Recently, the IRS added some chronic conditions to the list of preventative care benefits that are given with a high deductible health plan that do not require a deductible. The expansion was signed into law by President Trump in the summer of 2019. The expansion was an executive order by Trump designed to improve upon the cost and transparency of care options before the deductible.
In response to Trump’s executive order, the IRS issued a notice called 2019-45. With the passing of this order, there are medical care services and products that are not classified as preventative care for Americans who are suffering from chronic conditions. Any employer who utilizes high deductible health plans needs to take a look at the documents provided with that plan and have a conversation with their insurance agent. There might be some new changes to the way their high deductible health plans are covered, so it is important to review them.
Those covered through a high deductible health plan can typically establish and add contributions to a health savings account. In order to qualify and be considered as a high deductible health plan, any plan cannot provide healthcare benefits for any plan year until an agreed-upon minimum deductible is reached. Some high deductible health plans, however, could offer benefits to patients for preventative care without the need for a deductible.
The requirements for establishing and contributing to a health savings account include the fact that an individual must have coverage under a high deductible health plan and also have no current disqualifying health coverage. Most high deductible health plans meet the requirements for minimum deductibles and maximums that are out-of-pocket.
Under the new regulations, there are no benefits that can be covered by a high deductible health plan unless the minimum annual deductible is reached. A high deductible health plan might also include a low deductible when covering preventative care.
The IRS has included guidelines on what can be considered as preventive care benefits for high deductible health plan. Some examples of preventative health care benefits are yearly checkups and physicals, prenatal visits, vaccines and screenings for diseases like cancer.
Preventive care typically doesn’t include any medical service that will treat an existing condition. Those patients with chronic and existing conditions are exempt from obtaining medical care that results in more extensive medical procedures like amputation, heart attacks and strokes.
However, the new IRS rules do make it easier for patients with high deductible health plans to get benefits for their prescription drugs that treat their chronic conditions. The new notice includes prescription drugs to list of preventative care for individuals with chronic conditions.
As with all changing healthcare laws that impact our workplace, these new preventative care regulations can be confusing to employers. If you have any questions about how these new IRS regulations affect your medical stop-loss insurance, feel free to give us a call or drop us a line via email. We are here when you need us.