) under Internal Revenue Code (Code) section 223 without a deductible, or with a deductible below the applicable minimum deductible (self-only or family) for an HDHP.
The Treasury Department and the IRS, in consultation with the Department of Health and Human Services, have determined that certain medical care services received and items purchased, including prescription drugs, for certain chronic conditions should be classified as preventive care for someone with that chronic condition.
Code section 223 permits eligible individuals to establish Health Savings Accounts (HSAs) as long as certain requirements are met, one of which is being enrolled in an HDHP that provides no disqualifying health coverage, meeting certain requirements as to minimum deductibles and maximum out-of-pocket expenses. Generally, an HDHP may not provide benefits for any year until the minimum deductible for that year is satisfied. However, plans are permitted to cover preventive care services without a deductible or with a deductible below the minimum annual deductible required by Code section 223.
To be a preventive care benefit as defined for purposes of section 223, the benefit must either be described as preventive care for purposes of Social Security Act section 1861 or be determined to be preventive care in guidance issued by the Department of the Treasury (Treasury Department) and the IRS.
As a general rule, preventive care does not include services for any service or benefit intended to treat an existing illness, injury, or condition. However, this Notice provides that certain services and items for individuals with the specified chronic conditions listed can be treated as preventive care. Each of these services or items, when prescribed for an individual with the related chronic condition, must contain the following characteristics:
Accordingly, the following medical care services and items were determined to preventive care for someone with that chronic condition:
|Preventive Care for Specified Conditions:||For Individuals Diagnosed with:|
|Angiotensin Converting Enzyme (ACE) inhibitors||Congestive heart failure, diabetes, and/or coronary artery disease|
|Anti-resorptive therapy||Osteoporosis and/or osteopenia|
|Beta-blockers||Congestive heart failure and/or coronary artery disease|
|Blood pressure monitor||Hypertension|
|Insulin and other glucose lowering agents||Diabetes|
|Peak flow meter||Diabetes|
|Hemoglobin A1c testing||Diabetes|
|International Normalized Ratio (INR) testing||Liver disease and/or bleeding disorders|
|Low-density Lipoprotein (LDL) testing||Heart disease|
|Selective Serotonin Reuptake Inhibitors (SSRIs)||Depression|
|Statins||Heart disease and/or diabetes|
This Notice does not expand the scope of preventive care beyond the list. Furthermore, any medical care previously recognized as preventive care for these rules is still treated as preventive care.
For More Information
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