Compliance FYI: IRS Notice 2019-45 – Additional Preventive Items Under an HDHP

On July 17, 2019 the Internal Revenue Service (IRS) issued Notice 2019-45 regarding certain preventive care benefits that are permitted under a high deductible health plan (HDHP) including Health Savings Account (HSA) compatible plans. These benefits can be provided without applying a deductible or with a deductible below the applicable minimums.

Under Section 223 of the Internal Revenue Code (IRC), HDHPs may not provide benefits for any year until the applicable deductible is satisfied. However there is a safe harbor for benefits consisting of preventive care. As a result, HDHPs can provide preventive benefits without applying the deductible or can apply a deductible that is lower than the required minimum deductible. In order for benefits to be considered “preventive” they must be either defined as preventive under section 1861 of the Social Security Act (SSA) or determined preventive in guidance issued by the Department of Treasury or IRS.

The guidance addresses services and items used to treat chronic conditions. These items and services may be classified as “preventive” for someone with the particular chronic condition when prescribed for the purpose of preventing the exacerbation of the chronic condition or the development of a secondary condition. If prescribed as required, these items may be covered as “preventive” under the terms of the plan and paid immediately without applying the plan deductible.

The following list will be updated every five to ten years. It is important to note that guidance does not require that these items and services be covered. Rather, the items and services are permitted to be covered as “preventive”. The effective date for this notice is July 17, 2019.


Preventive Care for Specified Conditions 

For Individuals Diagnosed with

Angiotensin Converting Enzyme (ACE) inhibitors Congestive heart failure, diabetes, and/or coronary heart disease
Anti-resorptive therapy Osteoporosis and/or osteopenia
Beta-blockers Congestive heart failure and/or coronary heart 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 Live disease and/or bleeding disorders
Low-density Lipoprotein (LDL) testing Heart disease
Selective Serotonin Reuptake Inhibitors (SSRIs) Depression
Statins Heart disease and/or diabetes

TAKEAWAYS

The new guidance issued by the IRS allows High Deductible Health Plans to cover certain items and services for chronic conditions as “preventive care” without applying the deductible.

Employers should consult with their M3 Account Team and carrier/TPA partners to evaluate the new coverage options.

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