The IRS has expanded the list of preventive care benefits permitted to be provided by a high deductible health plan (HDHP) under Code Sec. 223(c)(2)(C) without a deductible, or with a deductible below the applicable minimum deductible for the HDHP, to include oral contraception, breast cancer screening, and continuous glucose monitors for certain patients.
Contraceptives
A health plan will not fail to qualify as an HDHP under Code Sec. 223(c)(2) merely because it provides benefits for over-the-counter (OTC) oral contraceptives, including emergency contraceptives, and male condoms before taxpayers satisfied the minimum annual deductible for an HDHP under Code Sec. 223(c)(2)(A). The HRSA-Supported Guidelines relating to contraceptives have been updated and no longer contain the “as prescribed” restriction.
Breast Cancer and Diabetes Care
The IRS has also clarified that all types of breast cancer screening for taxpayers (including those other than mammograms) who have not been diagnosed with breast cancer will be treated as preventive care under Code Sec. 223(c)(2)(C). Moreover, continuous glucose monitors for individuals diagnosed with diabetes are also treated as preventive care under Code Sec. 223(c)(2)(C).
Insulin Products Safe Harbor
The new safe harbor for absence of a deductible for certain insulin products under Code Sec. 223(c)(2)(G) will apply without regard to whether the insulin product was prescribed to treat taxpayers diagnosed with diabetes. or prescribed for the purpose of preventing the exacerbation of diabetes or the development of a secondary condition.
Effective Date
This guidance is generally effective for plan years (in the individual market, policy years) that begin on or after December 30, 2022.
Effect on Other Documents
Notice 2004-23 is clarified by noting the safe harbor for absence of a deductible for breast cancer screening.
Notice 2018-12 is superseded with respect to the guidance regarding male condoms.
Notice 2019-45 is clarified and expanded by noting the safe harbor for absence of a deductible for continuous glucose monitors and for certain insulin products pursuant to the Inflation Reduction Act of 2022.
