IRS Notice with HSA Implications Expands “Preventive” Care to Include Certain Chronic Conditions

The IRS has issued Notice 2019-45, in which it identifies certain chronic health conditions whose treatments will be considered “preventive.” As a result, such treatments can be covered by a health insurance plan without first meeting the minimum deductibles generally required of high deductible health plans (HDHPs) for health savings account (HSA) contribution eligibility purposes.  This guidance is effective July 17, 2019.

This guidance, which is effective July 17, 2019, notes that it is a response to an Executive Order issued by President Trump on June 24, 2019. The President charged the Secretary of the Treasury with the task of issuing guidance that would “expand the ability of patients to select HDHPs that can be used alongside an HSA, and that cover low-cost preventive care before the deductible, that helps maintain health status for individuals with chronic conditions.”

In general, “preventive” care does not include treatment for existing illnesses or conditions. Under current HDHP/HSA rules, treatments of a nonpreventive nature that are covered or reimbursed by a health plan without first satisfying HDHP conditions would generally disqualify a covered individual from HSA contribution eligibility.

Notice 2019-45 identifies the following conditions whose ongoing treatment may now be considered preventive, and, therefore, may be covered by a health plan without first satisfying an HSA-qualifying deductible.

  • Congestive heart failure
  • Coronary artery disease
  • Osteoporosis
  • Hypertension (high blood pressure)
  • Asthma
  • Diabetes
  • Liver disease
  • Bleeding disorders
  • Heart disease
  • Depression

The treatments listed for the above conditions include certain inhibitors, therapies, monitors, medications, screenings, tests, and statins, which will be considered preventive expenses for HDHP purposes. Items not listed in Notice 2019-45 will not be considered preventive for HDHP purposes.