Coverage for Those Who Suffer from Chronic Conditions

Posted by BAS - 08 August, 2019


Individuals covered by high deductible health plans may now receive coverage for certain chronic conditions as preventive care benefits. This is important because HDHP participants with conditions such as asthma, heart failure or diabetes can be covered for treatments and medications without having to first satisfy the plan’s deductible.

Under a high deductible health plan, a participant must pay all medical costs out of pocket, except the cost for preventive care, until the participant has paid the full deductible amount. A new IRS notice (IRS Notice 2019-45, which may be accessed by clicking here, expanded the definition of preventive care to include treatments for certain chronic illnesses. The notice does not require high deductible health plans to cover the treatments as preventive care, so plans have a choice of how to categorize services relating to chronic condition.

Benefits for services and items in the following list may now be considered preventive care for HDHP purposes.

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 (SSRIs) Depression
Statins Heart Disease and/or diabetes

Topics: Health Care Reform (ACA)

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