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The IRS issued Notice 2019-45, which adds 14 new preventive care items to the list of benefits that may be reimbursed by high deductible health plans without meeting any deductible amount. Specifically, Notice 2019-45 identifies items that may be considered preventive care for those with chronic illnesses.

Generally, under Sec. 223(c)(2)(A), a high deductible health plan may not provide benefits for any year until the minimum deductible for that year is satisfied. The one exception is preventive care services. To qualify as a preventive care benefit, the benefit must either be described as preventive care under Section 1861 of the Social Security Act or be determined to be preventive care in guidance issued by the IRS. 

Notice 2019-45 is effective July 17, 2019. The following services were added to the definition of preventive care – 

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


Congestive heart failure and/or coronary artery disease

Blood pressure monitor


Inhaled corticosteroids


Insulin and other glucose lowering agents


Retinopathy screening


Peak flow meter




Hemoglobin A1c testing


International Normalized Ratio (INR) testing

Liver disease and/or bleeding disorders

Low-density Lipoprotein (LDL) testing

Heart disease

Selective Serotonin Reuptake Inhibitors (SSRIs)



Heart disease and/or diabetes