Additional Preventive Benefits for Members with Chronic Conditions Notice Summary
Effective January 1, 2020, upon group renewal, benefits will be provided as identified in Internal Revenue Service (IRS) notice 2019-45. This notice expands the list of preventive care services for chronic conditions which may be covered for members in a high deductible health plan (HDHP) or qualified Health Savings Account (HSA) plan.
IMPORTANT NOTE: The services and items below are treated as preventive care only when prescribed to treat an individual diagnosed with the associated chronic condition, and only when prescribed to keep the chronic condition from becoming worse or to prevent the development of a secondary condition.
These services are not covered under the existing ACA Preventive Care benefit. Under the new benefit, when the specified services are rendered by an in-network/Category 1 and 2 provider, deductible will not apply, but the member may be responsible for coinsurance.
Preventive Care Covered:
Coverage Available Under:
Congestive heart failure, diabetes, and/or coronary artery disease
Angiotensin Converting Enzyme (ACE) inhibitors
Osteoporosis and/or osteopenia
Congestive heart failure and/or coronary artery disease
Blood pressure monitor
Medical - Continuous glucose monitor (CGM);
Hemoglobin A1c testing
Insulin and other glucose lowering agents
Liver disease and/or bleeding disorders
International Normalized Ratio (INR) testing
Low-density Lipoprotein (LDL) testing
Peak flow meter
Selective Serotonin Reuptake Inhibitors (SSRIs)
Heart disease and/or diabetes
No. This is not a mandated change. The IRS has given carriers the discretion whether they want to cover the services described above before the deductible.
This change will be applied to: Fully-insured HSA qualified High Deductible Health Plans including Individual, Small Group (1-50), Large Group (51+), and some self-funded groups.