Tax Notes logo

IRS Issues HSA Safe Harbor For Preventive Care Benefits.

MAR. 30, 2004

Notice 2004-23; 2004-1 C.B. 725

DATED MAR. 30, 2004
DOCUMENT ATTRIBUTES
  • Institutional Authors
    Internal Revenue Service
  • Cross-Reference
    For the full text of Notice 2004-25, see Doc 2004-6949.

    For the full text of Rev. Rul. 2004-38, see Doc 2004-6950.

    For the full text of Rev. Proc. 2004-22, see Doc 2004-6951.

    For the text of a related Treasury news release, see Doc 2004-

    6961.

    For a summary of Notice 2004-2, 2004-2 C.B. 269, see Tax Notes,

    Jan. 5, 2004, p. 73; for the full text, see Doc 2003-26905,

    2003 TNT 246-5, or H&D, Dec. 23, 2003, p. 3070.
  • Code Sections
  • Subject Area/Tax Topics
  • Jurisdictions
  • Language
    English
  • Tax Analysts Document Number
    Doc 2004-6948
  • Tax Analysts Electronic Citation
    2004 TNT 62-11
Citations: Notice 2004-23; 2004-1 C.B. 725

Clarified by Notice 2023-37

Clarified by Notice 2013-57

Notice 2004-23

PURPOSE

[1] This notice provides a safe harbor for preventive care benefits allowed to be provided by a high deductible health plan (HDHP) without satisfying the minimum deductible under section 223(c)(2) of the Internal Revenue Code.

BACKGROUND

[2] Section 1201 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. No. 108-173, added section 223 to the Internal Revenue Code to permit eligible individuals to establish Health Savings Accounts (HSAs) for taxable years beginning after December 31, 2003.

[3] Among the requirements for an individual to qualify as an eligible individual under section 223(c)(1) (and thus to be eligible to make tax-favored contributions to an HSA) is the requirement that the individual be covered under an HDHP. An HDHP is a health plan that satisfies certain requirements with respect to minimum deductibles and maximum out-of-pocket expenses. Generally, an HDHP may not provide benefits for any year until the deductible for that year is satisfied. However, section 223(c)(2)(C) provides a safe harbor for the absence of a preventive care deductible. That section states, "[a] plan shall not fail to be treated as a high deductible health plan by reason of failing to have a deductible for preventive care (within the meaning of section 1871 of the Social Security Act, except as otherwise provided by the Secretary)." An HDHP may therefore provide preventive care benefits without a deductible or with a deductible below the minimum annual deductible. On the other hand, there is no requirement in section 223 that an HDHP provide benefits for preventive care or provide preventive care with a deductible below the minimum annual deductible.

PREVENTIVE CARE SAFE HARBOR

[4] Preventive care for purposes of section 223(c)(2)(C) includes, but is not limited to, the following:

  • Periodic health evaluations, including tests and diagnostic procedures ordered in connection with routine examinations, such as annual physicals.

  • Routine prenatal and well-child care.

  • Child and adult immunizations.

  • Tobacco cessation programs.

  • Obesity weight-loss programs.

  • Screening services (see attached APPENDIX).

 

However, preventive care does not generally include any service or benefit intended to treat an existing illness, injury, or condition (See below for request for comments regarding drug treatments.)

INTERACTION WITH STATE LAW HEALTH CARE REQUIREMENTS

[5] Section 220(c)(2)(B)(ii) allows a high deductible health plan for purposes of an Archer Medical Savings Account to provide preventive care without a deductible if required by State law. However, section 220 does not define preventive care for this purpose. Section 223(c)(2)(C), for purposes of an HSA, does not condition the exception for preventive care on State law requirements. State insurance laws often require health plans to provide certain health care without regard to a deductible or on terms no less favorable than other care provided by the health plan. The determination of whether health care that is required by State law to be provided by an HDHP without regard to a deductible is "preventive" for purposes of the exception for preventive care under section 223(c)(2)(C) will be based on the standards set forth in this notice and other guidance issued by the IRS, rather than on how that care is characterized by State law.

COMMENTS REQUESTED

[6] Notice 2004-2, 2004-2 C.B. 269, requested comments concerning the appropriate standard for preventive care in section 223(c)(2)(C). We continue to request comments on the appropriate standard for preventive care, and in particular, recommendations concerning any benefit or service that should be added to those set forth in this notice and appendix. In addition, we request comments on the extent to which benefits provided by an employee assistance program, mental health program or wellness program may qualify as preventive care, including comments regarding the scope of treatments provided as benefits through counseling and health assessments. In particular, we request comments on the extent to which drug treatments, either solely by prescription or as part of an overall treatment regimen should be treated as preventive care and the appropriate standards for differentiating between drug treatments that would be considered preventive care and those that would not be considered preventive care.

[7] Send comments to: CC:PA:LPD:PR ( Notice 2004-2), Room 5203, Internal Revenue Service, POB 7604, Ben Franklin Station, Washington, DC 20044. Comments may be hand-delivered between the hours of 8 a.m. and 4 p.m. to: CC:PA:LPD:PR (Notice 2004-2), Courier's Desk, Internal Revenue Service, 1111 Constitution Avenue, NW, Washington, D.C. Alternatively, taxpayers may submit comments electronically at: Notice.2004.2.Comments@irscounsel.treas.gov (a Service Comments e- mail address).

DRAFTING INFORMATION

[8] The principal author of this notice is Shoshanna Tanner of the Office of Division Counsel/Associate Chief Counsel (Tax Exempt and Government Entities). For further information regarding this notice contact Ms. Tanner on (202) 622-6080 (not a toll-free call).

 

APPENDIX

 

 

Safe Harbor Preventive Care Screening Services

 

 

Cancer Screening

 

Breast Cancer (e.g., Mammogram)

 

Cervical Cancer (e.g., Pap Smear)

 

Colorectal Cancer

 

Prostate Cancer (e.g., PSA Test)

 

Skin Cancer

 

Oral Cancer

 

Ovarian Cancer

 

Testicular Cancer

 

Thyroid Cancer

 

 

Heart and Vascular Diseases Screening

 

Abdominal Aortic Aneurysm

 

Carotid Artery Stenosis

 

Coronary Heart Disease

 

Hemoglobinopathies

 

Hypertension

 

Lipid Disorders

 

 

Infectious Diseases Screening

 

Bacteriuria

 

Chlamydial Infection

 

Gonorrhea

 

Hepatitis B Virus Infection

 

Hepatitis C

 

Human Immunodeficiency Virus (HIV) Infection

 

Syphilis

 

Tuberculosis Infection

 

 

Mental Health Conditions and Substance Abuse Screening

 

Dementia

 

Depression

 

Drug Abuse

 

Problem Drinking

 

Suicide Risk

 

Family Violence

 

 

Metabolic, Nutritional, and Endocrine Conditions Screening

 

Anemia, Iron Deficiency

 

Dental and Periodontal Disease

 

Diabetes Mellitus

 

Obesity in Adults

 

Thyroid Disease

 

 

Musculoskeletal Disorders Screening

 

Osteoporosis

 

 

Obstetric and Gynecologic Conditions Screening

 

Bacterial Vaginosis in Pregnancy

 

Gestational Diabetes Mellitus

 

Home Uterine Activity Monitoring

 

Neural Tube Defects

 

Preeclampsia

 

Rh Incompatibility

 

Rubella

 

Ultrasonography in Pregnancy

 

 

Pediatric Conditions Screening

 

Child Developmental Delay

 

Congenital Hypothyroidism

 

Lead Levels in Childhood and Pregnancy

 

Phenylketonuria

 

Scoliosis, Adolescent Idiopathic

 

 

Vision and Hearing Disorders Screening

 

Glaucoma

 

Hearing Impairment in Older Adults

 

Newborn Hearing
DOCUMENT ATTRIBUTES
  • Institutional Authors
    Internal Revenue Service
  • Cross-Reference
    For the full text of Notice 2004-25, see Doc 2004-6949.

    For the full text of Rev. Rul. 2004-38, see Doc 2004-6950.

    For the full text of Rev. Proc. 2004-22, see Doc 2004-6951.

    For the text of a related Treasury news release, see Doc 2004-

    6961.

    For a summary of Notice 2004-2, 2004-2 C.B. 269, see Tax Notes,

    Jan. 5, 2004, p. 73; for the full text, see Doc 2003-26905,

    2003 TNT 246-5, or H&D, Dec. 23, 2003, p. 3070.
  • Code Sections
  • Subject Area/Tax Topics
  • Jurisdictions
  • Language
    English
  • Tax Analysts Document Number
    Doc 2004-6948
  • Tax Analysts Electronic Citation
    2004 TNT 62-11
Copy RID