High Deductible Health Plans Allowed to Provide Additional Preventive Care Benefits for Individuals with Chronic Conditions

A high deductible health plan (“HDHP”) is not permitted to pay for medical expenses until the plan’s deductible has been satisfied, with the exception of medical expenses incurred for preventive care.  Preventive care did not generally include expenses for any service or benefit intended to treat an existing illness, injury or condition.

In a welcome development, in IRS Notice 2019-45, the IRS and the Treasury Department have exercised their discretion under the Internal Revenue Code to broaden what is considered preventive care to include benefits for certain chronic conditions.  This change will allow a HDHP to pay for the following benefits for certain chronic conditions before the deductible has been met.

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 (SSRls) Depression
Statins Heart disease and/or diabetes


This list does not expand the list of preventive care services that must be paid for by a non-grandfathered group health plan without a deductible under the Affordable Care Act.

The IRS guidance is effective on July 17, 2019; however, it will likely take health insurance issuers and plans some time to evaluate the potential cost impact and revise policies/documents to allow for the expanded list of preventive care benefits.

About the Author:

Cynthia A. Moore is a Member in Dickinson Wright’s Troy office where she assists clients in all areas of employee benefits law. She can be reached at 248-433-7295 or cmoore@dickinsonwright.com and you can visit her bio here.