The IRS issued guidance in the form of two notices (Notice-2024-71 and Notice-2024-75) expanding the items and services that are considered preventive care and can therefore be covered under a high deductible health plan (HDHP) on a pre-deductible basis. The guidance also clarifies several items that are considered health care expenses for the purpose of reimbursement from an FSA or HSA.

• Notice 2024-71 provides a safe harbor that allows for FSA and HSA plans to treat all male condoms as medical care, meaning that FSA or HSA non-taxable funds may be used to pay or reimburse payment for condoms.
• Notice 2024-75 clarifies that the following items may be treated as preventive care, and therefore eligible for pre-deductible coverage under an HSA-eligible HDHP for plan years beginning on or after the date specified:
  • Condoms (December 30, 2022)
  • Oral contraceptives, including over-the-counter birth control pills and emergency contraceptives, regardless of whether a doctor has provided a prescription (December 30, 2022)
  • Breast cancer screenings (April 12, 2004; the current guidance expands on previous guidance, published on that date, that only listed mammograms as an example of preventive screenings for breast cancer)
  • Continuous glucose monitors (CGMs), if they measure glucose levels using a method or mechanism similar to those used by other glucometers (i.e., skin piercing; July 17, 2019, the date guidance on reimbursement of glucometers was originally published); if a CGM also performs other functions, those functions must fall under the definition of preventive care in order to be eligible for pre-deductible coverage
  • Insulin, as well as any devices used to administer insulin products described in Code Section 223(c) of the tax code, regardless of whether the insulin is prescribed to treat a diagnosis of diabetes or for prevention of exacerbation of diabetes or development of a secondary condition (December 31, 2022)
• While these items may be treated as preventive care – i.e., covered on a pre-deductible basis – by a HDHP, they are not required to be covered as preventive care under the Affordable Care Act preventive coverage mandate.