A high deductible health plan ("HDHP") is not permitted to pay for medical expenses until the plan's deductible has been satisfied, with the exception of medical expenses incurred for preventive care. Preventive care did not generally include expenses for any service or benefit intended to treat an existing illness, injury or condition.
In a welcome development, in IRS Notice 2019-45, the IRS and the Treasury Department have exercised their discretion under the Internal Revenue Code to broaden what is considered preventive care to include benefits for certain chronic conditions. This change will allow a HDHP to pay for the following benefits for certain chronic conditions before the deductible has been met.
|
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 |
|
Inhaled corticosteroids |
Asthma |
|
Insulin and other glucose lowering agents |
Diabetes |
|
Retinopathy screening |
Diabetes |
|
Peak flow meter |
Asthma |
|
Glucometer |
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 (SSRls) |
Depression |
|
Statins |
Heart disease and/or diabetes |
This list does not expand the list of preventive care services that must be paid for by a non-grandfathered group health plan without a deductible under the Affordable Care Act.
The IRS guidance is effective on July 17, 2019; however, it will likely take health insurance issuers and plans some time to evaluate the potential cost impact and revise policies/documents to allow for the expanded list of preventive care benefits.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.