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.
Chronic Condition: | Preventive Care Covered: | Coverage Available Under: |
---|---|---|
Congestive heart failure, diabetes, and/or coronary artery disease | Angiotensin Converting Enzyme (ACE) inhibitors | Pharmacy |
Osteoporosis and/or osteopenia | Anti-resorptive therapy | Pharmacy |
Congestive heart failure and/or coronary artery disease | Beta-blockers | Pharmacy |
Hypertension | Blood pressure monitor | Medical |
Diabetes | Glucometer | Medical - Continuous glucose monitor (CGM); |
Diabetes | Hemoglobin A1c testing | Medical |
Asthma | Inhaled corticosteroids | Pharmacy |
Diabetes | Insulin and other glucose lowering agents | Pharmacy |
Liver disease and/or bleeding disorders | International Normalized Ratio (INR) testing | Medical |
Heart disease | Low-density Lipoprotein (LDL) testing | Medical |
Asthma | Peak flow meter | Medical |
Diabetes | Retinopathy screening | Medical |
Depression | Selective Serotonin Reuptake Inhibitors (SSRIs) | Pharmacy |
Heart disease and/or diabetes | Statins | Pharmacy |
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.
No.