IRS Guidance Expands Definition of Preventive Care

IRS guidance in Notice 2019-45 released on preventative care

For most people, the definition of preventive care is broad and rather abstract in nature. However, under HSA rules, the definition becomes more important. Under an HSA-compatible health plan, medical expenses cannot be paid before meeting the deductible. The one exception is preventive care services. This week, the Treasury Department and the Internal Revenue Service released Notice 2019-45 which expands the interpretation of preventive care services. Specifically, Notice 2019-45 identifies items that may be considered preventive care for those with chronic illnesses.

Notice 2019-45 was released in response to the Executive Order issued in June, which directed the Treasury and IRS to consider ways to expand the use and flexibility of HSAs and HDHPs that cover low-cost preventive care.

What were the main criteria for adding items or services?

In order to include specific items or services, the Treasury and IRS focused on identifying items that met three qualifiers:

  • First, the service or item was low cost;
  • Next, there must have been medical evidence indicating the item or service would reduce the likelihood that the chronic condition would worsen or would result in a secondary condition; and
  • Finally, there was strong likelihood that the service or use of the item would prevent higher cost treatments.

While the above qualifiers were used to identify items, it is important to note that they cannot be used to add additional items in the future.

What services were added to the definition of preventive care?

Notice 2019-45 outlines services and items which are now considered preventive care for those diagnosed with chronic illnesses.

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 (SSRIs) Depression
Statins Heart disease and/or diabetes


When is Notice 2019-45 effective?

Notice 2019-45 is effective July 17, 2019. However, health plans will likely need time to make modifications before HSA-compatible plan offerings incorporate these services. There is no requirement to include these services. The notice merely permits the items and services to be included in preventive care for those with chronic illnesses.

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