Preventive Care for Specified Chronic Conditions - Indy - REG ANH BSH

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.

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);
Pharmacy - All other glucometers

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

 Is this a mandated change?

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.

 What products will be impacted?

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.

 Will services be covered at 0% member cost share, the same as preventive care under the Affordable Care Act (ACA)?

No.