January 13, 2020
Recently, the Internal Revenue Service (IRS) issued Notice 2019-45, which permits (but does not require) HSA/HDHP arrangements to cover certain chronic condition treatments before participants satisfy their deductibles. Below are details that will be relevant to plan sponsors.
Notice 2019-45, provides that HDHPs paired with HSAs can reimburse the following chronic condition treatments, provided they are prescribed for their corresponding conditions:
HSA/HDHPs and Chronic Condition Treatments
Preventive Care for Specific Conditions | For Individuals Diagnosed with |
Angiotensin Converting Enzyme (ACE) inhibitors | Congestive heart failure, diabetes, and/or coronary artery disease |
Anti-resoprtive 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 Sertonin Reuptake Inhibitors (SSRIs) | Depression |
Statins | Heart disease and/or diabetes |
Plan sponsors interested in implementing this pre-deductible coverage should note the following:
- The chronic condition treatments listed above are the only ones currently permitted under the HSA rules. The IRS will review and update this list approximately every 5-10 years and will continue considering standards for preventive care.
- HSA/HDHP arrangements can continue providing pre-deductible coverage for current preventive items/services such as annual well visits and immunizations.
- HSA/HDHP arrangements generally can require cost-sharing for the above items/services but cannot require cost-sharing if they overlap with ACA preventive services such as statins.
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