HDHP Preventive Care And Telehealth Safe Harbors
A high deductible health plan can cover certain preventive care and telehealth before the deductible without costing an employee HSA eligibility. The list has been updated several times. Here is what employers should know, and a reminder to check current status.
What Counts As Preventive Care
Preventive Care Before The Deductible
An HDHP may pay for preventive care without a deductible. IRS guidance defines what qualifies, and treatment of an existing illness generally does not. The IRS definition is specific, so employers should not assume that every low-cost service is allowed before the deductible. Review the plan’s preventive list with the carrier and a tax adviser before communicating it to employees. For a quick estimate, use our free HDHP vs PPO calculator.
Chronic Condition Care
IRS Notice 2019-45 lists certain items and services for chronic conditions that are treated as preventive care when prescribed for that purpose. The notice covers a defined list, and only when the items are prescribed for the stated condition. Employers should check with the carrier or a tax adviser before adding any of them to a plan’s pre-deductible coverage.
Notice 2024-75 Updates
Notice 2024-75 added over-the-counter oral contraceptives and male condoms, treated all breast cancer screening for people without a diagnosis as preventive, and treated continuous glucose monitors for diabetics as preventive. Employers should read the notice itself, or have an adviser do so, before changing the plan’s pre-deductible list. Carriers may adopt these items at different times, so confirm with the plan before telling employees what is covered.
Insulin Products
The same notice clarified that the insulin product safe harbor applies regardless of why the insulin is prescribed. Employers that offer insulin before the deductible should check that the plan wording matches this clarification. A tax adviser or the carrier can confirm how the plan applies the safe harbor to its prescription drug list.
The Telehealth Safe Harbor
Before The Deductible
A plan may cover telehealth and other remote care before the deductible without disqualifying employees from HSA contributions. Plans may offer remote care without a deductible, but the rules have details about which services count. Employers should have the carrier and a tax adviser confirm that the plan design fits before promoting the benefit to employees. Business owners can find the entity-by-entity rules in HSA Rules for Business Owners.
Now Permanent
Recent federal legislation made the telehealth safe harbor permanent for plan years beginning on or after January 1, 2025. Since the safe harbor is no longer temporary, plans no longer need to track an expiration. Employers should still confirm the plan wording, because carriers and administrators may describe telehealth coverage differently in their documents.
Check Plan Wording
Plan documents and carrier materials should match how telehealth is actually covered. Confirm current status before changing a plan. A mismatch between what the document says and how claims are paid can create confusion for employees and HSA eligibility questions. HR should ask the carrier to confirm in writing how remote care is handled under the plan.
Other Recent HSA Changes
Bronze And Catastrophic Plans
Recent legislation treats Bronze and Catastrophic Exchange plans as HSA-compatible starting January 1, 2026. IRS Notice 2026-05 says they need not be purchased through an Exchange. HSA eligibility also depends on the individual’s other coverage, so employers should avoid broad statements to employees. A tax adviser can confirm how the rule applies, and plan documents should be checked before an employee opens an account.
Direct Primary Care
Certain direct primary care arrangements are permitted alongside HSA eligibility starting January 1, 2026, subject to the rules in the law. The details matter, including the type of arrangement, fees and what services it covers, so employees should not assume that every membership qualifies. Employers should point staff to a tax adviser for individual questions.
Rules Can Change
These items are recent. Check current IRS guidance before relying on them. New laws and guidance can change how a benefit is treated, so build a habit of checking before each renewal and open enrollment. A tax adviser or counsel can confirm the current position when a plan change depends on it.
Preventive Care And Telehealth Safe Harbors For HDHPs
Preventive Care Safe Harbor
A plan does not lose HDHP status because it covers preventive care without a deductible, or with a deductible below the minimum annual deductible. The safe harbor is limited to preventive care as the IRS defines it, so each pre-deductible benefit should be checked against that definition. Employers should review the plan’s schedule of benefits with the carrier before renewal.
Telehealth Safe Harbor
Section 223 also allows a plan to cover telehealth and other remote care before the deductible is met without disqualifying the plan as an HDHP. The safe harbor helps plans that cover virtual visits from day one, but the benefit must fit the rule’s description. Employers should ask the carrier to confirm that the plan’s design meets the requirements for HSA-qualified coverage.
HDHP Definition
An HDHP is defined by a minimum annual deductible and a maximum out-of-pocket limit. Those dollar figures are adjusted for inflation each year. Employers should check the current-year figures, since the limits change annually and the plan must meet both. A plan that looks like an HDHP on paper may fall outside the definition if its limits are set incorrectly.
Other Coverage Can Disqualify
An individual generally cannot be covered by other health coverage that is not an HDHP, apart from limited exceptions set out in the statute. Employees with a spouse’s plan, a health FSA or other coverage may be affected, so a short eligibility question at HSA enrollment is a good idea. A tax adviser can confirm how the exceptions apply to an individual.
Not Every Pre-Deductible Benefit Qualifies
The safe harbors are specific. A benefit that falls outside them can cause the plan to fail HDHP status for HSA purposes. Employers sometimes add a popular benefit to the plan without checking this rule, and it can affect every HSA contributor. Review plan changes against the safe harbors with the carrier and a tax adviser before they take effect.
Confirm With Plan Documents
We can help you with reviewing plan design before renewal so pre-deductible benefits line up with the safe harbors.
Source: 26 U.S.C. 223.
Frequently Asked Questions
Can an HDHP cover preventive care before the deductible?
Yes, for care that qualifies as preventive under IRS guidance.
Is telehealth allowed before the deductible?
Yes. The telehealth safe harbor is now permanent for plan years beginning on or after January 1, 2025.
Did the preventive list change recently?
Yes. IRS Notice 2024-75 added and clarified several items. Check current guidance for updates.
Does treating an existing illness count as preventive?
Generally no. Chronic condition care counts only for the items IRS guidance lists.
Who decides what our plan covers?
The plan sponsor and carrier set coverage. We can help you compare it to IRS rules.
Is this legal advice?
No. This page is general information, not legal or tax advice. Rules change, so confirm current status with your attorney, tax advisor or the IRS.
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Laws and rules referenced
26 U.S.C. § 223 — Health savings accounts: eligibility, contribution limits and the age 55 catch-up.
IRS Notice 2004-50 — HSA questions and answers: eligibility, other coverage, FSAs and HRAs, and contribution rules.
This page is general information, not legal or tax advice. Rules change and facts matter, so confirm your situation with counsel or a qualified advisor.
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