Fina lly, most employers reported that they would add pre-deductible coverage for additional health care services if allowed by law. Figure 1 Percentage of Employers That Expanded Pre-Deductible Coverage in HSA- Data and Study Sample Eligible Health Plans for Preventive Services Allowed Under IRS Rule 2019-45 November 4, 2021, #410 The data for this study come from an online survey of benefits decision makers. A total of 354 large employers were surveyed, including 270 that made changes to pre-deductible coverage and 62 that did not. Not all respondents answered every question. The survey averaged 10 minutes. The research was Employers Added Pre-Deductible Coverage for Preventive Don't Know If Coverage conducted in July and August of 2021. Was Expanded, 6% Services in Response to Increased IRS Flexibility Appetite for Adding More Services: While a substantial amount of pre-deductible coverage has been added, there is an appetite among employers for adding more services if allowed by the IRS, and among policymakers as evidenced by The Chronic Disease Management Act, which was reintroduced in the U.S. Congress as recently as IRS Notice 2019-45 allows health savings account (HSA)-eligible health plans the flexibility to cover 14 Did Not Expand May 2021. This bipartisan, bicameral legislation would provide HSA-eligible health plans additional flexibility Coverage, 18% medications and services used to prevent the exacerbation of chronic conditions prior to meeting the plan to provide pre-deductible coverage for services that manage chronic conditions. deductible. Recent research from the Employee Benefit Research Institute (EBRI) reported on findings from a 2021 EBRI survey of employers that collected information on their response to the 2019 guidance. The survey About EBRI: The Employee Benefit Research Institute is a private, nonpartisan, nonprofit research institute found that many employers added pre-deductible coverage as a result of the IRS notice. Furthermore, among based in Washington, DC, that focuses on health, savings, retirement, and economic security issues. EBRI does employers not offering pre-deductible coverage, nearly all either planned to add such coverage or were not lobby and does not take policy positions. The work of EBRI is made possible by funding from its members considering doing so. Expanded Coverage, and sponsors, which include a broad range of public, private, for-profit and nonprofit organizations. For more 76% information go to www.ebri.org or connect with us on Twitter or LinkedIn. Source: Employee Benefit Research Institute survey. A Thank You To Our Funder: This study was conducted with the funding support of the National IRS Notice 2019-45 Pharmaceutical Council. The U.S. Department of Treasury issued guidance on July 17, 2019, via IRS Notice 2019-45 to further increase the flexibility of health savings account (HSA)-eligible health plans to cover specific low-cost 1 Figure 2 ### preventive services to prevent the exacerbation of chronic conditions on a pre-deductible basis. Preventive Care Measures Covered on a Pre-Deductible Basis as a Result of IRS Notice 2019-45 With IRS Notice 2019-45 in place, all HSA-eligible health plans are now able to adopt a more flexible Insulin and Other Glucose Lowering Agents 66% benefit design offering more protection for certain medical services through a value-based insurance design (V-BID) plan structure. Blood Pressure Monitor 66% Glucometer 61% Beta Blockers 54% Hemoglobin A1C Testing 50% Adding Coverage: Three in four employers (76 percent) said that they have added pre-deductible coverage as a Low-density Lipoprotein (LDL) Testing 44% result of IRS Notice 2019-45. Another 94 percent of employers not offering pre-deductible coverage reported that Inhaled Corticosteroids 43% they planned to add such coverage or were considering doing so. Angiotensin Converting Enzyme (ACE) Inhibitors 39% Statins 38% Selective Serotonin Reuptake Inhibitors (SSRIs) 35% Types of Coverage Added: Pre-deductible coverage was often added for health care services related to heart Retinopathy Screening 35% disease and diabetes care. Two-thirds added pre-deductible coverage for blood pressure monitors and Anti-Resorptive Therapy 29% insulin/glucose lowering agents; 61 percent added coverage for glucometers; and 54 percent added coverage for beta-blockers. Health care services least likely to have pre-deductible coverage include peak flow meters and INR International Normalized Ratio (INR) Testing 25% testing (25 percent, each respectively). Peak Flow Meter 25% 0% 20% 40% 60% 80% Source: Employee Benefit Research Institute survey. 1 https://www.irs.gov/pub/irs-drop/n-19-45.pdf EBRI’s on Twitter! @EBRI or http://twitter.com/EBRI EBRI blog: https://ebriorg.wordpress.com/ E EB BR RI I on on T Twitt witte er r: : @ @E EB BR RI I o or r htt http:/ p://t /twit witter ter..c com/ om/E EB BR RI I B Blog: log: htt https ps:/ ://ebr /ebrior iorg. g.wor wordp dpr re es ss s..c com/ om/ © 2021, Employee Benefit Research Institute, 901 D St. SW, Suite 802, Washington, DC 20024, 202/659-0670 www.ebri.org 2 3